Utilization and cost of outpatient services: A cross-sectional study on the Iran Health Insurance Organization insurees in Fars province.

ABSTRACT

Background and Aims: Analyzing the utilization of health services is necessary for allocating the resources and planning the provision of health services. The present study aimed at investigating the utilization and cost of outpatient services and the factors affecting it among the insurees of the Iran Health Insurance Organization in Fars province in 2019. Methods: The study population consisted of all Iran Health Insurance Organization insurees in Fars province in 2019 (n = 2,618,973). The data on the utilization and cost of the services were extracted from the information systems of Fars Health Insurance Organization. The descriptive statistics of the utilization and cost of outpatient services were provided by gender, age, and type of insurance fund. The effects of different factors on the utilization and cost of various services were also investigated using univariate analysis as well as cross-sectional regression. The data analysis was done using EXCEL and STATA 15 software as well. Results: The average utilization rates of laboratory, drug, and radiology services were 0.940, 0.945, and 0.108 prescriptions per year, respectively. In addition, the mean costs of laboratory, drug, and radiology services were $1.13, $7.44, and $2.26 per year, respectively. The univariate and multivariate analyses showed that gender, type of insurance fund, and age had significant effects on the utilization and costs of laboratory, drug, and radiology services (p < 0.05). Conclusion: The utilization and expenditure of outpatient services were higher among the elderly and women. To control the costs of insurance organizations, it is helpful to identify the effective factors. In addition, due to the increasing trend of aging in Iran, it seems necessary to periodically monitor the pattern of the elderly people's utilization of health services and to plan to increase sustainable resources for insurance financing in the coming years.