Managing Hospital medicine Costs in Healthcare Reform: Case Shari'ati Hospital

Background: The continuous growth of healthcare and medicine costs as a strategic commodity requires tools to identify high cost populations and cost control. After the implementation of the healthcare Reform plan in Iran, a huge share of hospital funding has been spent on undesirable costs due to changes in the use of medicines and instruments. Objective: The aim of this study was to compare the cost of medicines in both the pre and post period of health plan implementation to detect abnormalities and low frequency patterns in the medical prescriptive that account more than 30% of hospital budget funds. Method: Therefore a data mining model has been used. First, by forming incidence matrices on the cross-features; categorized prescriptions information. Then using normalized risk function to identify abnormal and high cost cases based on the distance between the input data and the mean of the data. The data used are 15078 records, including information from patientschr('39') prescriptions from Sharichr('39')ati HIS in Tehran-Iran from 2012 to 2016. Results: According to the obtained results, the proposed model has a positive Likehood ratio (LR+) of 6.35.  

Keywords:

Anomaly detection , Data mining , healthcare reform plan , medicines cost , Abnormalities