كليدواژه :
بستري , بيمه , سالمند , الگوي مصرف , بيمارستان
چكيده فارسي :
زمينه و هدف: سالمندي جمعيت براي سازمان‌هاي بيمه‌گر، فرصتي است كه در صورت نبود برنامه‌ريزي تبديل به تهديد مي‌شود. اين مطالعه با هدف شناسايي الگوي مصرف خدمات بستري سالمندان تحت پوشش بيمهٔ نيروهاي مسلح در سال 1397 انجام شد.
روش‌بررسي: اين پژوهش توصيفي‌تحليلي و مقطعي بود. جامعهٔ آماري را بيمه‌شدگان 60 سال و بيشتر خدمت‌گيرنده از بيمارستان‌هاي طرف قرارداد و غيرطرف قرارداد تشكيل دادند. تعداد نمونه 491 نفر بود كه به‌روش طبقه‌بندي تصادفي انتخاب شدند. داده‌ها از پايگاه گزارشات بخش اسناد پزشكي و روزپرداخت بانك اطلاعاتي سازمان (Oracle) جمع‌آوري شد و با نرم‌افزار SPSS نسخۀ 24 تحليل شد. در اين پژوهش آزمون‌هاي يومن-ويتني و كروسكال واليس با سطح معناداري 0٫05 به‌كار رفت.
يافته‌ها: ميانگين مدت اقامت 1٫5±5٫58 روز بود. ميزان بيشتر روز-بستري، براي بخش قلب به تعداد 252 بيمه‌شده (18٫95درصد) و از نظر نوع خدمت مربوط به باي‌پس شريان كرونر 4٫70±8٫17 روز بود. بيمارستان‌هاي با ماهيت سپاه، مراكز پرمراجعه‌تر بستري نظامي بودند. آزمون كروسكال واليس بين مدت اقامت بخش‌هاي مختلف با نوع خدمت (0٫002=p) و نيز بين هزينه‌هاي درماني گروه‌هاي سني مختلف (0٫001>p) تفاوت معنادار نشان داد. هزينهٔ بيشتر پرداخت‌شده مربوط به بخش قلب و گروه سني سالمندان جوان و هزينهٔ كمتر مربوط به بخش راديوتراپي بود. آزمون يومن-ويتني نشان داد، زنان به‌طور معناداري هزينهٔ بستري بيشتري از مردان دارند (0٫041=p).
نتيجه‌گيري: براساس يافته‌هاي پژوهش بار و هزينهٔ بيشتر بستري سالمندان مربوط به بيماري‌هاي قلبي است؛ بنابراين برنامه‌ريزي جهت توسعهٔ تعهدات سازمان بيمه به‌منظور پيشگيري از بروز چنين بيماري‌هايي كه كاهش كيفيت زندگي و ناتواني زودرس را در سالمندان در پي خواهد داشت، از ملزومات مواجهه با اين پديده است.
چكيده لاتين :
Background & Objectives: Aging growth and changes in the pattern of diseases in this crowd, cause exponential growth of costs. The aging of population is a demographic and epidemiological phenomenon; however, it requires socioeconomic solutions and healthcare management. The
health services required by the insured population vary according to age and demographic conditions. Therefore, it seems necessary to pay attention to the epidemiological and demographic developments of the population to determine the critical measures for effective planning.
Furthermore, the aging of population has increased the financial burden of social security systems; it is necessary to consider appropriate
measures in this area. Population aging is an opportunity for the insurer organizations; the receivers of the healthcare services might be threatened
in the lack of adequate planning. Thus, this study aimed to identify the consumption pattern of inpatient services in the insured elderly covered
by the Armed Forces Health Insurance in 2018.
Methods: This descriptive–analytical study was of a cross–sectional design. The study statistical population included the elderly aged ≥60 years
who were classified in three age categories (60–69 years, 70–79 years, ≥80 years), and used hospital services of the contracted and non–contracted
hospitals with the Armed Forces Health Insurance in 2018, where inpatient medical records were filed for them. The number of samples in this
study, considering the minimum number required for relational research (causal–comparative), according to Krejcie and Morgan (1970) (who
stated that for the communities of ≥100000, 384 individuals suffices), 491 subjects were selected by random stratified sampling method as the
research sample from the three mentioned groups of the elderly. The study inclusion criterion was having ≥60 years of age by the beginning of
2018. As per the study exclusion criteria, according to the information provided in the insurance system of the organization, the elderly should
have not experienced concurrent overlapping access to inpatient services. In total, the study samples were hospitalized 1330 times, on a temporary
or permanent basis, in the contracted and non–contracted hospitals. Accordingly, from each age group of the elderly, the first 100, the second
100, etc. were randomly selected from the inpatient services consumption data, i.e., extracted from the medical documents. We also considered
the payroll reports of Organization Database (Oracle); these data were then analyzed using SPSS. In this study, the Kruskal–Wallis test was
employed to examine the between–group differences. Additionally, if the Kruskal–Wallis test result was significant, Mann–Whitney U post–hoc
test with the adjustment of p–value was applied. The desired significance level was 0.05.
Results: In this study, the default normality of the data was checked using the Shapiro–Wilk test. The relevant results indicated that the data of
this study were significantly different from the normal curve. Therefore, non–parametric tests were used to examine between–group differences.
The mean±SD duration of stay of the studied elderly was 5.58±1.5 days. The largest proportion of the total hospitalization days of the elderly
samples was related to the cardiac ward by 252(18.95%) insured subjects; respecting the type of service, this rate belonged to the coronary artery
bypass with the mean±SD duration of 8.17±4.70 days. Among the referrals for hospitalization, the hospitals of contracted military/corps nature
were the most visited military hospitalization center. The least–cost was paid for the radiotherapy ward (1.041.871 Rials) and the highest was
paid for the cardiology ward (8.593.036.458 Rials). There was a significant relationship between the mean stay duration at different wards and
the service type (p=0.001). Moreover, there was a significant difference between the treatment costs in different age groups (p<0.001). The
highest–paid expenses were related to cardiovascular care services and the younger group of elderly. The obtained data suggested that older
women’s cost of hospitalization (18.531.525 Riala) was significantly more than that in men (16.701.832 Rials) (p=0.041).
Conclusion: Based on the current research findings, the highest–burden and cost of hospitalization of the elderly belonged to cardiovascular
diseases. Thus, planning to expand insurance organization commitments to prevent the occurrence of such diseases is necessary. Such issues could reduce the quality of life and present premature disability in the elderly. It is also crucial to address the phenomenon of population aging.
