Document Type : Original Article
Authors
Abstract
INTRODUCTION: Hospitals are one of the most important institutions in providing health‑care
services. Highly experienced specialists, advanced technology, and decisive decisions about patients’
deaths and lives are all gathered in a dynamic and unique organization called Hospital. A huge portion
of human, financial, and equipment resources are allocated to teaching hospitals; however, these
hospitals are always faced with a lack of funding. The purpose of this study was to investigate the
financial challenges of teaching hospitals and providing solutions.
MATERIALS AND METHODS: A qualitative study was conducted using face‑to‑face interviews
with a purposeful sample of 37 top and middle managers in the level of the Ministry of Health, its
universities, teaching hospitals, and its affiliated departments in Tehran. Thematic analysis approach
was used to analyze the data by applying MAXQDA10 software.
RESULTS: Six themes among the reasons for financial challenges in teaching hospitals were
insufficient funding for the educational and research sections and paying more attention to treatment,
increased financial burden due to presence of medical student, indigent patients, disability in budget
managing due to their dependence on medical universities, relative autonomy of hospitals, and
payment systems. Among other factors, there are also insurance problems arisen from increased
deductions on bills due to insurance astringency and delayed payment.
CONCLUSION: The findings of the present study indicated that the major financial challenges
of teaching hospitals faced severe financial problems, which had a negative effect on their entire
activities and led to weakness in the implementation of their missions. Considering budget division
among three defined missions of teaching hospitals (treatment, research, and education), the largest
share of budget was allocated to treatment. Therefore, an appropriate and definite budget division
is suggested to improve the allocation of resources to all three missions and to enhance staff’s and
patients satisfaction.
Keywords
Standards. Iran, Tehran: Moein Publisher; 1997. p. 22.
2. Comparative Study of Health Indicators of the Eastern
Mediterranean Region (EMRO) in 2001. Office of Financial and
Budget Planning, Department of Management and Resources
Development, Ministry of Health and Medical Education; 2004.
3. Ahangar A, Ahmadi AM, Mozayani AH, Dizaji SF. The role of
risk‑sharing mechanisms in finance health care and towards
universal health coverage in low‑and middle‑income countries
of World Health Organization regions. J Prev Med Public Health
2018;51:59‑61.
4. Grifin D. What is hospital and how it works? In: Arab M, Valli L,
Ravangard R, Kavusi Z, Ostovar R, editors. Salami M. Tehran:
SID Publication; 2015. p. 33.
5. Sabermahani A, Goodarzi G, Barouni M, Khakian M. Estimation
of technical efficiency of general hospitals of Kerman university
of medical sciences by data envelopment analysis (DEA) method
in 2007. J Kerman Univ Med Sci 2010;17:59‑67.
6. Gooch K. The Financial Challenges Facing Hospitals, Health
Systems: 4 Takeaways. Hospital CFO Report; 17 April, 2018.
Available from: https://www.beckershospitalreview.com/
finance/the-financial-challenges-facing-hospitals-health-systems4-takeaways.html. [Last accessed on 2018 Oct 30]
7. Kupersmith J. Quality of care in teaching hospitals: A literature
review. Acad Med 2005;80:458‑66.
8. American Hospital Association. Teaching Hospitals: Their Impact
on Patients and the Future Health Care Workforce. Report No.:
202.638.1100. Washington (USA): Association of American
Medical Colleges; 2009. p. 8.
9. Browne E. Teaching Hospitals. Islamic Medicine; 2002. Available
from: http://www.theinfolist.com/php/SummaryGet.php?Find
Go=Listofuniversityhospitals. [Last updated on 2017 Jan 17; Last
accessed on 2016 Aug 29].
10. Trotta A, Cardamone E, Cavallaro G, Mauro M. Applying the
balanced scorecard approach in teaching hospitals: A literature
review and conceptual framework. Int J Health Plann Manage
2013;28:181‑201.
11. Najafi C. Designing the model of evaluation of hospital operation.
Tehran. Management and Resources Development Department.
Centre of Development Management and Administrative Reform;
2008.
12. Trotta A, Cardamone E, Cavallaro G, Mauro M. Applying the
balanced scorecard approach in teaching hospitals: A literature
review and conceptual framework. Int J Health Plann Manage
2013;28:181‑201.
13. Padmore JS, JaegerJ, Riesenberg LA, Karpovich KP, Rosenfeld JC,
Patow CA, et al. “Renters” or “owners”? Residents’ perceptions
and behaviors regarding error reduction in teaching hospitals:
A literature review. Acad Med 2009;84:1765‑74.
14. Hayden EW. Non‑Profit Hospitals Face Structural as Well
as Financial Challenges: Lessons from Massachusetts. Paper
24. Financial Services Forum Publications; March, 2005.
p. 13‑4. Available from: http://www.scholarworks.umb.edu/
financialforum_pubs/24. [Last accessed on 2016 May 05].
15. Najafpour ZH, Gudarzi Z, Keshmiri F, Pourreza A. Comparison
of education and research indicators of patient safety status
between selected hospitals of Tehran university of medical
sciences based on WHO standards. Bimonthly Educ Strateg Med
Sci 2014;7:241‑8.
16. Grosskopf S, Margaritis D, Valdmanis V. Effect of teaching on
hospital productivity. Soc Econ Plan Sci 2001;35:189‑204.
17. Revision in Managing Teaching Hospitals; 8 April, 2016.
Available from: http://www.shahrekhabar.com. [Last updated
on 2016 May 11; Last accessed on 2016 Apr 05].
18. Isna News. Lack of Education and Caring Space in Hospitals, a
Major Problem in Teaching Hospitals; 25 April, 2016. Available
from: http://www.isna.ir/news/93120301158. [Last updated on
2016 Apr 30; Last accessed on 2016 May 02].
19. Nasrollahpour Shirvani D, Mouodi S. Evidence‑Based
Policymaking in Health System and its Achievements and
Challenges in Iran. Babol, Babol University of Medical Sciences
and Health Care Services: Nooj Publishing; 2013.
20. Kane RL, Bershadsky B, Weinert C, Huntington S, Riley W,
Bershadsky J, et al. Estimating the patient care costs of teaching
in a teaching hospital. Am J Med 2005;118:767‑72.
21. Hosek J, Palmer A. Teaching and hospital costs. J Health Econ
1983;2:29‑46. Available from: http://www.sciencedirect.com/
science/article/pii/0167629683900103. [Last accessed on
2016 Jun 24].
22. Schwartz RW, Pogge C. Physician leadership is essential to the
survival of teaching hospitals. Am J Surg 2000;179:462‑8.
23. Nuss MA, Robinson B, Buckley PF. A statewide strategy
for expanding graduate medical education by establishing
new teaching hospitals and residency programs. Acad Med
2015;90:1264‑8.
24. Huckman R, Song H, Barro J. Cohort Turnover and Productivity:The July Phenomenon in Teaching Hospitals. Report No.: 11182.
Massachusetts: National Bureau of Economic Research; 2005.
p. 45.
25. Thier SO, Kelley WN, Pardes H, Knight AW, Wietecha M. Success
factors in merging teaching hospitals. Acad Med 2014;89:219‑23.
26. Punch Editorial Board. Teaching Hospitals and Healthcare
Challenges. Available from: http://www.punchng.com/topics/
editorial/. [Last updated on 2015 Sep 22; Last accessed on
2015 Aug 25].
27. Castro Lobo MS, Ozcan Y, Sliva A, Estellita L, Fiszman R.
Financing reform and productivity change in Brazilian teaching
hospitals: Malmquist approach. CEJOR 2010;18:141‑52.
28. Association of American Medical Colleges. New Challenges
for the Council of Teaching Hospitals and the Department of
Teaching Hospitals. Discussion Paper; April, 1984. Available
from: https://www.aamc.org/download/371974/data/0484_
new_challenges_for_the_council_of_teaching_hospitals.pdf. [Last
accessed on 2017 May 10].
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