Relationship Between Hospital Cost Based on Current Procedural Terminology and Out-of-Pocket Payment of Oil Company Retirees

 Relationship Between Hospital Cost Based on Current Procedural Terminology and Out-of-Pocket Payment of Oil Company Retirees Marzie Afshoon 1, Leila Riahi 2*, Leila Nazarimanesh 3 1 Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran Abstract Introduction: This study aimed to investigate the relationship between hospital cost based on current procedural terminology and patients’ out-of-pocket payment by examining the most common surgical procedures in Oil Company retires, including cataract surgery, coronary angiography, total knee arthroplasty, and total hip replacement. Methods: This applied study utilized a descriptive - analytical design. The target population included oil company retires hospitalized in private hospitals in Tehran. The data were collected by examining the medical records archived in the Oil Industry Pension Fund from 2014 to 2015. In total, 920 samples were selected, 459 of which had been gathered before the implementation of Current Procedural Terminology and 461 after its implementation. In the end, the data were analyzed using SPSS V. 20 software by paired t-test and Wilcoxon test. Results: The results of statistical tests showed a significant difference in the direct payment of patients undergoing angiography before and after the implementation of Current Procedural Terminology (P < 0.05). In addition, the Wilcoxon test showed a significant difference in the patient’s franchise for cataract surgery (P = 0.01; Z = -12.07). Conclusions: The health reform plan has increased the out-of-pocket payment in private hospitals. However, it can be reduced by proper monitoring and management. Keywords: CPT Book; Out-of-Pocket Payment; Direct Payment; Franchise   Please cite this article as follows: Afshoon M, Riahi L, Nazarimanesh L. Relationship Between Hospital Cost Based on Current Procedural Terminology and Out-of-Pocket Payment of Oil Company Retirees. Hakim Health Sys Res 2019; 21(4): 306- 312.    *Corresponding Author: Ph.D., Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran. Tel: +98-9121131901, Email: [email protected]