Dissertations / Theses on the topic 'Bureau of Hospital Reimbursement'
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ALORBI, GENEVIEVE AKU. "ESSAYS ON HOSPITAL REIMBURSEMENT AND QUALITY OF HEALTHCARE PROVISION." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1333.
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This dissertation seeks to investigate how hospital reimbursement policy affects the quality of care provided to patients when providers compete for healthcare labor that is limited in supply. Cost payment systems fully reimburse a provider’s the total cost of healthcare provided, fixed reimbursements are predetermined at a fixed amount and mixed reimbursements have a cost and fixed component. The first chapter investigates how government reimbursement schemes that induce quality competition among health providers affects the choice of quality of care provided to patients and how these choices depend on the labor supply constraints in the healthcare labor market. We build a theoretical model that explicitly incorporates the healthcare labor supply into a framework of a hospital cournot competition, to show how a hospitals' choice of quality of patient care will be directly influenced when there is a shortage of health personnel in a regulated reimbursement system. We find that multiple equilibria can arise in healthcare markets depending on the consumers’ sensitivity to quality and hospitals’ share of cost when investing in quality. Contrary to existing findings, we are able to show that the effects of reimbursement schemes can vary in different equilibria and in different labor market situations. For instance, in high patient quality sensitivity hospital markets under a high hospital quality equilibrium, we can show that a cost payment scheme decreases a provider’s quality of care while a fixed reimbursement scheme increases quality. More importantly we find that the labor market constraint increases or decreases the effect of the reimbursement system on quality of care. Consequently, the labor constraint changes the quality choice of the provider as compared to the quality level that would have been induced by a particular reimbursement’s policy incentive for quality. In the second chapter, we carry out some of the testable implications of the theoretical finding from the first chapter. This paper investigates how higher Medicare payments brought about by geographical reclassification affects a provider’s quality of care as captured by registered nurses (RN) and licensed practical nurses (LPN) staffing, as well as patient outcomes (mortality, urinary tract infections, pneumonia, peptic ulcer deep vein thrombosis) and length of stay when hospitals compete for nurses. In contrast with past literature, we specifically allow for asymmetry in the hospital’s choice of quality, by permitting coefficients to differ across reclassified hospitals in response to the higher Medicare payments. This asymmetry is based on the relativity of the labor cost faced by the hospital due to competition for nurses in the healthcare labor market. Using Healthcare Cost and Utilization Project (HCUP) and the Center for Medicare and Medicaid (CMS) data from the period 2001 to 2011, we find that hospitals who face relatively higher labor costs will post reclassification increase their RN to LPN staffing ratio as compared to hospitals in their post geographical reclassification areas. A higher RN staffing by these hospitals will result in an improvement of quality of care as the incidence of patient complications due to Pneumonia, Peptic Ulcer and Deep Vein Thrombosis reduces for hospitals that were reclassified after allowing for asymmetry in response to the higher Medicare payment due to differences in labor costs (Pneumonia and Peptic Ulcer complications improve as compared to pre re-class area hospitals and DVT in both pre/post re-class area hospitals). Length of stay also increases for hospitals that faced a higher labor cost while mortality and UTI complications remain unchanged post reclassification. Finally, in the third chapter, we examine how the for profit (FP) or not for profit (NFP) status of hospitals impact the choice of nurse staffing and patient outcomes when there is an increase in provider reimbursement due geographical reclassification. Most of the past studies focus on mortality and length of stay in FPs and NFPs, we extend these studies by investigating the impact of geographical reclassification on patient outcomes that have been established as outcomes sensitive to nursing care. From our regression results, with reference to the ratio of RN to LPN staffing, we find evidence that an increase in Medicare payments will have a greater impact in FPs than in NFPs as compared to their pre re-class geographical area control hospitals. We also find that in hospitals that face a relatively higher labor cost as compared to their controls; (1) There is no difference in the impact of reclassification between FPs and NFPs (2) There is a better response from FPs than NFPs to geographical reclassification when the outcome considered is DVT as evidenced by a decreases in cases of DVT (3) NFPs decrease length of stay whiles FPs increase length of stay as compared to their post re-class geographical area hospitals.
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Talongwa, Catherine. "Racial Differences in Hospital Readmission and Reimbursement Rates for Patients with Congestive Heart Failure." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7958.
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Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a sample of 11,905 patient records from 675 hospitals in California; the readmission discharge data and insurance reimbursement rates were analyzed by ethnicity and payer type. The results indicated that there was not a statistically significant difference between non-Hispanic Blacks as compared to non-Hispanic Whites in relation to readmission rates (M = 49.6, SD = 38.28) or insurance reimbursement rates (M = 50.88, SD = 36.52). Non-Hispanic Blacks had a higher readmission rate (36%) as compared to Whites (29%), and although these results are not significant, they support the need for healthcare professionals to develop programs that meet the needs of the community. The results of this study contribute to positive social change by providing information that healthcare professionals may be able to use to decrease CHF readmissions and improve access to care for non-Hispanic Blacks and other vulnerable patient groups.
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Liang, Lilin. "Hospital responses to changes in reimbursement methods : an economic analysis of Taiwan’s national health insurance programme." Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/308/.
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In 1995, the Taiwanese government introduced the Case Payment Scheme (CPS) to initiate a prospective payment method for diagnosis-related groups under the National Health Insurance (NHI) programme. The aim of the CPS was to rectify the supplier induced demand caused by the fee-for-service plan and to improve the efficiency of health services. However, this scheme created a dual reimbursement system for the NHI, under which, some services were reimbursed on the basis of claims for fees, while others were bundled together and paid a fixed rate per discharge. This study examines changes in hospital behaviour in this context based on the assumption that hospitals have incentives to maximise the profits from both payment plans. The aim is to quantify the effects of reimbursement changes on different dimensions of the delivery of health care. This research also evaluates the global budget programme which has changed the budget allocation mechanism within the hospital sector since 2002. Empirical investigations were carried out for all the hospitals contracted into the NHI over the period 1998-2004. To model hospital behaviour, this study employs different econometric methods, including instrumental variables, panel data model, semiparametric estimation, seemingly unrelated regressions and limited dependent variable models. The results suggest that hospitals react to the shift toward the dual payment system by selecting patients, altering treatment patterns, changing the case mix and adjusting treatment intensity. Policymakers do not appear to have anticipated these phenomena. These findings indicate that there could be fundamental problems in the parallel use of retrospective and prospective payments, due to the improper reimbursement incentives embodied within the system. As mixed payment systems have been adopted around the world, this research has implications for existing and future reimbursement reforms.
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Barrington, James D. "Analysis of Two Strategies for Structuring Medicare Reimbursement to Maximize Profitability in Acute Care General Hospitals." Scholar Commons, 2010. https://scholarcommons.usf.edu/etd/1569.
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The healthcare literature sometimes cites Medicare as a negative determinant of hospital profitability. However, a review of Florida acute care short-term general hospital data revealed a subset of profitable hospitals with high percentages of their revenue structure comprised of Medicare reimbursements. Some investigators might contend that these hospitals are just better managed; that hospital profitability is not related to patient mix or payer source. Although good management enhances financial health, there are perhaps other reasons why certain hospitals can become profitable with Medicare as their primary revenue source.
Research findings indicate there is wide geographic variability shown for per-capita volumes of discretionary procedures reimbursed by Medicare, and broad variations in Medicare spending per enrollee for general acute care short-term hospitalizations. It was also found that many of the hospitals performing higher rates of discretionary procedures and showing the ability to make a profit with Medicare are investor owned.
The focus of this study, covering years 2000-2005, was to examine two strategies using discretionary procedures under Medicare that Florida investor owned hospitals may employ to increase profitability and maintain long-term financial health.
Part 1 of the study examined the association between long-term financial viability, measured by the total assets divided by total liabilities (TATL) ratio (the reciprocal of the debt ratio) and percentages per hospital of two discretionary cardiac and orthopedic procedure variables, reimbursed by conventional Medicare. A positive association was found between the TATL ratio and these variables, as well as significant marginal effects in the association between the TATL ratio and interaction terms for hospital ownership (where investor owned = 1 and not-for-profit = 0) and the discretionary cardiac procedure variable and ownership and the discretionary orthopedic procedure variable.
Part 2 used total charges as the dependent variable for patient discharges reimbursed by Medicare HMO. It was found that investor owned hospitals generally assess significantly higher charges than not-for-profits for discretionary CABG and valve replacement procedures for patients with equivalent levels of medical services and hospitalization. It was also found that charges significantly increase for both investor-owned and not-for-profit hospitals located in the southern region of Florida.
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Mendonça, Maria Angelica Lopes Chaves. "Estimativa de custo direto de lesões traumáticas maxilofaciais em crianças e adolescentes em um hospital público do Município de São Paulo." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/23/23148/tde-03072010-103139/.
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O presente estudo procurou obter uma estimativa dos custos diretamente ligados ao atendimento de lesões traumáticas maxilofaciais em crianças e adolescentes, comparados com a população adulta acometida do mesmo agravo, bem como o perfil sóciodemográfico da população atendida em um Hospital Público do Município de São Paulo, Brasil,com o intuito de fornecer evidências para avaliação quantitaiva do dano em perícias odontolegais,. Material e Método. Os dados dos prontuários foram colhidos, no período de janeiro de 2002 a dezembro de 2008 dos pacientes atendidos no serviço de Cirurgia Buco-Maxilofacial de um hospital do município de São Paulo. As variáveis classificatórias foram descritivamente apresentadas em tabelas de contingência contendo frequências absolutas (n) e relativas (%). A associação entre elas foi avaliada com o teste Qui-quadrado ou teste da razão de verossimilhança. Para a análise dos custos diretos foram utilizados os valores de referência da Tabela do Sistema de Informações de Tratamento Ambulatorial do Sistema Único de Saúde- SIA-SUS do Ministério da Saúde. Resultados Do1.200 casos analisados, 419preencheram os requisitos da pesquisa. O grupo caso obteve 108 registros (faixa etária até 19 anos), e os demais foram classificados, como grupo controle (acima de 20 anos de idade). O grupo caso apresentou uma incidência de 1,5% ao ano de lesões traumáticas, e a média de idade no grupo caso foi de 14,35 +- 4,76 e no grupo controle foi de 33,65 +- 11,73 anos de idade. Em relação ao sexo predominaram os indivíduos do sexo masculino em ambos os subgrupos O tipo de tratamento cirúrgico prevaleceu em ambos os subgrupos, e o tempo de internação em dias foi cerca de duas vezes maior no grupo controle em relação ao grupo caso, entretanto as complicações foram mais freqüentes no grupo caso em relação ao grupo controle. Os tipos de lesões mais freqüentes no grupo caso foram as fraturas nasais/dentárias, seguidas das fraturas e mandíbula, e que no grupo controle o quadro inverteu-se. A distribuição de custos teve o maior número de casos na faixa de custos até R$500,00 em ambos os subgrupos amostrais A freqüência de ocorrência de complicações foi significativamente maior no grupo caso, em relação ao grupo controle, da mesma forma que os retornos ambulatoriais foram também significativamente maiores neste grupo. Conclusões A distribuição de custos teve o maior número de casos na faixa de custos até R$500,00 em ambos os subgrupos amostrais; esses custos foram calculados com base no repasse de verbas da Tabela de Valores do Sistema Único de Saúde, onde não esta discriminado o custo dos honorários profissionais. A valoração do dano nas atividades periciais deve considerar, além dos custos diretamente envolvidos com o atendimento do traumatizado, as consequências para suas atividades diárias especialmente quando se trata de criança ou adolescentes cuja função social ainda está por se definirThe aim of this study is to provide evidence for the quantitative assessment of injury in forensic dentistry investigation, thorough the estimate of costs directly linked to the care of maxillofacial trauma lesions in children and adolescents, compared to adults who suffered the same injuries, as well as trace a social demographic profile of the patients admitted in a public hospital in Sao Paulo. Material and Method. The hospital chart data were collected from January 2002 to December 2008 and the charts belonged to patients cared for by the Buco-Maxillofacial Surgery Department of a hospital in Sao Paulo. Classification variables were described in contingency tables which comprise absolute (n) and relative (%) frequencies. Their association was assessed using the chi-square test. Reference prices from the Ambulatory Care Price Table, provided by the Unified Health System (SIA-SUS), the government managed Public Health System in Brazil, were used to determine direct costs. Outcome: out of the 1200 cases analyzed, 419 matched the requisites of this survey. The case group comprised 108 cases (up to 19 years old) and the other 311 were classified as the control group (above 20 years old). The incidence rate of trauma lesions was of 1,5% per year in the case group and the average age was of 14,35 +-4,76, while in the control group, the average age was 33,65 +- 11,73. Male individuals prevailed in both groups and so did the surgical treatment. The number of days of hospital stay was about twice as big in the control group in relation to the case group. Complications, however, were more frequent in the case group. The most frequent kinds of lesion in the case group were the dental or nasal fractures, followed by jaw fractures, and this was directly opposite to what happened in the control group. The Unified Health System (SUS) reimbursed treatments of up to 500 reais in both groups. The frequency of complications and returns to the Ambulatory Care facilities were significantly higher in the case group. Conclusion: The reimbursement of expenses happened more frequently when treatment cost up to 500 reais in both sample groups. These costs were calculated taking reference prices from the Ambulatory Care Price Table, provided by Unified Health System (SUS). The prices dont include professional fees. When calculating how much to refund, the Government should take into account not only the direct costs involved in caring for the injured patient, but also the consequences such treatments have on their daily activities, especially when we consider that children and adolescents do not have a their social roles defined yet.
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Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations." Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Kerns, Elizabeth E. "A Study on the Efficacy of the Medicare Bundled Payments for Care Improvement Initiative at a Large Community Hospital in the Southeast United States." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/7044.
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In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues.
Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program.
The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.
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Mbi, Feh Marilyn Keng-Nasang. "Physicians' Perceptions and Practice Regarding the Prevention of Catheter-Associated Urinary Tract Infections in the ICU." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1699.
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Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.
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Lucente, Betty C. "Hospitals' Decision to Vertically Integrate Skilled Nursing Units Before and After the Balanced Budget Act." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/1495.
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The decision to vertically integrate services and deliver care has both management and policy concerns for healthcare in the United States. The change in reimbursement, which was enacted with the Balanced Budget Act of 1997, influenced the availability of post acute services for acute hospital inpatients. Prior to this change, post acute services were reimbursed based on cost similar to the pre DRG era of Medicare reimbursement. The change in payment had the potential to make discharging patients more difficult resulting in a prolonged length of stay without additional payment and at increased costs for hospitals. As a result of this change hospitals made arrangements to provide care for this population. The choices included vertical integration, contracting or hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) The Williamsons theory is based on the proposition that three transaction dimensions determine the most efficient method of operation for a firm: uncertainty, frequency, and asset specificity. Depending on the "market", organizations may elect to arrange services through the spot market, contract for services, or vertically integrate the service. The study uses data from the American Hospital Association survey as well as the Area Resources files to determine if individual hospitals have made contract arrangements, vertically integrated, or relied on the spot market to provide skilled nursing services. Data is collected before and after the BBA and analyzed using multiple regression analysis and then subjected to significance testing. Sixteen hypotheses are tested that focus on the three dimensions of transaction cost theory. Findings support the importance of transaction frequency and asset specificity, while only weak support is offered for transaction uncertainty. The results differ from the Chiu study, which found strong support for uncertainty and weak support for frequency. This study is unique in that it examines data from two time periods surrounding a major reimbursement change in Medicare. It makes an important contribution to the empirical testing of transaction cost economics and the decision to vertically integrate in health care.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Stearns, Sally Clark. "Price variation under DRG hospital reimbursement the effects on service choice and health outcome /." 1987. http://catalog.hathitrust.org/api/volumes/oclc/17973631.html.
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Bedard, Jean C. "Use of data envelopment analysis in accounting applications evaluation and illustration by prospective hospital reimbursement /." 1985. http://catalog.hathitrust.org/api/volumes/oclc/13037162.html.
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Thesis (Ph. D.)--University of Wisconsin--Madison, 1985.Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 228-233).
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Fernandes, Ana Cristina Campos. "How does the choice of the nutritional screening tool and malnutrition diagnosis influence hospital reimbursement?" Bachelor's thesis, 2018. https://repositorio-aberto.up.pt/handle/10216/114530.
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LIN, MING-CHANG, and 林明昌. "To find out the characteristics of outpatients with high usage of medical resources using Central Region Branch of Bureau of National Health Insurance outpatients’ reimbursement records." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/38250088894428834904.
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碩士國立中正大學
資訊管理所
95
This study used literature review to select factors that influence outpatients’ to consume high usage of the medical resources. The target databases contains outpatients’ reimbursement records are used to select the needed attribute of the data for data mining. The characteristics of outpatients with high usage of medical resources and the correlation or rules related to their medical care seeking behavior can be used as reference for government to further counseling plans or for polices making.
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Yen, Yu-Ju, and 嚴玉茹. "A Medical Profession Review Research for Oversea Emergency Reimbursement Using Logistic Regression and Two-stage Integrated Models: Based on The Bureau of National Health Insurance - Taipei Devision." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/88911895822467874362.
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碩士輔仁大學
應用統計學研究所
99
The overall political and economic environment have changed a lot in recent years, people has more opportunity to go abroad more frequently for business, tourism, visiting relatives and other reasons, therefore, the application cases for NHI(National Health Insurance) overseas emergency reimbursement medical expenses are also increasing. Facing the growing complexity and high volume of application cases, how to reduce the error of administrative review by subjective judgments and increase the accuracy and how to establish a good pattern of medical profession review and data segment to pay on time are getting crucial. Therefore, this study, based on NHI data, analyze the source of application cases, medical institutions location and the distribution of personal characteristics, growing payment of medical expenses, and make use of the decision tree to mining the relationship between medical profession review and the independent variable group, Screening the key variables and affecting important group of independent variables to strengthen the management level, in the meantime, the study also build a reimbursement medical expenses predictive model by using logistic regression one-stage and two-stage integrated decision tree to improve the accuracy of payment jobs.The conclusion of the study indicates that Mainland China has the most overseas emergency reimbursement case and its ratio is 77.0% in which Taiwanese capital hospitals in China ratio is 32.0% and major place of medical treatment is Shanghai and Jiangsu that ratio is 49.7%. The research findings indicate that the important variables of decision tree are the number of medical treatment, medical illness, payment conditions. The two models, logistic regression one-stage and two-stage integrated decision tree, have the same forcasting accuracy and prediction capability.
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Chang, Long-Chung, and 張隆鐘. "Financial Risk Analysis of Inpatient Services in the PPS/DRGs Reimbursement System – Example of a Regional Teaching Hospital in Southern Taiwan." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/88658922949936981715.
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碩士長榮大學
醫務管理學系碩士班
93
As the health insurance expenditures keep rising, all countries are facing the pressure of losing the financial balance on health insurance; therefore, the payment system reforming mechanisms have come into being, such as Global Budget and DRG payment system so as to hold back the medical expenditures. In order to control effectively the medical expenses and allocate reasonably the limited health services resources, the NHI has been phasing in the Global Budget system step by step, and will launch the Diagnosis Related Groups (DRGs) payment system for the inpatient services. To assess the financial risks hospitals will be taking after the implementation of this DRG payment system, this study is to compare the actual medical fee with DRG fixed fee (R), take the difference （ΔR） between the two fees, and calculate the difference to fixed fee ratio for each DRG patient （ΔR/R）. Briefly, the main purposes of this study are to compare the financial risks of medical treatment across clinical departments and major disease category (MDC), and make comparisons on the financial risks across physicians within specific MDC and DRG. This study uses insurance claims data from the National Health Insurance prepared by a regional teaching hospital located in the southern Taiwan. All the inpatient services excluding psychiatric (MDC19 ＆ MDC20) and cancer cases within the time period of July through December 2004 were included. After data screening, appropriate analytical approaches were adopted for analysis which included: (1) descriptive statistics—providing a basic description of sample data; (2) one-way ANOVA—comparing the means of difference to fixed fee ratios between clinical departments, MDCs, and DRGs, respectively, and comparing the means of difference to fixed fee ratios across physicians in specific MDCs and/or DRGs; and (3) Scheffe’s multiple comparisons—identifying the units with statistically significant difference. Briefly speaking, the results show that, among all clinical departments, the department of internal medicine would incur the highest financial risk had the DRG reimbursement system been put in action, followed by department of surgery, and department of pediatrics; in contrast, department of orthopedics and department of obstetrics & gynecology would stand in a more favorable stance. In terms of financial risks for different MDCs, the results show that the MDC01 patients (diseases on nerve system) would cause the highest financial risk and, to the contrary, MDC14 patients (pregnancy, birth & nursing periods) would be at the lowest financial risk. In addition, the financial risks that different physicians would bring forth in treating same type of MDC patients would be significantly different in the categories of MDC01, MDC04, MDC05, MDC06 and MDC08. Further, when inpatient services were examined for physicians treating same DRGs cases, the result shows that the financial risks did not reach significant difference. In summary, there exist significant differences in the financial risks for treating patients in different clinical departments. Therefore, it is suggested hereby that appropriate operations programs be developed and implemented in accordance with the characteristics of different clinical departments and needs of patients so as to meet financial risk balance. As for the financial risks on treatment of different MDC patients, since there also exist significant differences, it is proposed hereby that it would be better to identify those major disease categories in the local community and then make best use of hospital specialty and medical resources to effectively reduce the financial risks on treatment of different types of MDC patients. What deserves closer attentions is the fact that physicians would cause significant differences in the financial risks on treatment of same type of MDC patients. Therefore, from the perspective of operations management, it would be necessary to launch certain programs (e.g., clinical guideline, restrictions on consumption of supplies and medicine, etc.) to help physicians to use medical resources in a more financially efficient way.
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Tu, Shiu-Jen, and 涂秀貞. "The Financial Analysis of Hospitalization Medical Services under TW-DRGs Reimbursement System – A Case Study of an Existing Regional Teaching Hospital." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/47643523804313323002.
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碩士國立高雄應用科技大學
商務經營研究所
98
In the aim to control the reasonable growth of medical expenses and establish a reasonable reimbursement basis under the existing global budget payment scheme, on January 1, 2010, the National Central Health Insurance Bureau officially launched in phases the 3rd version of DRGs (Diagnosis Related Groups), which superseded “Fee-For-Service” and became the principle for hospitalization medical expenses reimbursement. The research adapted “secondary data” – Utilizing the real hospitalization medical expenses declared to National Health Insurance Bureau by the sampled hospital for the period of Jan. 2009 to Dec. 2009 – applying the fixed amount payment under DRGs, to identify the difference from the actual medical expenses and the ratio of the difference over the fixed amount payment defines as Financial Index used to evaluate the financial impacts of the sample hospital under the new payment principle(DRGs). The research is to explore; under DRGs reimbursement system; whether there is any significant differences in its Financial Index between each respective clinical department, each respective MDC (Major Diagnostic Categories), in addition, between each respective clinical department under the same MDC. Furthermore, to utilize the factors impacting the hospitalization medical expenses to establish the forecast model and eventually provide the sample hospital a strategic reference. The findings of the research indicated that under DRGs reimbursement system, among the six major departments, orthopedic and surgical department’s Financial Index are relatively high with positive increase in terms of financial performance. The other four departments include internal, gynecology, pediatrics and other departments appeared to be “negative” with decreased financial performance. There is significantly different financial influence in between the each respective eight major MDCs, except MDC#11 (kidney and the urethra relevant disease) and the MDC8(skeleton、the muscular system and the connective tissue relevant diseases) present positive figures, all the other six MDCs indicate negative, except MDC5(Circulation Desease), the rest of seven MDCs indicates significant differential in its financial performance due to different department. Regression Analysis indicates “positive” in terms of the relevance between age and MDC3(ENT and oral disease) but negative against to MDC6 (Disease of digestive system), MDC7 (diseases of hepatibilary system or pancreas) and MDC11 (diseases relevant to kidney and urethra). The factor of gender only indicates significant differential in MDC3 and MDC11. All eight MDCs indicate a ‘negative” relevance with “Days of hospitalization’ but a positive relevance with “relative weighting”. In terms of medical resource consumption control, core clinical specialties are relatively superior to non-core clinical specialties. The result of the research concludes that different department and MDC indicates significant differential, the same MDC in different department indicates significant differential. In order to reduce the overall financial risk and boost up the overall financial performance of the sample hospital, it should look into the detailed therapy procedures of those MDC with the relative high Financial Index and create a role model, meanwhile to enforce the cost control on those MDCs/Departments with relatively poor financial performance.
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Chen, Hsin-Ling, and 陳秀玲. "Study on the Health-Promoting Lifestyle and Leisure Participation of health professionals in Health Bureau Taitung Hospital." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/54483935206008407147.
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碩士國立臺東大學
身心整合與運動休閒產業學系
101
Study on the Health-Promoting Lifestyle and Leisure Participation of health professionals in Health Bureau Taitung Hospital Advisor: Seam Chang, Ph.D. Graduate: Hsin-Ling Chen M. Ed. Thesis, 2013 ABSTRACT The purpose of this study was to explore the health-promoting lifestyle and leisure participation of the health professionals in Health Bureau Taitung Hospital. The questionnaire on the health-promoting lifestyle and leisure participation of the health professionals in Health Bureau Taitung Hospital wsa adopted, and data were collected from 300 participants in which 273 effective questionnaires were returned, response rate of 91%; according to the content of the questionnaires, the data was analyzed by SPSS/PC 12.0 together with the adopted instruments inclusive of descriptive statistics, t-test, one way ANOVA, Pearson correlation. The main findings of the study are as follows: 1. Interpersonal Support ” was the highest score and “Health Responsibility” was the lowest score of the health-promoting lifestyle among Health Care Professionals in Taitung hospital. 2. Sport was the highest score and Social interaction was the lowest score among Health Care Professionals in Taitung hospital. 3. There were significant differences among the Health Care Professionals’ job, gender, age, education degree, salary status, and years of service in their health-promoting lifestyle. 4. There were significant differences among the Health Care Professionals’ gender, age, education degree, marital status, and years of service in their leisure participation . 5. There was a positive correlation between the Health-Promoting Lifestyle and Leisure Participation of health professionals in Health Bureau Taitung Hospital. Finally, the finding of this study provided substantial suggestions for the government, medical professionals and future researchers. Keywords: Health Care Professionals, health-promoting lifestyle, Participation in Recreational Activities
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Shih, Jhao-po, and 石兆珀. "A Study of Promoting the Medical Service Quality of Pre-Hospital Emergency：The Case of Fire Bureau, Kinmen County." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/72254234276206999573.
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碩士國立高雄大學
高階經營管理碩士在職專班(EMBA)
100
The main purpose of this research is to discuss the causes of misuse of first aid before sending to hospital in Kinmen, and survey the degree of satisfaction concerning first-aid quality, so as to understand the necessary improvement of first-aid services. In addition, five evaluative aspects and twenty-eight factors in questionnaire are extracted through the features of first aid in Kinmen, and subsequent planning of emergency system, in combination of literature review and interview with experts. From the interview, the causes of misuse in first-aid resources for the people in Kinmen? The Study suggests that three dimensions be implemented: 1.Law dimension: the maturity of law enactment is related to the rights and obligations the common people and Emergency Medical Technician (EMT) should have. Immaturity of laws brings about loopholes in the law; therefore, revision of laws is suggested to protect the rights of EMT and people. 2.Educational guidance: right use of first-aid resources can be proceeded in the society and school, teaching people proper exploitation of an ambulance. 3.Emergency system: based on user pays, patients that are not emergent should pay at a reasonable rate, which helps the truly-needed. From the analysis of IPA, the directions that need to improve most within the service needs are identified, and provide fire-control institutions with significant references on adjusting first-aid resources. After the results of statistics, the understanding of service quality has a positive and remarkable influence on the degree of satisfaction. Therefore, hypothesis one is established, and some factors in the population statistics variables show differences between the degree of importance and satisfaction. The survey result of satisfaction degree of emergency service quality shows: people think that preferable factors are the identifiable appearance of an ambulance, and staffs with professional certificates in the aspect of EMT, supplement of ambulance equipments and maintenance of emergency vehicles and materials in the aspect emergency outfits, accurate execution of emergency handling in the aspect of emergency procedure, and first-aid accuracy of evaluation and technique in the aspect of first-aid results. Suggestions to the Kinmen Fire Bureau: As for factors that people think highly important and better achievements of fire control organizations, and also the most significant base, the authority concerned should maintain and continue to elevate the base, and keep the investment in the existing resources and quality control. On the other hand, factors that people think trivial are the understanding of free 119 first -aid and neatness of EMT apparel, the authority concerned should reduce the investment in these two items, which helps cut down on relevant expenses. Besides, the worst achievement turns out the review and care of subsequent first-aid evaluation from the fire control organizations, which indicates that improvement is needed in this part, and consideration for the wounded or dependents should be carried out, and review the results so as to improve people’s reactions.
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O'Reilly, Daria Joan. "The introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in Newfoundland and Labrador : the impact on hospital utilization by patients with schizophrenia /." 2005.
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Huang, Wei-ting, and 黃瑋婷. "The Comparision between Patient and Hospital Characteristics to Length of Stay and Reimbursement in A Selected DRG: A Case in Simple Pneumonia and Pleurisy." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/31510913143410005882.
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碩士中臺科技大學
健康產業管理研究所
100
Background: In Tw-DRGs, the same reimbursement fee is given in different levels of hospitals among a selected DRG group except the basic fee such as physician fee or ward fee. However, “the same disease pay the same money” ignore that the healthcare expenditure and resource utilization are dramatic different among hospitals and the surplus or deficit of payment is also different in a selected DRG group. Most high severity patients gathered in the higher level hospitals. The difference of healthcare expenditure is more than basic payment fee. The implemented case payment items were tended to surgical cases, less cases of internal medicine were inclusive. Pneumonia had a important place in clinical medicine, public health, and healthcare administration. Objective: This study used individual level(patient characteristics) and group level (hospital characteristics) simultaneously to identify the association with length of stay and reimbursement in a selected DRG. The patient characteristics included gender, age, clinical specialty, complication/comorbidity, ICU admission, and surgery procedures. The hospital characteristics included ownership, contract type, teaching type, accreditation category, and area location. Methods: We adopt a set of a selected DRG from National Health Insurance Research Database, and 8,099 case of simple pneumonia and pleurisy (DRG089- DRG09102) were selected finally. Descriptive statistics, ANOVA, t- test, χ2 test and HLM were used to identify the association of patient (individual level) and hospital (group level) to length of stay and reimbursement. Results: (1)The length of stay(LOS) was significantly different from gender, clinical specialty, CC(complication/comorbidity), surgery and ICU. The length of stay in the 0-17 years old was higher than over 18 years old. (2)The reimbursement was significantly different from clinical specialty, CC, surgery and ICU. The reimbursement in the 0-17 years old was higher than over 18 years old, and medical centers was higher than that regional and distinct hospitals. (3)Excess of LOS’s geometric mean was significantly different from clinical specialty, surgery, ICU and hospital ownership. Excess of LOS’s geometric mean in the 0-17 years old was higher than over 18 years old. (4)Excess of fixed payment amount was significantly different from clinical specialty, CC, surgery, ICU, and hospital distinguish. Excess of fixed payment amount in the 0-17 years old was higher than over 18 years old, and medical centers was higher than that regional and distinct hospitals. Conclusion: (1) This study was found that the inappropriate discrimination of age in this selected DRG resulted in the tendency toward admiting younger adult patients in hospitals. The age discrimination would be divided into three age groups to protect the resoures utilization of elder patients. (2)Mostly patients has higher disease severity in medical centers, it is should be considered that the differences in severity of patients among all levels of hospitals and let them pay more reasonable cost-plus. (3)Hospital characteristics was significantly smaller than patient characteristics in the influence of LOS and reimbursement, it should be explore more possible factors of hospital characteristics in the future.
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LAI, SHIN-GOEI, and 賴辛癸. "Differences of hospital length of stay and charges between pre-and post-implementation of the new laber health insurance reimbursement rates: An empirical study." Thesis, 1992. http://ndltd.ncl.edu.tw/handle/33401749658315946183.
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Hsiao, Te-Wu, and 蕭德武. "Evaluate 2006 Bureau of Health Promotion Definition of Metabolic Syndrome with The Elders Health Examination in a Community Hospital." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/67489408495136226804.
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碩士亞洲大學
長期照護研究所
96
Objective: The study aims to 3 categories: (1) to investigate the correlations of BHP, NCEP and IDF definition of metabolic syndrome and their prevalence respectively. (2) The relation between components of BHP definition and elderly people who suffered from it. (3) Whether traditional cardiovascular risk factors influence metabolic syndrome or not. Methods: This is a cross sectional study, collected 387 aged individuals of health examination in one year from a community hospital, 197 were female and 190 male. They were all above 65 years old, functional independent and living in community. A complete history, life style questionnaire, physical examination and blood sample for biochemistry were done. The characteristics of study population were demonstrated with descriptive statistics, expressed by mean and standard deviation, distinguished the variation of sex with t-test. Components of metabolic syndrome were seen in percentile and the sex difference compared by chi-square (χ2). Cohen’s kappa coefficient (κ) was applied for agreement of three different kinds of metabolic syndrome definition. Logistic regression was used for factors evaluation for predicting metabolic syndrome. Odds ratio was also applied for comparing each other in the risk factors of cardiovascular disease. The goodness of fit in every model was examined. Results: In Taiwan, Bureau of Health Promotion in Department of Health established a metabolic syndrome definition, which achieves the agreement with National Cholesterol Education Program and the International Diabetes Federation. The uniformities of them were nearly perfect. The prevalence rate in order is 33.3 %, 26.1 %, 25.3 % respectively. The highest rate was defined by Bureau of Health Promotion. Moreover, the female suffered from metabolic syndrome was higher than the male. Logistic regression appeared to discover that the blood pressure, blood sugar, triglyceride and waist circumference have strong correlation to metabolic syndrome. They served as the predictive operator quite well. But, the high density lipoprotein cholesterol is not actually ideal on the elders, the forecast potency is not so good. In the traditional cardiovascular risk factors, it was confirmed that sex, total cholesterol and blood pressure related with metabolic syndrome. As for the low density lipoprotein cholesterol, high density lipoprotein cholesterol and smoking has not reached in statistical significance. Conclusion: The high density lipoprotein cholesterol in elderly people is not proper to take metabolic syndrome the predictive operator (p > .05). Adjusts its tangential point value or uses World Health Organization definition might help. If the components of metabolic syndrome definition by Bureau of Health Promotion applied to predict old person, the adaptive is worth discussing. Study a better parameter to get the diagnostic tool more accurate. It might be considered that the strong relativity with metabolic syndrome - total cholesterol and uric acid take the predictive operator with old people (p < .05).
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Tsay, Yeuan-Pern, and 蔡遠鵬. "An analysis on the deduction factors of reimbursement for inpatient medical expenses under the national health insurance scheme--A Case Study of District Teaching Hospital." Thesis, 1998. http://ndltd.ncl.edu.tw/handle/03971613059491927779.
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HUI, CHEN YA, and 陳雅慧. "A Study of the Correlation between Job Stress, Leisure Participation and Mental Health in Nursing Staffs at Health Bureau Taitung Hospital." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/44cmu8.
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碩士國立臺東大學
健康促進與休閒管理碩士在職專班
97
The purpose of this study was to explore the nursing staffs’ condition of job stress, leisure participation, mental health condition, and by which to understand the differences and effects led by the factor of their distinct background. The objects of this study were the nursing staffs of Taitung Hospital.There were 102 valid copies of questionnaire were retrieved and the retrieval rate was 97.14%. The data was then analyzed with statistics methods including t-test, one-way ANOVA, Scheffe-test, Pearson and Product-moment correlation, etc. Results showed that (1) Average job stress which was within the range of mild to moderate pressure. Leisure participation which was in the range of rare to moderate. The mental health condition was in between normal and good.(2) Pressure difference varied depending on the age, marriage condition, number of siblings and year of service. Nurses with age older than 41 y/o, married, with siblings and with working experiences more than 21 years had the less job stress. (3) Leisure participation also varied significantly according to the nursing staff’s marriage condition, number of siblings, working department and annual income. Those which were unmarried, without siblings, operation room staffs and with annual income between 41~60 hundred thousand NT dollars had higher leisure participation. (4) Mental health condition varied significantly on the nursing staff’s working shift and annual income. Those who work on midnight shifts and with annual income between 41~60 hundred thousand NT dollars had poor mental health condition. (5) There was no correlation between job stress and leisure participation rate in nursing staffs. There was a significant negative correlation between leisure participation and mental health. The more leisure activity participated the better would be in the mental health performance. However, job stress had a positive relationship with mental health, the higher working pressure, the worse mental health condition was (p<.05).
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Syu, Guang-Jhih, and 許廣智. "The Study of the Intention of the Emergency Midical Technicians of the Fire Bureau, Kaohsiung City Government to Implement Pre-hospital 12-lead Electrocardiogram." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/h663re.
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碩士樹德科技大學
資訊工程系碩士班
105
Pre-hospital 12-lead electrocardiogram (EKG) has been implemented for many years in many advanced cities of Europe and the United States. In Kaohsiung, the Fire Bureau, the Health Bureau and Kaohsiung Veterans General Hospital promote the project together since 2011. The 12-lead EKG in the ambulances has several advantages, including to diagnosis acute myocardial infarction (AMI) early, to activate the cardiac catheterization medical team before arriving and further to shorten the ischemic cardiac damage in patients with AMI. This study used the decomposed theory of planned behavior (DTPB) and adopted questionnaire way to investigate the intention of the emergency medical technicians (EMTs) of the Fire Bureau, Kaohsiung City Government about the implementation of 12-lead EKG. According to the results of questionnaire, the study demonstrated the following findings. Firstly, the intention of the EMTs to implement 12-lead EKG is positive. Secondly, the intention of the EMTs to implement 12-lead EKG varied, according to different age, education level, seniority, EMT level, EMT instructor qualification, the experience of implementing 12-lead EKG examination and saving AMI patients. Thirdly, the intention of the EMTs for the implementation of 12-lead EKG is positively correlated with three levels of the proposed decomposed behavior model.
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Tadesse, Menelik Legesse. "Healthcare waste management, quantification and intervention in Addis Ababa City Administration health bureau public health facilities." Thesis, 2019. http://hdl.handle.net/10500/26614.
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Healthcare waste management is very important due to its hazardous nature that can cause risk to human health and the environment. The study wished to determine the amount of healthcare waste generated in 15 public health centres and 3 hospitals and evaluate the healthcare waste management practices in Addis Ababa City Administration. The aim of the study was to develop a manual for healthcare facilities based on the findings on healthcare waste management practice, quantification and intervention. Data was obtained from questionnaires distributed to 636 randomly selected healthcare professionals, ancillary staff and managers and by means of surveying the facilities.
The mean HCW generation rate was 10.64 + 5.79 kg/day, of which 37.26% (3.96 + 2.017kg/day) was general waste and 62.74% (6.68 + 4.293 kg/day) was hazardous waste from the surveyed health centres. HCW generation and quantification was not measured and documented in any of the HCFs. Quantifying HCW would help determine the type of waste as well as the HCFs that generate the highest and lowest HCW, which could have implications for resource allocation in managing HCW.
Segregation of different types of wastes was not regularly done. Some HCFs had separate storage areas for HCW and separate containers for hazardous and nonhazardous waste. In some instances, however, the containers were not clearly marked. Regarding storage, some of the HCFs had interim storage sites and HCW disposal sites. Several interim storage facilities lacked security and surveillance and were not cleaned after collection. In addition, HCW remained at the interim storage facilities for more than 48 hours before final disposal. The main forms of on-site treatment of HCW before disposal were burning, crushing sharps, sterilisation and chemical disinfection. The most common treatment method used for HCW was incineration. Most HCW handlers had not received adequate training; did not wear PPE, and did not take precautionary measures, such as washing their hands and heavy duty gloves after handling HCW. The researcher developed a manual for effective HCW management and training of HCW handlers. Based on the findings, the study makes recommendations for policy, education, HCW management, including generation, segregation, storage, transportation and disposal, and further research.Health Studies
D. Litt. et Phil. (Health Studies)
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Tsai, Yung Yu, and 蔡永裕. "Analysis on the variations of price and volume of health care under the implementation of “Hospital Excellence payment program” by Taiwan’s Bureau of National Health Insurance." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/51840198678537565303.
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碩士高雄醫學大學
醫務管理學研究所碩士在職專班
95
Purpose: We aim to explore the variation of prices and volumes of healthcare provided by district hospitals in Taiwan under the implementation of “Hospital Excellence Payment Program (HEPP)” by Bureau of National Health Insurance (BNHI) at year 2003. We hope to show the group effects of behavioral changes before and after the implementation of new payment system (hospital global budget) and provide the insight for references of decision makers in the Bureau and Ministry of Health. Methods: All of the district hospitals that had joined to the HEPP during the year 2003 were selected as study group. We extracted the BNHI claimed data of district hospitals from 2002 to 2005. Changes of prices and volumes of inpatient and outpatient services during study period were analyzed. Data of the second and third quarters (Q2 and Q3) of 2003 were excluded because of SARS attack during these months. Hence, only Q3 and Q4 of 2002, Q1 and Q4 of 2003, and Q1 of 2004 were taken as period before implementation of HEPP. And from the Q2 to the Q4 of 2004 were defined as period of after implementation. Paired t test and regression model of GEE were used to analyze the changes of healthcare providing behaviors among these district hospitals. Results: There were 149 out of 362 (41.2%) district hospitals that joined the HEPP. The percentages of health care expenditures claimed by these hospitals were 44.3% among all district hospitals. However, the budgets that were really reallocated to the 44.3% of district hospitals were 47.3% of total budget for all district hospitals. The growth rate changes of outpatient volumes and expenditures of healthcare before and after HEPP were obviously declined in hospitals of beds fewer than 50, beds of 50-99, and beds of greater and equal than 100. As for the growth rate of inpatients service volumes, there were no obvious changes. According to the analyses of GEE model, the trends of averaged cost per outpatient were increased when taken the Q4 of 2002 as a base line to compare with Q4 of 2003 and 2004. In the GEE model of averaged cost per outpatient service, the time trend, averaged cost of drug per visit, and averaged cost of ancillary service per visit were the 3 major influencing factors. On the other hand, the results of the GEE analyses showed that the time trend and the averaged length of stay were the 2 major influencing factors. Conclusions: Under the implementation of the new hospital global budget payment, hospitals that had joined the HEPP were finally reimbursed more money for healthcare that provided during Q2 to Q4 of 2004. Healthcare providing behaviors of hospitals in the HEPP showed that the volumes of outpatient and inpatient services were under constrained. However, the prices of outpatient and inpatient services of them were increased year by year. Further study on the waiting list and satisfaction of services from patient side has to be done for the references of decision making of policy evaluation.
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Chen, Hsuan-Ta, and 陳炫達. "A Study of Hospital Expenditure Prior and Post the Implementation of the Center of Excellence—Examples of the Central Region Branch, Bureau of National Health Insurance." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/44178225578932058475.
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碩士臺中健康暨管理學院
健康管理研究所
93
Abstract In order to use the medical resources more efficiently and improve the quality of medical services, under the system of global budgeting, the Bureau of National Health Insurance implemented the Center of Excellence from July 1st , 2004 to December 31st, 2004, with the concept of hospital self-management and individual budgeting. The hospital’s expenditure is true-up quarterly. Since the bureau does not allow the hospitals to roll over the unused points of in-patient and outpatient expenditure, the hospitals will have to take some financial risks if the expenditure goes beyond the target quota. When the points of expenditure of first two months of the quarter are approaching the target quota, the hospitals will control the amount of medical services in the last month to avoid the risks. Thus, the quantities of services reduce tremendously, which is called “Quarter-End Effect” in this research. This research finds out the growth of accumulating amount of outpatient services of all hospitals joining the Center of Excellence slows down in the late September 2004. This fact can explain we do have the “Quarter-End Effect”. Those non-participating hospitals don’t have noteworthy change in the amount of medical services, which means they don’t have the “Quarter-End Effect”. Whether the hospital joining the Center of the Excellence or not actually impacts the practice, the amount of medical services provided. To resolve the “Quarter-End Effect” phenomenon, this research suggests that all hospitals prepare quarterly closing at different month.
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Oliveira, Vanessa Anjos de. "Avaliação Farmacoeconómica em Portugal." Master's thesis, 2019. http://hdl.handle.net/10316/88374.
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Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de FarmáciaO desenvolvimento de novas tecnologias na área da saúde tem contribuído para a melhoria do estado de saúde e qualidade de vida da população, porém, nem toda a inovação contribui da mesma forma para o aumento dos ganhos em saúde, portanto é necessário utilizar métodos que permitam medir e avaliar o custo de oportunidade dos bens e serviços de saúde. Para valorizar os custos e benefícios relativos de cada tecnologia são utilizadas metodologias de Avaliação de Tecnologias de Saúde, cujo objetivo é apoiar a decisão de utilização e financiamento das tecnologias de saúde. O processo de financiamento dos medicamentos requer uma detalhada avaliação farmacoterapêutica e farmacoeconómica de forma a garantir racionalidade na comparticipação e aquisição. O presente trabalho pretende ilustrar a avaliação farmacoeconómica de tecnologias de saúde, nomeadamente de medicamentos, em Portugal. Inicialmente, caracteriza a avaliação de tecnologias de saúde, nomeadamente o Sistema Nacional de Avaliação de Tecnologias de Saúde. Focar-se-á na descrição da avaliação farmacoterapêutica e farmacoeconómica, de forma a garantir racionalidade na comparticipação e aquisição das tecnologias de saúde. No seguimento da avaliação farmacoeconómica apresentam-se as orientações para estudos de avaliação económica de medicamentos, dando ênfase às técnicas de avaliação económica. Na parte final referem-se não só as condições de financiamento com dados do seu valor em contexto real garantindo uma avaliação ao longo do ciclo de vida da tecnologia, como também a rede europeia para avaliação de tecnologias de saúde, nomeadamente as orientações EUnetHTA.
The development of new health technologies has contributed to improve the health and quality of life of the population. However, not all innovation contributes equally to the increase in health gains. Therefore, it is necessary to use methods to measure and evaluate the opportunity cost of health services. Health Technology Assessment methodologies are used in order to enrich the relative costs and benefits of each technology, whose purpose is to support the decision to use and fund health technologies. The funding process requires a detailed pharmacotherapeutic and pharmacoeconomic evaluation to ensure rationality in the reimbursement and acquisition. This work presents some key points regarding the pharmacoeconomic evaluation, indicating the methodological guidelines for studies of economic evaluation of medicines, namely the analysis techniques. In addition, it illustrates the re-evaluation and the European network for Health Technology Assessment.
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Hsu, Fu-Keng, and 徐富坑. "Evaluation on“Hospital Medical Care Quality Reports”Exposed by the Kao-Ping Branch of Bureau of National Health Insurance－Outpatients’Information Selection of Medical Services, Attitude and Expectation." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/76768038055117477187.
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碩士臺北醫學大學
醫務管理學系
93
Public report cards on health care were performed in many countries for decades. But it is a new policy to Taiwanese. The Kao-Ping Branch of Bureau of National Health Insurance has providing a website of“Hospital Medical Care Quality Reports”since 2002 that will be good for patient to select hospital and to stimulate quality improvement of hospital. The result of this study showed 78.6% persons of interview have never heard this website, 83.2% persons thought “Hospital Medical Care Quality Reports”would be helpful to improve medical care quality of hospital, and 77.4% persons thought “Hospital Medical Care Quality Reports”would provide them some useful information to select hospital. There were 62.3% patients would shift to better hospital whenever he found the hospital was not good enough in the evaluation of report card. According to this study 70% patients wanted to increase items of report card especially in drugs errors. In the other questionnaire item 71.9% of patients hoped to impose all of hospitals to attend the evaluation of medical care quality reports.
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Tsai, Tung-yuan, and 蔡東原. "An Assessment Of Medical Utilization Of Diagnosis-Related Groups Payment Systems Of Bureau Of National Health Insurance – An Example of Chronic Pulmonary Obstructive Patients In A Regional Teaching Hospital In Southern of Taiwan." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/18990264672676660500.
Full textAbstract:
碩士義守大學
管理研究所碩士班
96
Since 1998, the total cost of medical care service was increasing gradually, resulted in the negative balance of budget of national health insurance in Taiwan and this problem is going to worsen in the future. In order to effectively control the growth of medical expenditure, the medical insurance organizations, the Department of Health, Executive Yuan, adopted the Global Budget System to establish the basis of payment system planned to adopt Diagnosis Related Groups on hospital medical expenditure. This study used the impatient data from a regional teaching hospital in southern of Taiwan. The patients rolled who are more than 17-year-old and admitted to this hospital which was diagnosed as Chronic Obstructive Pulmonary Disease and in charged by a Chest Specialist since 2004 to 2007. Total number of 1,092 patients were including in this study. The finial result of patients post excluded cases of death, transferration or against discharge, there were no difference between the distribution of sex, age, disease severity and length of service in this period of each year, except the total fee of each admission was increased from 35,655 to 49,447 on this period. And the generation of antibiotic agents which initial prescription for this admission were shifted from 1st generation to 2nd generation antibiotic regiment. It is concluded that, although the payment system changed from fee-for-service system to Global budget System on 2002, Self-Management on 2003 and Excellent Program of each hospital on 2004 which implemented by Bureau of National Health Insurance in order to more control the growth of medical care service expenditure, especially the total fee of each impatient charge. But the different result was noted in our study. In the future, the system of payment system of Diagnosis Related Groups will be implanted, and we hope the actual clinical medicine utilization will consider for the quality of medical service.
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Dias, Inês Manuela Barbosa. "Relatórios de Estágio e Monografia intitulada " O estabelecimento de comparações na avaliação farmacoterapêutica de medicamentos em Portugal"." Master's thesis, 2019. http://hdl.handle.net/10316/88288.
Full textAbstract:
Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de FarmáciaA presente monografia tem como finalidade o desenvolvimento de um trabalho individual de investigação experimental, culminando este na elaboração de um documento com elevado rigor técnico-científico. Esta dissertação será composta por três capítulos:✓ CAPÍTULO I – Relatório de Estágio: Farmácia Hospitalar;✓ CAPÍTULO II – Relatório de Estágio: Farmácia Comunitária;✓ CAPÍTULO III – O estabelecimento de comparações na avaliação farmacoterapêutica de medicamentos em Portugal.Relativamente ao capítulo I e II, estes dirão respeito aos estágios realizados entre os meses de janeiro e junho. No capítulo I, será feita uma análise “swot” do estágio realizado nos serviços farmacêuticos do Hospital Cuf Porto, que decorreu durante o mês de janeiro e fevereiro. No que diz respeito ao capítulo II, também será realizada uma análise “swot”, neste caso, do estágio realizado em farmácia comunitária (Farmácia Barreiros), que decorreu entre o mês de março e junho. Relativamente ao terceiro capítulo, este terá como objetivo primordial a introdução ao tema“O estabelecimento de comparações na avaliação farmacoterapêutica de medicamentos em Portugal”. Na primeira parte, será realizado um pequeno resumo de determinados assuntos,nomeadamente, avaliação de tecnologias em saúde, comparticipação, avaliação prévia, entre outros. Após serem esclarecidos estes assuntos, será realizada a análise de relatórios de avaliação de medicamentos de uso humano referentes ao ano de 2017. Os parâmetros estudados em cada um dos relatórios serão devidamente compilados numa tabela, sendo possível, depois, proceder à análise dos mesmos e retirar as respetivas conclusões.
The purpose of this monograph is to develop an individual work of experimental research,culminating in the elaboration of a document with high technical-scientific rigor. This dissertation will consist of 3 chapters:➢ Chapter I – Internship Report: Hospital Pharmacy;➢ Chapter II – Internship Report: Community Pharmacy.➢ Chapter III – The establishment of comparisons in the pharmacotherapeutic evaluation of drugs in Portugal;In relation to chapter I and II, these will relate to curricular internships between January and June. In chapter I, a “swot” analysis of the internship performed in the pharmaceutical services of the Hospital CUF Porto, which took place during the month of January and February, will be performed. As regards chapter II, a “swot” analysis will also be carried out, in this case, of the internship at a community pharmacy, which took place between March and June.In relation to the third chapter, this will have as its primary objective the introduction to the theme "The establishment of comparisons in the pharmacotherapeutic evaluation of drugs inPortugal". In the first part, a brief summary of certain subjects will be made, namely, assessmentof health technologies, reimbursement, prior evaluation, among others. After these issues are clarified, the analysis of the evaluation reports of human use medications for the year 2017 will be carried out. The parameters studied in each of the reports, will be duly compiled in a table, and subsequently, proceed to the analysis of them and withdraw the respective conclusions.