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Piterman, Hannah, and Hannah Piterman@med monash edu au. "Tensions around introducing co-ordinated care a case study of co-ordinated care trial." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20050418.092951.
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The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered.
The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.
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Ullmann, Sven-Roland. "Auswirkungen differierender Fallgewichtungen innerhalb von Diagnosis Related Groups." [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=969843658.
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Kortevoß, Axel. "Krankenhausplanung unter Bedingungen der German-Diagnosis Related Groups." Diss., lmu, 2005. http://nbn-resolving.de/urn:nbn:de:bvb:19-48261.
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Schum, Alexandra. "Erlösvergleich für Schockraumpatienten nach Bundespflegeverordnung, Australian Refined- Diagnosis Related Groups (AR-DRG) und German Diagnosis-Related Groups (G-DRG) einer Klinik der Maximalversorgung." Diss., lmu, 2006. http://nbn-resolving.de/urn:nbn:de:bvb:19-63169.
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Noronha, Marina Ferreira de. "Classificacao de hospitalizacoes em Ribeirao Preto: os diagnosis related groups." Sao Paulo : [s.n.], 2001. http://www.saudepublica.bvs.br/P/teses/MHdout3.pdf.
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Nickel, Marc. "Kalkulation von Fallkosten für Diagnosis Related Groups (DRGs) in der Kardiologie." [S.l.] : [s.n.], 2004. http://deposit.ddb.de/cgi-bin/dokserv?idn=970094248.
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Rutz, Stefan. "Die Einführung von Diagnosis Related Groups in Deutschland : Interessen - Anreize - erste Ergebnisse /." Lohmar : Eul, 2006. http://deposit.d-nb.de/cgi-bin/dokserv?id=2887385&prov=M&dok_var=1&dok_ext=htm.
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Gao, Fei, and 高菲. "Systematic review of the impacts of diagnosis related groups and the challenges of the implementation in Mainland China." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/206937.
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1.1 Background:
Since Diagnosis Related Groups (DRGs) systems were firstly introduced in USA in 1983, they have begun to be implemented in more developed countries and some developing countries among the world during two decades. As one of the prospective payment systems, it focuses on enhancing the efficiency through reduction in the length of stays in hospitals, and improves the health care services by decreasing and controlling the unnecessary treatments. This paper reviewed the impacts of DRGs both in the countries with long period’s implementation and in China, including the above beneficial outcomes and negative influences in health care delivery. Furthermore, considering the current concerns of health care delivery in Mainland China, this paper discussed the difficulties and challenges in widely implementation over the whole country.
1.2 Methods:
This study focused on the published papers in English through Pubmed, Google scholar, Google and in Chinese through CNKI. The articles in Chinese were searched from 1994. A literature search of all articles was conducted using keywords such as DRGs, impacts, efficiency, and quality both in English and in Chinese, so that relevant studies had been chosen according to the aims of the review.
1.3 Result:
This review revealed the beneficial outcomes within health care delivery after the implementation of DRGs, which focused on the decrease in average length of hospital stay and the medical expenses per case. In addition, the relevant adverse outcomes had been reflected simultaneously through the studies, which were mainly indicated through the increase in emergency visits and mortality rates. The findings included both the benefits DRGs brings and negative outcomes, and the current effects of DRGs in Mainland China.
1.4 Conclusion:
Diagnosis Related Groups (DRGs) system plays the different roles in different kinds of health care systems. It controls the medical expenses through less hospital activities, which can be indicated by the decreases in both the lengths of hospital stay and medical expenditures per case through the literatures. However, this system may produce the adverse outcomes within health care delivery due to insufficient, intentional, and cost-saving services. Furthermore, China has introduced this payment system since 1994, and needs to overcome the challenges through the gradual implementation process.published_or_final_version
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Master of Public Health
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Doege, Vanessa Martini Susanne. "Krankenhäuser auf dem Weg in den Wettbewerb : Der Implementierungsprozess der Diagnosis Related Groups /." Wiesbaden : Gabler Verlag / GWV Fachverlage GmbH, Wiesbaden, 2009. http://dx.doi.org/10.1007/978-3-8349-9979-5.
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Doege, Vanessa Martini Susanne. "Krankenhäuser auf dem Weg in den Wettbewerb : der Implementierungsprozess der Diagnosis Related Groups /." Wiesbaden : Gabler, 2008. http://d-nb.info/990564479/04.
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Beyerlein, Fred M. "The effects of diagnosis related groups (DRGs) on hospital nutrition services in Arizona." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276655.
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A mail questionnaire surveyed Arizona hospital dietary departments to reveal the most frequently initiated changes in dietary practice since the implementation of Diagnostic Related Groups (DRGs). The most frequently initiated change was remodeling the service/cafeteria areas to increase consumer appeal and subsequent sales. Fee-for-service nutrition was the tenth most frequently initiated change. Non-subsidized employee feeding was the second least frequently initiated change since DRGs. Hospital size was found to correlate significantly (alpha ≥ 05) with innovative management, development of DRG avenues of recovery, purchase of computers, development of clearly defined treatment plans, utilization of time studies and staffing, and the implementation of corporate wellness programs. Only a few hospitals have determined costs for DRG dietary treatments, or know standard length of stay for each DRG. The number of dietitians documenting services and patient outcome must increase or their cost effectiveness may never be known.
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Lossin, Astrid. "Auswirkungen der Vergütungsform auf Kosten und Qualität der Krankenhausbehandlung : diagnosis related groups und Pflegesätze im Vergleich /." Berlin : wvb, Wiss. Verl, 2006. http://www.wvberlin.de/data/inhalt/lossin.htm.
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Schick, Jens. "Vorbereitung der deutschen Krankenhäuser auf die G-DRG-Einführung /." Münster : Schüling, 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=012774352&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Seik, Bettina. "Eine G-DRG-gerechte Steuerung des Krankenhauses mit Hilfe einer Grouper-OLAP-Kalkulations-Box - GOK-BOX." Berlin Logos-Verl, 2006. http://deposit.d-nb.de/cgi-bin/dokserv?id=2865578&prov=M&dok_var=1&dok_ext=htm.
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Machnik, Simon. "Diagnosis related groups Effekte auf Handlungsweise und Zielsetzung von Krankenhäusern ; eine modelltheoretische und empirische Analyse im Kontext der DRGs." Bayreuth Verl. PCO, 2008. http://d-nb.info/989568679/04.
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Alzahrani, A. M. M. "The use of diagnosis related groups in the management of acute hospitals : an international study." Thesis, Swansea University, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635772.
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This thesis covers the development and application of a system for classifying patients into groups on the basis of their types of disease and the average scale of resources used in their treatment. The system is known as the Diagnosis Related Groups classification, and as the name indicates, patients are first assigned to a specific grouping, or 'Major Diagnostic Category', according to the diagnoses recorded on the discharge abstract. This, plus the design feature which classifies cases by organ system, makes the DRGs clinically meaningful as well as aiming to produce groups which are homogeneous in terms of their resource utilisation. The DRGs, first developed to cover patients in acute hospitals, permit the measurement of case mix - the mix of patient types treated over a given time. Complexity of case mix has a bearing on the resources consumed in a hospital, and is important in planning services, monitoring performance, and the costing of patient care. The DRG classification was created in the USA by researchers at Yale University. This, and its subsequent refinement in answer to criticisms which identified weaknesses and alternative systems put forward, are described in chapters 1 and 2. An overview of the international scene is dealt with in chapter 3, whilst chapter 4 looks at how the US Government adopted DRGs as the basis of payment for the treatment of publicly funded patients. Chapters 5-8 focus on the application of DRGs in France, the Netherlands, Australia and the UK. A case study of progress made and problems met in implementing a DRG project in West Glamorgan Health Authority is given in Chapters 9 and 10. Finally, an account of health care in the Kingdom of Saudi Arabia is given in Chapter 11, with a general review of progress made over the past quarter century, as background to a provisional view of the potential for DRGs in that country, and recommendations on how to proceed in Chapter 12. The conclusion from the survey of literature on the DRGs is that the classification is the best case mix measurement system currently available, and that its various applications can make it an extremely useful management tool. There is potential for further development, and through its implementation in an increasing number of countries, international comparisons become possible which could be of worldwide benefit in improving the effectiveness of health care provision.
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Rummel, Sandra Ilona. "Kosten und Erlöse bei der Abrechnung geburtshilflicher Leistungen nach dem System der Diagnosis-Related-Groups (DRG)." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-66325.
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Foit, Kristian. "Marktorientierte Steuerung im Krankenhaussektor /." Köln : Kölner Wissenschaftsverlag, 2006. http://aleph.unisg.ch/hsgscan/hm00163340.pdf.
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Raupach, Karsten. "Der Übergang zur DRG-basierten Vergütung von Krankenhausleistungen in Deutschland : verfassungsrechtliche Fragen zur Einführung des neuen Vergütungssystems und Überlegungen zu den Konsequenzen für die zivilrechtliche Arzt- und Krankenhaushaftung /." Göttingen : Cuvillier, 2006. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=015007633&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Reusch, Marcus. "Avaliação de desempenho de unidade hospitalar por Diagnosis Related Groups (DRG) – casuística cirúrgica: um estudo de caso." Universidade do Vale do Rio dos Sinos, 2015. http://www.repositorio.jesuita.org.br/handle/UNISINOS/4721.
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A dificuldade e os métodos para avaliar o desempenho das organizações de saúde representam um enorme desafio para os gestores hospitalares. O Diagnosis Related Groups (DRG) constitui-se em um completo sistema de classificação, que visa instrumentalizar a gestão hospitalar possibilitando a mensuração e avaliação de desempenho das instituições hospitalares. Foi proposta a utilização da metodologia DRG para avaliar o desempenho da casuística cirúrgica de uma unidade hospitalar. A fundamentação teórica enfatizou três temas: Histórico e evolução da classificação DRG, a classificação AP-DRG e a avaliação do desempenho e gestão hospitalar por DRG. O método utilizado consistiu em uma pesquisa tipo estudo de caso único com abordagem exploratória e descritiva de dados, de natureza quali-quantitativa. O campo do estudo foi um Hospital Geral de Grande Porte (HGGP). Os dados foram coletados a partir das informações contidas nos documentos de alta hospitalar de cada paciente submetido a procedimento cirúrgico, no período de um ano (Agosto de 2013 a Julho de 2014), foram após processados no Software Grouper, instrumento inicial da análise, dando origem a 213 DRGs cirúrgicos distintos. Foi desenvolvido o processo de implantação da metodologia DRG, identificados impactos na gestão dos serviços hospitalares com o uso do DRG, comparado o desempenho da casuística cirúrgica do HGGP com outras instituições hospitalares utilizando o DRG e foram identificadas oportunidades de melhoria em processos da assistência hospitalar no HGGP. Constatou-se que 16 DRGs corresponderam a 50% de toda casuística cirúrgica, e 44 DRGs (20% dos 213 DRGs cirúrgicos da amostra) representaram 80% de toda casuística cirúrgica da instituição. Para comparação de desempenho, foram utilizados dados publicados anualmente do Sistema de Saúde de Portugal. Dos 20 DRGs mais frequentes do HGGP, três apresentaram um desempenho inferior ao do grupo de Portugal. Nos outros 17 DRGs da amostra estudada, o desempenho foi superior, aferido em termos de tempo de permanência hospitalar. O objetivo geral proposto para o trabalho, da utilização do DRG para avaliar o desempenho da casuística cirúrgica da instituição foi alcançado.
The difficulty and the methods to evaluate the performance of health organizations represent a huge challenge for hospital managers. The Diagnosis Related Groups (DRG) is a complete classification system, which aims to equip the hospital management enabling the measurement and evaluation of hospitals performance. We propose the use of DRG methodology to evaluate the performance of the surgical cases within a hospital unit. The theoretical foundation emphasized three themes: History and evolution of the DRG classification, the AP-DRG classification and performance evaluation and hospital management by DRG. The method used consisted of case study research with qualitative and quantitative exploratory and descriptive approach of data. The field of study was a General Hospital with 386 beds. The data were collected from the information contained in the hospital discharge document of each patient that underwent surgery in the period of one year (August 2013 to July 2014), and processed in the Grouper Software, initial instrument of the analysis, originating 213 different surgical DRGs. It was found that 16 DRGs accounted for 50% of all surgical cases, and 44 DRGs (20% of 213 sample surgical DRGs) accounted for 80% of all surgical cases of the institution. For comparison, we used data published annually by the Health Care System of Portugal. Of the 20 most frequent DRGs of the General Hospital, three presented a performance lower than the group of Portugal. However the performance of the other 17 DRGs of the sample was higher considering the hospital length of stay. The general objective proposed for the study, using the DRG to evaluate the performance of the surgical cases of the institution was achieved, as well as the objectives of developing the process of implementation of the DRG methodology, identification of impacts in the management of hospital services with the use of DRG, the comparison of the surgical series of the General Hospital performance with other hospitals using DRG and identification of improvement opportunities in processes of hospital care.
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Freitag, Philipp Michael. "Qualitätssicherung in der stationären Versorgung qualitätsbezogene Implikationen des DRG-basierten Vergütungssystems von Krankenhausleistungen." Hamburg Kovač, 2006. http://www.verlagdrkovac.de/978-3-8300-2950-2.htm.
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Rübsamen, Katrin. "Verfassungsrechtliche Apsekte des Fallpauschalensystems im Krankenhauswesen (DRG-Vergütungssystem)." Baden-Baden Nomos, 2007. http://d-nb.info/988192985/04.
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Hart, Dominique [Verfasser], and Gerd [Gutachter] Jungkunz. "Untersuchung zur Vorbehandlung psychiatrischer Patienten vor und nach Einführung der Diagnosis Related Groups / Dominique Hart ; Gutachter: Gerd Jungkunz." Würzburg : Universität Würzburg, 2018. http://d-nb.info/1163201782/34.
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Raisch, Dennis William 1952. "ANALYSIS OF ANTIBIOTIC THERAPY IN SELECTED DIAGNOSIS RELATED GROUPS (CLINICAL PHARMACY, PATIENT CARE, LENGTH OF STAY, TREATMENT, CHARGES)." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/276371.
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Qvick, Bryan Ingemar. "Erlösvergleich 1030 polytraumatisierter Patienten bei der Abrechnung nach Bundespflegesatzverordnung und German Diagnosis-Related Groups (G-DRG) unter speziellen Gesichtspunkten." Lübeck Zentrale Hochschulbibliothek Lübeck, 2010. http://d-nb.info/1001713028/34.
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Jagdfeld, Frank Herbert. "Möglichkeiten und Grenzen der Abbildung der stationären Psychosomatik im DRG-System : eine empirische Untersuchung zur Fallgruppenhomogenität am Universitätsklinikum Aachen /." Aachen : Shaker, 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=013209843&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Krämer, Nicolas. "Strategisches Kostenmanagement im Krankenhaus Anwendung unter besonderer Berücksichtigung von DRG-Fallpauschalen." Hamburg Kovač, 2008. http://d-nb.info/992492211/04.
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Zugl.: Duisburg, Essen, Univ., Diss., 2008 u.d.T.: Krämer, Nicolas: Entwicklung einer Konzeption für ein strategisches Kostenmanagement im Krankenhaus sowie seine Anwendung unter besonderer Berücksichtigung von DRG-Fallpauschalen
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Miele, Bernd. "Patientenorientierte Kostenrechnung Leitfaden für die Einführung einer Prozesskostenrechnung im Krankenhaus." Saarbrücken VDM Verlag Dr. Müller, 2006. http://d-nb.info/988795795/04.
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Carlsson, Lennart. "Clinical and economic features of categories of patients in defined populations /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-193-8/.
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Lierse, Meike. "Das deutsche DRG-System Anspruch und Wirklichkeit einer Vergütungsreform im Gesundheitswesen ; gesundheitsökonomische Evaluation am Beispiel von Patienten mit Hirninfarkt." Saarbrücken VDM Verlag Dr. Müller, 2007. http://d-nb.info/991337735/04.
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Ferguson, Lorraine J. "Health care reform and structural interests: Casemix as a tool for reform in the Australian health industry." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36766/1/36766_Digitised%20Thesis.pdf.
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This thesis uses a policy research framework to examine the development, implementation and evaluation of the casemix-based health care reform policies that were embedded within the 1988 and 1993 Medicare Agreements between the Commonwealth Department of Health and states and territories of Australia. Alford's (1975) conceptual framework of structural interests is used to examine the power of strategically placed interests in health care, and the barriers and challenges those interests pose to reform of the hospital system in particular. Alford (1975:14) argued that health systems must be understood in terms of the continuing struggle between the dominant structural interests (mainly doctors) and the challenging structural interests (government bureaucrats, health administrators, health planners and academic researchers) who try to reform the health system. Casemix-based hospital management information and funding systems provide tools for understanding hospital activity and costs and in doing so, provide incentives for improving efficiency and reforming clinical practice.
The aims of the study were to gain a better understanding of the processes used in developing the reform policies; to explain in an analytical way, who influenced what was decided in relation to policy development and implementation; to examine the impact of the implementation of casemix-based funding policies in two Australian states from the points of view of the structural interests in health care; and to summarise the implications for future health care reform policy development m Australia. The data collection methods used for this study include depth interviews with fifteen casemix 'elites', a focused synthesis of important documents related to casemix policy, and secondary analysis of hospital activity data to evaluate the impact of casemix-based funding in the States of Victoria and South Australia.
The findings clearly demonstrate that the inclusion of the casemix-based reform policies into the 1988 Medicare Agreements was a deliberate approach by the challenging structural interests to signal a new era of reform and accountability for the Australian public hospital system. The use of the Casemix Development Program as a policy instrument was seen by the stakeholders to have a positive impact in terms getting commitment to policy direction and for developing expertise in casemix-based systems, but it was criticised for a lack of research priorities and the subsequent waste of funds.
Casemix-based funding systems were seen by the stakeholders to have both positive and negative aspects. Both the challenging and dominant structural interests agreed that there was an improvement in management information and financial systems, giving them better information for budget allocation and resource management. This resulted in improved hospital access and efficiency, as measured by patient throughput, length of stay and average cost per casemix-adjusted separation. The dominant structural interests found that with better information and more accountability for resource use there was an improved focus on team work and patient management. Despite these improvements, there was a belief among the dominant structural interests that quality of care had deteriorated under casemix-based funding.
Negative aspects of casemix-based funding systems were seen to include a focus on technical efficiency at the expense of allocative efficiency and an emphasis on acute hospital services and throughput without consideration of the resources required for other services; particularly community services which had to deal with early discharges. Stakeholders also felt that there was increased pressure on bedside clinical staff with the increases in patient throughput and acuity, and that these pressures threatened the ability of so called teaching hospitals to adequately train health professionals and to conduct research.
While the casemix-based reform policies resulted in a coalition of the challenging and dominant structural interests to improve health care delivery in Australia, there is no evidence to suggest that there has been any real change in the social, economic and political structures which reinforce medical dominance in health care in Australia.
Recommendations for future policy research and policy learning are made with a view to improving the nature of health care reform policy and its impact on the health of the Australian population.
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Hellberg, Jonas, and Robin Lindgren. "Att mäta eller inte mäta? : En kvalitativ undersökning om prestationsmätningar på en av Blekingesjukhusets kliniker." Thesis, Blekinge Tekniska Högskola, Sektionen för management, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-1122.
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Blekinge Hospital suffers from a budget shortage of 100 million SEK, while the government now requires that hospitals will no longer be running a deficit. Blekinge Hospital will then use their limited resources to survive in the future and the activity must be enhanced in order to keep costs low without having to lay off personnel. The idea is that the organisation should be more efficient with a more efficient resource usage. Performance measurement systems are important tools for achieving the policies set out within an organization, measuring and evaluating performance is a way to see where improvements in efficiency may be necessary in the business. Balanced Scorecard (BSC) is one of several measuring systems, where the focus is on measuring non-financial performances. Diagnosis Related Groups (DRG) is another performance measurement systems used in healthcare so that comparisons between hospitals can easily be performed. The purpose of this study was to investigate what performance measurement systems that Blekinge Hospital uses and how they are used. To examine this, qualitative interviews with politicians and officials of the Blekinge county council and employees working at one of Blekinge Hospital clinics has been conducted. The result shows that the Blekinge Hospital has problems in maintaining and evaluating the results of performance measurements. This is mainly due to time and resource constraints, but also as a result of lack of communication down to the clinics from the hospital's management and officials. On the other hand, this study shows that Blekinge Hospital used DRG to a greater extent than the BSC which was not used at all. We see this as a result of good communication and understanding of what the measurement system is good at.Blekingesjukhuset dras med ett budgetunderskott på 100 miljoner kronor, samtidigt som regeringen nu kräver att sjukhusen inte längre får gå med underskott. Blekingesjukhuset får då använda sina knappa resurser för att klara sig framöver och verksamheten måste effektiviseras för att hålla nere kostnaderna utan att behöva avskeda personal. Tanken är att verksamheten ska effektiviseras och att resurser ska användas på ett mer effektivt sätt. Prestationsmätningssystem är viktiga verktyg för att uppnå de strategier som satts upp inom ett företag, att mäta och utvärdera prestationer är ett sätt att se var effektivitetsförbättringar kan behöva göras i verksamheten. Balanced Scorecard (BSC) är ett av flera mätsystem, där fokus ligger på att mäta icke finansiella prestationer. Diagnosrelaterade grupper (DRG) är ett annat prestationsmätningssystem som används inom vården för att jämförelser mellan olika sjukhus enkelt ska kunna utföras. Syftet med denna studie var att undersöka vilka prestationsmätningssystem som Blekingesjukhuset använder och hur dessa används. För att undersöka detta har kvalitativa intervjuer med politiker och tjänstemän på landstinget Blekinge samt anställda som arbetar på en av Blekingesjukhusets kliniker genomförts. Resultatet visar att Blekingesjukhuset har problem när det gäller att upprätthålla och utvärdera resultatet av prestationsmätningar. Detta beror främst på tid- och resursbrist, men även som följd av brist på kommunikation till Klinikerna, från sjukhusets ledning och tjänstemän. Däremot användes DRG i större utsträckning än BSC, som inte användes alls, vilket vi ser som ett resultat av god kommunikation och förståelse för vad mätsystemet är bra till.
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Qvick, Bryan Ingemar [Verfasser]. "Erlösvergleich 1030 polytraumatisierter Patienten bei der Abrechnung nach Bundespflegesatzverordnung und German Diagnosis-Related Groups (G-DRG) unter speziellen Gesichtspunkten / Bryan Ingemar Qvick." Lübeck : Zentrale Hochschulbibliothek Lübeck, 2010. http://d-nb.info/1001713028/34.
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Klinke, Sebastian. "Ordnungspolitischer Wandel im stationären Sektor : 30 Jahre Gesundheitsreform, DRG-Fallpauschalensystem und ärztliches Handeln im Krankenhaus /." Berlin : Pro Business, 2008. http://d-nb.info/989791610/04.
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Klinke, Sebastian. "Ordnungspolitischer Wandel im stationären Sektor 30 Jahre Gesundheitsreform, DRG-Fallpauschalensystem und ärztliches Handeln im Krankenhaus." Berlin Pro Business, 2007. http://d-nb.info/989791610/04.
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Vitikainen, Kirsi. "Essays on diagnosis related groups (DRGs) : Empirical stimation of the impact of a more accurate measurement of outpatient production on hospital efficiency and productivity." Thesis, University of York, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.533501.
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Ossig, Sonja. "Vergütung von Krankenhausleistungen und Haftung für Behandlungsfehler : Deutschland und die USA im Vergleich /." Wiesbaden : Dt. Univ.-Verl, 2005. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=014747872&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Antioch, Kathryn M. "Improving cost effectiveness, distributional justice and allocative efficiency in hospital funding and service delivery in Australia and internationally." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5296.
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Freitag, Philipp Michael. "Qualitätssicherung in der stationären Versorgung : qualitätsbezogene Implikationen des DRG-basierten Vergütungssystems von Krankenhausleistungen /." Hamburg : Kovač, 2007. http://www.verlagdrkovac.de/978-3-8300-2950-2.htm.
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Simões, Sara Patrícia Henriques. "A cirurgia de ambulatório em Portugal." Master's thesis, Mestrado em Decisão Económica e Empresarial, 2016. http://hdl.handle.net/10400.5/13164.
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Mestrado em Decisão Económica e EmpresarialO presente relatório, que tem por base o estágio realizado na empresa IASIST, teve como finalidade caracterizar, para o ano de 2014, a Cirurgia de Ambulatório (CA) em Portugal Continental, através de análises estatísticas e econométricas realizadas no software Stata. No nosso país, existem atualmente 1.876 procedimentos considerados como potencialmente "Ambulatorizáveis", agrupando-se em 67 Grupos de Diagnósticos Homogéneos (GDH). Associado a este conceito está o financiamento, cuja fórmula e respetivos critérios se encontram definidos na portaria n.º 163/2013 de 24 de Abril. Neste trabalho testei quatro modelos de regressão binários onde concluí que as variáveis comuns a todos eles (exceto ao modelo 2), que contribuem para o aumento da probabilidade de realização cirúrgica em regime de Ambulatório, são: o género feminino, a região de Lisboa e Vale do Tejo, os hospitais monográficos e o GDH 39. Verifiquei ainda que há evidências de que a maioria dos episódios, distribuídos pelos GDH possíveis de realizar em Ambulatório, são efetuados sem a necessidade de pernoita hospitalar do doente, tendo as realizações em Ambulatório com pernoita um peso muito pequeno no total de cirurgias. Não obstante, dada a literatura disponível, será necessária mais evidência para aferir o real impacto da CA nos hospitais.
This report, based on the internship at IASIST, was intended to characterize, for the year 2014, the Ambulatory Surgery (AS) in mainland Portugal, through statistics and econometrics analysis utilising the Stata software. In Portugal, there are currently 1.876 procedures included in the concept of AS, clustered into 67 Diagnosis Related Groups (DRG). Regarding its financing, the guidelines are defined by law No. 163/2013 of April. In this essay I tested four binary regression models and concluded that the common variables which increase the probability to perform AS in all models (except in model 2) are: being female, receiving care at Lisbon and Tagus Valley region, the monographic hospitals and the DRG 39. Furthermore, there is evidence that the majority of occurrences distributed by the DRG which can be performed in an outpatient setting are therefore made without a patient?s overnight stay, thus meaning
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Costa, João Tiago da Silva. "A variabilidade no consumo de recursos nos traumatismos crânio-encefálicos." Master's thesis, Escola Nacional de Saúde Pública. Universidade Nova de Lisboa, 2013. http://hdl.handle.net/10362/11520.
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RESUMO - Portugal atravessa um contexto socioeconómico conturbado onde se têm imposto várias reformas, nomeadamente ao nível da Saúde.
Atualmente, o financiamento do internamento hospitalar é feito por grupos de diagnóstico homogéneo com base num sistema prospetivo, reunindo os episódios em grupos clinicamente coerentes e homogéneos, de acordo com o consumo de recursos necessário para o seu tratamento, tendo em conta as suas características clínicas. Apesar do objetivo deste sistema de classificação de doentes, é aceite que existe variabilidade no consumo de recursos entre episódios semelhantes, sendo que a mesma variabilidade pode representar uma diferença significativa nos custos de tratamento.
Os Traumatismos Cranio-encefálicos são considerados um problema de saúde pública, pelo que os episódios selecionados para este estudo tiveram por base os diagnósticos mais comuns relacionados com esta problemática. Procurou-se estudar a relação entre o consumo esperado e o observado bem como, a forma em que esta relação é influenciada por diferentes variáveis. Para verificar a existência de variabilidade no consumo de recursos, bem como as variáveis mais influentes, foi utilizada a regressão linear e constatou-se que variáveis como a idade, o destino pós-alta e o distrito têm poder explicativo sobre esta relação. Verificou-se igualmente que na sua generalidade as instituições hospitalares são eficientes na prestação de cuidados.
Compreender a variabilidade do consumo de recursos e as suas implicações no financiamento poderá suscitar a dúvida se a utilização de GDH será o mais adequado à realidade portuguesa, de forma a ajustar as políticas de saúde, mantendo a eficiência e a qualidade dos cuidados.ABSTRACT - Portugal is going through a rough crisis, which has provoked deep changes in policies, namely in Healthcare. Currently, the funding for hospitals is done using Diagnosis Related Groups, based on a prospective payment system, gathering all of the cases in clinically coherent and homogenous groups, accordingly with the level of the resource consumption that is necessary for their treatment, taking into account their characteristics. Despite of the objective of this patient classification system, it’s widely accepted that exists some degree of variation in resource consumption between similar cases, which can lead to a significant difference in the costs of treatment. Traumatic Brain Injury is considered as an public health problem, and as such, the cases that were selected for this study were based on the most common clinical diagnosis related with this theme. In this research, it was intended to study the relation between the expected and the effective resource consumption, and the influence of different variables. In order to verify the existence of variation, as well as the most influent variables, a linear regression was built, using variables as such as age, discharge destination and geographical districts, which can explain the relation between them. Also, it was verified that, generally, the hospitals were efficient in health care providing. Understanding the variation of resource consumption and it’s implicantions can raise the doubt if the use of DRG’s is the most adequate to the Portuguese reality, in order to adjust the healthcare policies, maintaining the efficiency and quality of care.
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Šimeček, Petr. "Hodnotový management a controlling." Doctoral thesis, Vysoké učení technické v Brně. Fakulta podnikatelská, 2010. http://www.nusl.cz/ntk/nusl-233736.
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The doctoral thesis deals with the possibilities of utilizing value management and controlling methods and instruments in medical facilities with the purpose of economical, effective and efficient use of disposable resources of these organisations. The reason why this topic was chosen is endeavour to prove that the controlling system can be implemented in medical facilities and thus effectiveness of financial management in these organisations increased. The aim of the thesis is to analyse main problems and currently value management and controlling methods and instruments use in medical facilities and based on this analysis identify suitable value management and controlling methods usable management system framework of medical facility. The thesis based on the utility functions analysis of the most important actors of the health services market evaluates the potential growth of efficiency of these services introducing the Diagnosis Related Groups system of Financing and using theoretical model of this market. In consequence questionnaire survey analysis currently praxis of medical facilities management in Czech Republic compared with corporate sector and identifies possibilities of value management and controlling application in medical facilities. Currently is identified suitable costs calculation and management instrument for medical facilities in the framework of ABC/M, whereas planning and controlling process is projected in the framework of ABC/M using original mathematical methods for complex in-house price accounting and complex in-house process prices cost calculations based on for this purpose key usage of linear algebra tools for business economy as tool for mathematical model creation, which makes possible the fair description of firm in-house cost flow without any approximations and simplifications. This tool provides for practice important analytical comfort and essentially makes the scale of econometrical tools longer in the field of business management. In the case study is presented costs and calculations model of medical facility based on Activity Based Costing principles inclusive integrative suggestion of usage comprehensive system of the financial management based on advantages offered by the model of business cost flow listed above in framework of executive information system. Contribution of the doctoral thesis for theory and its contribution for further development of medical facilities management and managerial practice are emphasized in the end part thesis.
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姚驥如. "住院病人病種費用及其影響因素分析." Thesis, University of Macau, 2010. http://umaclib3.umac.mo/record=b2454964.
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Gualberto, Felipe Augusto Souza. "Valor disgnóstico da nested PCR em tempo real em pacientes com meningite tuberculosa." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5134/tde-26082014-093325/.
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Introdução: A meningite tuberculosa (MTB) é a forma mais grave e fatal de tuberculose. O diagnóstico oportuno e o tratamento adequado e precoce são os principais fatores associados com o bom prognóstico. Os métodos utilizados na prática médica diária - achados clínicos, exames de imagem e análise de líquido cefalorraquidiano (LCR) - têm baixa acurácia. A pesquisa do DNA do Mycobacterium tuberculosis no LCR através da reação em cadeia da polimerase (PCR, do inglês polimerase chain reaction) com a metodologia nested é promissora, especialmente quando associada à praticidade da amplificação do DNA em tempo real. Objetivo: Avaliar o valor diagnóstico da nested PCR em tempo real (nRT-PCR, do inglês nested real-time PCR) na investigação de pacientes com MTB. Métodos: Estudo observacional realizado em duas fases: uma prospectiva e outra retrospectiva. Na fase prospectiva, foram incluídos pacientes com suspeita de MTB internados no Instituto de Infectologia Emílio Ribas (IIER). Informações clínicas, laboratoriais e radiológicas foram coletadas, assim como amostra de LCR de todos os pacientes. A partir de critérios internacionais padronizados, os pacientes foram categorizados como \"MTB Definitiva\", \"MTB Provável\", \"MTB Possível\" e \"Não MTB\". A nRT-PCR, utilizando o gene alvo mpt64, foi realizada em todas as amostras de LCR no Laboratório de Meningites Bacterianas do Instituto Adolfo Lutz. Sensibilidade, especificidade e intervalos de confiança (IC 95%) da nRT-PCR foram calculados com base no padrão-ouro (cultura positiva para M. tuberculosis ou isolamento de BAAR no sistema nervoso central) e nos pacientes com outros diagnósticos estabelecidos (Não MTB). Também foi calculada a proporção de pacientes com a nRT-PCR positiva em cada categoria clínica. Na fase retrospectiva, foi realizada uma revisão de prontuários de pacientes que tiveram a nRT-PCR solicitada no IIER e no Centro de Referência e Treinamento em DST/AIDS. Os mesmos procedimentos de categorização diagnóstica, cálculos de sensibilidade e especificidade foram adotados. Resultados: Na fase prospectiva, foram incluídos 102 pacientes, sendo 92 deles infectados por HIV. Nove deles tiveram o padrão-ouro positivo e foram classificados como \"MTB Definitiva\" e 81 deles tiveram outros diagnósticos estabelecidos (\"Não MTB\"). A sensibilidade e a especificidade da nRT-PCR foi 100% (IC95%:70-100 e 95-100, respectivamente). A positividade da nRT-PCR na categoria \"MTB Provável\" foi 50% (4/8 pacientes) e 25% na \"MTB Possível\" (1/4). Na fase retrospectiva, 56 pacientes foram incluídos, sendo 48 infectados por HIV. A nRT-PCR teve sensibilidade de 83% (5/6) e especificidade de 100% (0/45). A positividade na categoria \"MTB Provável\" foi 60% (3/5) e não houve pacientes classificados como \"MTB Possível\". Conclusão: A nRT-PCR apresentou boa sensibilidade e ótima especificidade, demonstrando seu valor diagnóstico na identificação oportuna de casos de MTBBackground: Tuberculous meningitis (TBM) is the most serious and lethal presentation of tuberculosis. Timely diagnosis and appropriated treatment are the main factors associated with good outcome. Methods used in the daily medical practice - clinical, radiological and cerebrospinal fluid (CSF) findings - have low accuracy. Search for Mycobacterium tuberculosis DNA in the CSF by polymerase chain reaction (PCR) using the nested methodology is promising, especially when combined with the practical approach of the real time DNA amplification. Objective: To evaluate the diagnostic value of a nested real-time PCR (nRT-PCR) in the investigation of patients with TBM. Methods: A two-phase observational study was carried out: prospective and retrospective. In the prospective phase, patients with suspected TBM hospitalized at \"Instituto de Infectologia Emílio Ribas\" (IIER) were included. Clinical, laboratory and radiological data were collected, as well as CSF samples of all patients. According to international standard criteria, patients were categorized as \"TBM Definite\", \"TBM Probable\", \"TBM Possible\" and \"Not TBM\". The nRT-PCR, using the mpt64 gene, was performed on all CSF sample in the Laboratory of Bacterial Meningitis, Adolfo Lutz Institute. Sensitivity, specificity and confidence intervals (95% CI) of the nRT-PCR were calculated based on the gold standard (culture positive for M. tuberculosis or AFB isolation on the central nervous system) and on patients with other established diagnoses (\"Not TBM\"). The proportion of patients with a positive nRT-PCR in each clinical category was also calculated. In the retrospective phase, medical chart review was performed in those patients who had the nRT-PCR requested in IIER and in the \"Centro de Referência e Treinamento em DST/AIDS\". The same diagnostic categorization and calculations of sensitivity and specificity were adopted. Results: 102 patients were included in the prospective phase, 92 of them HIV-infected. Nine of them had the gold standard positive and were classified as \"TBM Definite\" and 81 of them had other diagnoses established (\"Not TBM\"). The sensitivity and specificity of the nRT-PCR were 100% (95%CI: 70-100 and 95-100, respectively). The nRT-PCR positivity in category \"TBM Probable\" was 50% (4/8 patients) and 25% in \"TBM Possible\" (1/4). In retrospective phase, the nRT-PCR had a sensitivity of 83% (5/6) and specificity of 100% (0/45), among the 56 included patients (48 of them HIV infected). Positivity in \"TBM Probable\" category was 60% (3/5) and no patients were classified as \"TBM Possible\". Conclusion: The nRT-PCR showed good sensitivity and excellent specificity, showing its diagnostic value in the timely identification of TBM
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Pinto, Rosana. "Sistemas de informações hospitalares de Brasil, Espanha e Portugal: semelhanças e diferenças." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/2292.
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Previous issue date: 2010Objetivo: Proceder à comparação entre Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) e os sistemas de informações hospitalares de Espanha e Portugal, utilizando como eixos de comparação os fatores que comprometem a qualidade da informação hospitalar no Brasil e limitam a sua utilização. Metodologia: Os principais procedimentos metodológicos adotados neste estudo foram a Revisão da Literatura e a Análise Documental. A Revisão a Literatura visou efetuar a caracterização do sistema de informações brasileiro e a extração de artigos científicos nacionais, dos principais limitantes a qualidade da informação hospitalar no Brasil. A Revisão da Literatura foi também utilizada para pesquisa na literatura científica internacional das principais características dos sistemas de informação de Espanha e Portugal. Através da Análise documental foram relacionadas as principais portarias relativas ao sistema de informações hospitalares brasileiro e complementada a pesquisa sobre os sistemas de informações hospitalares de Espanha e Portugal. Resultados: Foram localizados 35 artigos que direta ou indiretamente versam sobre a qualidade dos dados do SIH-SUS. Os limitantes à qualidade da informação do sistema brasileiro, selecionados para estudo, estão relacionados ao registro dos prontuários, à qualidade da informação clínica, à cobertura do sistema, às influências do sistema de pagamento, à subnotificação das internações e à identificação das reinternações e transferências do mesmo paciente. As principais constatações foram: (a) alguns limitantes à qualidade da informação no sistema brasileiro existem também nos sistemas internacionais, contudo, grande parte dos problemas aqui detectados, já foi solucionada por esses países. (b) problemas no registro dos prontuários, comum aos três países, estão relacionados à falta de valorização da informação e ao não estabelecimento de regras para seu preenchimento; (c) os sistemas de pagamento aos hospitais adotado por Brasil, Espanha e Portugal são bastante semelhantes. A maior diferença encontra-se na classificação; no Brasil é adotada a classificação por procedimentos e na Espanha e Portugal, a classificação de pacientes através da metodologia DRG; (d) a cobertura do SIH-SUS, embora não universal, é mais abrangente que a cobertura dos sistemas de informações hospitalares de Portugal e Espanha, cobrindo as internações hospitalares, domiciliares e em regime hospital-dia realizadas em hospitais gerais e especializados, de agudos, crônicos e psiquiátricos. (e) não foram obtidas informações sobre subnotificação nos sistemas internacionais. No SIH-SUS, esta acontece, principalmente, pelo não registro no sistema, de todas as internações ocorridas por unidades hospitalares cuja remuneração não é baseada na produção de serviços e; pelo subsídio, pelas secretarias de saúde, de internações não contabilizadas pelo sistema, devido a limitações à emissão de AIHs ou a políticas que direcionam ou restringem a cobrança de determinados procedimentos; (f) nos sistemas de informação do Brasil e Espanha não é possível a identificação das reinternações e transferências nos registros que não identifiquem o paciente, em Portugal a identificação é limitada. Considerações Finais: Questões identificadas como críticas para a qualidade da informação do sistema de informações hospitalares brasileiro, décadas atrás, continuam impactando a informação do sistema atualmente. As portarias referentes à assistência hospitalar e ao SIH-SUS dizem respeito, em sua grande maioria, a modificações no mecanismo de reembolso; apenas um número bastante restrito destas, visa implementar melhorias na qualidade da informação do sistema. Os gestores do SIH-SUS no Ministério da Saúde necessitam compreender e valorizar as necessidades e problemas detectados pelos usuários do sistema, com atenção especial, aos problemas apontados pelos pesquisadores brasileiros, quando da implementação de modificações no sistema. É necessária também, uma aproximação dos sistemas de informações hospitalares internacionais, buscando conhecer como as questões críticas em nosso sistema foram equacionadas nestes sistemas, e como as soluções adotadas podem ser adaptadas a nossa realidade.
Objective: This study aims to compare the Hospital Information System of the Unified Health System (SIH-SUS) and hospital information systems in Spain and Portugal, with emphasis on the factors identified as limiting the quality and use of information produced by the SIH-SUS. Methods: The main methodological procedures used in this study were the Literature Review and Documentary Analysis. A Literature Review aimed to characterize Brazilian hospital information system and extraction the major limiting factors for the quality of Brazilian hospital information in national scientific articles. A Literature Review was also used for researching the international scientific literature for main characteristics of Spain and Portugal hospital information systems. The documentary analysis was adopted aiming to related main ordinances relating to the Brazilian hospital information system and complement the researching of Spain and Portugal hospital information systems. Results: We found 35 articles directly or indirectly related to SIH-SUS data quality. The limiting factors for the quality of Brazilian hospital information studied are related to the registration of medical records, quality of clinical information, system coverage, payment system influences, the underreporting of hospitalizations and the same patient identification of readmissions and transfers. The main findings were: (a) some limiting factors for the quality of information in Brazilian hospital information system are also in the international information systems, however, most of the problems identified here, has already been solved by these countries; (b) problems in the medical record registry exist in all three countries and they are related to lack of value of information and do not establish rules for its completion; (c) hospitals payment systems adopted by Brazil, Spain and Portugal are much similar. The biggest difference lies in the classification, in Brazil is adopted for the classification procedures and in Spain and Portugal, the classification of patients using DRG methodology; (d) SIH-SUS coverage is not universal, but is much more comprehensive than Spain and Portugal hospital information systems, covering hospital, domiciliary and day hospital regime in general and specialized hospitals and acute, chronic and psychiatric disorders. (E) it was not found information about underreporting in international hospital information systems. This happens in SIH-SUS mainly by the underreporting of all hospitalizations in the system for hospitals whose remuneration is not based on production of services, and the subsidy by the Secretarias de Saúde of admissions do not recorded by the system, due to limitations on the issuance of AIH or policies that direct or restrict the collection of certain procedures; (f) it is not possible to identify readmissions and transfers on the records that do not identify the patient in the Brazil and Spain hospital information systems. In Portugal hospital information system the identification is limited. Conclusion: Issues identified as critical to the quality of information from hospital information system in Brazil, decades ago, are still impacting the system information nowadays. Ordinances relating to hospital and the SIH-SUS are relate mostly to changes in the reimbursement mechanism, only a very restricted number of them, aimed to implement improvements in the quality of the information system. The managers of the SIH-SUS in the Ministry of Health thus need to understand and appreciate the needs and problems encountered by users of the system, with special attention to the problems posed by Brazilian researchers, upon implementation of system modifications. We also need an approximation to the international hospital information systems, trying to understand how the critical issues in our system were equated with those systems, and how the adopted solutions can be adapted to our reality.
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Delhumeau, Cécile. "Contribution à la modélisation des durées de séjour du CHU de Grenoble." Phd thesis, Université Joseph Fourier (Grenoble), 2002. http://tel.archives-ouvertes.fr/tel-00004392.
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Cette thèse propose une méthodologie permettant l'identification des groupes homogènes de malades (GHM) du Centre Hospitalier Universitaire (CHU) de Grenoble dont la durée de séjour (DS) s'écarte de la "référence nationale", mais aussi d'identifier la présence d'éventuels groupes d'"outliers" (patients avec des DS extrêmes) dans ces GHM. L'enjeu est de taille : des séjours longs entraînent une occupation des lits supérieure à ce que permet la valorisation financière correspondant à la pathologie prise en charge. Il est donc important de repérer ces GHM, responsables du coût élevé du point Indice Synthétique d'Activité (ISA), unité d'oeuvre des hôpitaux utilisée par le Programme de Médicalisation des Systèmes d'Information pour connaître leur activité, leur allouer le budget correspondant, et contraindre à une productivité optimale. Les écarts entre la distribution des DS des GHM grenoblois et celle de leurs homologues de la base nationale ont été comparés. Pour chaque GHM, un profil, fondé sur la comparaison des quartiles de DS des distributions nationales et grenobloises, deux à deux, a été construit. Des méthodes statistiques de classification (analyse en composantes principales, classification hiérarchique, analyse discriminante et modèles de mélange) ont été utilisées pour repérer aisément et sûrement les GHM économiquement coûteux. De manière empirique, les profils grenoblois semblent se structurer en 9 catégories. La classification hiérarchique identifie 4 catégories de GHM, dont une particulière comptant 16 GHM, dans laquelle un tiers des patients participe fortement à la dérive en points ISA du CHU, et pour qui la mise en place d'une action économiquement rentable serait aisée. Le modèle de mélange montre que les GHM se structurent en 3 catégories et permet de valider la classification issue de l'approche multidimensionnelle.
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Kraak, John R. "Drug packages for selected diagnosis related groups." 1992. http://catalog.hathitrust.org/api/volumes/oclc/25978845.html.
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Thesis (M.S.)--University of Wisconsin--Madison, 1992.Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaf 176).
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Chiang, Chia-Yu, and 江家瑜. "Does Diagnosis Related Groups-based Prospective Reimbursement System Work?" Thesis, 2013. http://ndltd.ncl.edu.tw/handle/59357900536444519882.
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博士國立臺北大學
會計學系
101
The main purpose of the dissertation is to investigates whether the Taiwan Diagnosis Related Group-based prospective reimbursement system (Tw-DRG) works in Taiwan. This study consists of two independent chapters. Chapter 1 examines whether the Tw-DRG scheme improved hospital performance in a private not-for-profit hospital in Taiwan. This study compares data from the case hospital concerning monthly financial data and related information for 26 departments from 2009 (before the implementation of the system, i.e., the pre-Tw-DRG period) with that from 2010 following the implementation of the system (the Tw-DRG period). This study employs a pre- and post-design with a comparison group study approach. The intervention group consists of departments where more than one case is reimbursed under the Tw-DRG policy and are classified as the Tw-DRG group; and the comparison group consists of departments that do not have any cases reimbursed under the policy and are classified as the non-Tw-DRG group. Departmental operating profitability and efficiency in the case hospital are used to measure hospital performance over the two aforementioned periods. The results find that in contrast to the non-Tw-DRG group, the performance of the Tw-DRG group in the case hospital deteriorated after the introduction of the Tw-DRG program. This study aims to contribute to a better understanding of the economic roles of the Tw-DRG policy. Documenting the relationship between the regulatory intervention and hospital performance has policy implications for health policy officials and healthcare organizations. The findings of this study might also be valuable for health policy officials and healthcare organizations in other countries who are considering the implementation of prospective reimbursement systems. In Chapter 2, this study examines the effects of a Physician fee (PF) program on a hospital’s performance before and after the implementation of the Tw-DRG scheme. I use a private not-for-profit hospital in Taiwan to investigate the research question. The data sample contains 624 monthly observations of the 26 departments in the case hospital for the period 2009-2010. Of the 26 departments, 18 have implemented the Tw-DRG reimbursement system and are classified as the Tw-DRG group; and the other 8 departments are classified as the non-Tw-DRG group. Since the introduction of the TW-DRG system, the physicians in both groups have been paid under the PF program. The pay-performance sensitivity measure is used to examine the relationship between hospital performance and physicians’ compensation before and after the implementation of the Tw-DRG system. The departments are classified according to their degree of Tw-DRG involvement, and the effects of the PF program on the hospital’s performance are assessed. Overall, the results show that the case hospital’s performance deteriorated after the implementation of the Tw-DRG system. The results imply that conflicts arise between departments that are under the Tw-DRG reimbursement scheme and those that have implemented the PF program. This study also provides evidence that physicians’ behavior affects their clinical performance, especially under a strict cost containment payment policy. Hence, health service researchers and healthcare providers should reexamine incentive mechanisms for physicians that work under similar payment policies.
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Huang, Chia-Hui, and 黃嘉蕙. "Diagnosis Related Groups, Catch-Up Effect and Health Expenditures." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/94929542882808963739.
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碩士淡江大學
產業經濟學系碩士班
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In the field of health economics, how to control for the growth of health expenditure is an important issue. Because of health expenditure continuing to increase during past thirty years in most OECD countries, governments have imposed heavy financial pressure, so how to control for the growth becomes the subject of efforts of many governments in OECD countries. Diagnostic Related Groups to limit the amount of health payments, forcing hospitals to control for their own health care costs. While DRGs payment system was implemented to suppress the health expenditure, catch-up effects, as mentioned in the literature, and the effects of DRGs payment system may conflict each other. The thesis hence also discusses whether the catch-up effects of health expenditure exist. It will examine whether countries with low initial health expenditure catch up with countries with higher initial health expenditure. This thesis mainly uses 2010 OECD Health Data., The data of 29 countries over the period from 1980 to 2008 were analyzed. It uses the 2SLS for panel model for the analysis of the impact of the implementation of DRGs system and the effect of initial health expenditure on the growth rate of health expenditures, including per-capita real total health expenditure, per-capita real public health expenditure and per-capita real private health expenditure while controlling for the GDP growth rate, growth rate of population aged 65 and above and growth rate of life expectancy at birth. It uses Laporte and Windmeijer’s (2005) model, which is capable of estimating the panel data model with binary explanatory variables in which treatment effect is not fixed, changing over time , through adding pulses variables to capture effects prior to and after the implementation of the DRGs system. This study finds that the implementation of diagnosis-related-groups system will make the growth rate of per-catipa real public health care spending be reduced in the second year after the implementation. Nonetheless, the DRGs payment system is not effectively in reducing growth rate of public health spending in the long-run. This thesis also finds that catch-up effect exists. It makes health expenditure grow for those countries with low initial public health expenditure. In consideration of both the DRGS effects and catch-up effects, it rationalizes the long-run growth of the majority of OECD countries.
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Munson, Mark Roger, and David Richard Whipple. "Diagnosis related groups for DOD: background of a competitive strategy." Thesis, 1987. http://hdl.handle.net/10945/22751.
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