Rate and Causes of Claim Denials in Iranian Hospitals: A Systematic Review and Meta-analysis

Context: One of the most important income sources of hospitals is the payment of insurance organizations, part of which is not paid as deductions in Iran. Studies have reported different values for insurance deductions, proposing various reasons. Objectives: The present study aimed to provide the published evidence of these deductions and their causes over the past ۱۳ years. Data Sources: This systematic review and meta-analysis was conducted in ۲۰۲۱. Data were collected via searching in databases such as Google Scholar, Scopus, PubMed,Web of Science, SID, Magiran, and Irandoc until August ۲۰۲۱ using keywords such as “deduction”, “medical deduction”, “hospital”, “medical center”, and “Iran”. Data Extraction: To calculate the pooled values of hospital deductions, a random-effects meta-analysis was performed in the Stata software version ۱۵ at ۹۵% confidence interval. In addition, the possible heterogeneity of the studies was evaluated using the I۲ statistic, and a forest plot was also used to report the results. Publication bias was assessed using a funnel plot. Results: In total, ۱۶ articles were included in the meta-analysis. The pooled percentage of deductions (PPCD) based on random effects was ۵% (۹۵% CI: ۲.۸۸ - ۷.۱۲۴), and the hypothesis was rejected (PPCD = ۰; Z = ۳۱.۲۶; P = ۰.۰۰۰). Based on the random-effects method, the pooled prevalence of deductions was ۴۵.۲۱% (۹۵% CI: ۱۷.۶۰۱ - ۷۲.۸۲۴). Moreover, the pooled prevalence of deductions (PPVD) was considered statistically significant (PPVD = ۰; Z = ۲۵۱.۱۶; P = ۰.۰۰۰). The variation in ES attributable to heterogeneity (I۲) was estimated at ۹۹.۶%, and documentation problems were considered the most common cause of deductions (۱۷.۹۶%). Conclusions: According to the results, the prevalence of deductions in Iranian public hospitals is significant, and the share of deductions from the bill claimed by the hospital is manageable, albeit small.

Keywords:

Deduction , Health Insurance , Hospital , Medical Care , Iran