Academic literature on the topic 'Insurance-based rehabilitation'

Stroke rehabilitation focuses on alleviating post-stroke disability. Post-acute care (PAC) offers an intensive rehabilitative program as transitional care following acute stroke. A novel home-based PAC program has been initiated in Taiwan since 2019. Our study aimed to compare the current inpatient PAC model with a novel home-based PAC model in cost-effectiveness and functional recovery for stroke patients in Taiwan. One hundred ninety-seven stroke patients eligible for the PAC program were divided into two different health interventional groups. One received rehabilitation during hospitalization, and the other received rehabilitation by therapists at home. To evaluate the health economics, we assessed the total medical expenditure on rehabilitation using the health system of Taiwan national health insurance and performed cost-effectiveness analyses using improvements of daily activity in stroke patients based on the Barthel index (BI). Total rehabilitative duration and functional recovery were also documented. The total rehabilitative cost was cheaper in the home-based PAC group (p < 0.001), and the cost-effectiveness is USD 152.474 ± USD 164.661 in the inpatient group, and USD 48.184 ± USD 35.018 in the home group (p < 0.001). Lesser rehabilitative hours per 1-point increase of BI score was noted in the home-PAC group with similar improvements in daily activities, life quality and nutrition in both groups. Home-based PAC is more cost-effective than inpatient PAC for stroke rehabilitation.

Work stress and burnout are common problems in rehabilitation services. Usually, attempts to account for stress and burnout focus on the qualities of the individual and the demands of the organisational environment. However, the current paper has responded to recent demands in the occupational stress literature to examine burnout from a third perspective, namely the institutional level. This level of analysis transcends the boundaries of organisations and can be defined by the various political, economic, social and legal constraints that characterise a broad area. It is argued that the rapid growth of insurance-based rehabilitation in Australia has created a unique institutional context that has significant implications for the development of stress and burnout among rehabilitation counsellors. Rehabilitation counsellors in this context face a diverse array of conflicting demands within a system that often does not support the goals of rehabilitation. It is proposed that the development of strategies to reduce stress and burnout in this area would benefit from an institutional-level analysis. While individualised stress management training clearly has a role in the minimisation of stress and burnout, it is proposed in the current paper that this issue has human resource management and educational implications that must be addressed.

Purpose Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting its use. Methods We conducted a retrospective cohort analysis of rehabilitation between 2013 and 2019 using the Korean National Health Insurance database. All patients aged 28 days to 18 years who had been admitted to 245 ICUs for more than 2 days were included. Neonatal ICUs were excluded. Results Of 13,276 patients, 2,447 (18%) received PT/OT-provided rehabilitation during their hospitalization; prevalence was lowest for patients younger than 3 years (11%). Neurologic patients were most likely to receive rehabilitation (adjusted odds ratio [aOR], 6.47; 95% confidence interval [CI], 5.11–8.20). Longer ICU stay (versus ≤ 1 week) was associated with rehabilitation (aOR for 1–2 weeks, 3.50 [95% CI, 3.04–4.03]; 2–3 weeks, 6.60 [95% CI, 5.45–8.00]; >3 weeks, 13.69 [95% CI, 11.46–16.35]). Mechanical ventilation >2 days (aOR, 0.78; 95% CI, 0.67–0.91) and hemodialysis (aOR, 0.50; 95% CI, 0.41–0.52) were negatively affecting factors. Conclusion Prevalence of rehabilitation for critically ill children was low and concentrated on patients with a prolonged ICU stay. The finding that mechanical ventilation, a risk factor for ICU-acquired weakness, was an obstacle to rehabilitation highlights the need for studies on early preventive rehabilitation based on individual patient needs.

BackgroundLimited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance.ObjectiveThis study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State.DesignThis was a retrospective descriptive study with a cross-sectional design.MethodsA cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses.ResultsPhysical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between.LimitationsThis study was based on commercial insurance claims data from one state.ConclusionsFindings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions.

Background In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. Objective We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states. Methods The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria. Results In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP. Conclusion Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.

This article presents a theoretical framework for vocational rehabilitation based on social systems theory. Social systems theory provides a unifying perspective for vocational rehabilitation both from a service delivery standpoint and from a professional development standpoint. Professional issues in the public and private sectors are addressed, including insurance specialist certification and ethical standards. It is proposed that social systems theory can supplant the strongly imbedded medical and psychological models at the metatheoretical level, while complementing the other models in the study of the individual.

ObjectiveTo evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I–II.DesignPragmatic randomised clinical trial with blinded outcome assessment.SettingMultidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada.Participants340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury.InterventionsParticipants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation.Primary and secondary outcome measuresOur primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury.ResultsThe median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported.ConclusionsTime-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.Trial registration numberNCT00546806.

The phenomenon of work stress is ubiquitous and has been the source of considerable attention over the past few decades. Work stress is a common problem in human services, particularly in the area of rehabilitation. The prevalence of this problem for rehabilitation has, however, been fuelled over the last two decades by the rapid growth of the insurance-based rehabilitation sector in Australia. The expansion of this sector has created a major market for rehabilitation practitioners. Using a qualitative research paradigm, the current study examined the insurance-based rehabilitation context in Australia. Specifically, this study explored the influence of this context on the experience of work stress for rehabilitation professionals. Although attempts to account for work stress usually focus on the qualities of the individual and organizational factors, the current study has responded to the call in occupational stress literature to examine this phenomenon at a broader, contextual level. Twenty-five rehabilitation professionals were asked to provide visual representations to illustrate their experience of the insurance-based rehabilitation work context. Interviews were conducted with each participant to elicit a more in-depth understanding of this experience. The findings revealed that the insurance-context appears to be characterized by inconsistency, chaos, confusion, and a strong focus on profit and cost effectiveness as depicted by the themes Maelstrom, Co-dependent Liaisons, Implosion of Responsibility, Legislative Pluralism, External Trumping and Greed. The deleterious influence of this context on rehabilitation professionals manifested in several ways as represented by the themes Impotence, Cynicism, Going Through the Motions, and Betrayal. A metaphor of a virus was used to provide a context for understanding how rehabilitation professionals were infected by the stressors inherent in the unhealthy contextual environment of the insurance sector. The results of this study have important implications for informing future policy, practice and research within the rehabilitation industry. Clearly, the health of the insurance sector needs to improve to ensure the well-being of rehabilitation professionals such as those who participated in this study. Improved health of this sector must include a greater respect for the profession of rehabilitation. Also crucial to the improved health of the sector is consistency in legislation and procedures that underpin rehabilitation. In addition, rehabilitation professionals must accept responsibility for enhancing their core competencies if they are to inoculate themselves against the harmful influence of the broader insurance context. Strategies to inoculate rehabilitation professionals against the infiltration of these contextual stressors must include an understanding of business administration and policy. Finally, the findings suggest that unless the health of the sector and the rehabilitation professionals improve, poor rehabilitation outcomes are likely to continue to plague the insurance industry and the experience of work stress and turnover among rehabilitation professionals will remain unacceptably high.

The phenomenon of work stress is ubiquitous and has been the source of considerable attention over the past few decades. Work stress is a common problem in human services, particularly in the area of rehabilitation. The prevalence of this problem for rehabilitation has, however, been fuelled over the last two decades by the rapid growth of the insurance-based rehabilitation sector in Australia. The expansion of this sector has created a major market for rehabilitation practitioners. Using a qualitative research paradigm, the current study examined the insurance-based rehabilitation context in Australia. Specifically, this study explored the influence of this context on the experience of work stress for rehabilitation professionals. Although attempts to account for work stress usually focus on the qualities of the individual and organizational factors, the current study has responded to the call in occupational stress literature to examine this phenomenon at a broader, contextual level. Twenty-five rehabilitation professionals were asked to provide visual representations to illustrate their experience of the insurance-based rehabilitation work context. Interviews were conducted with each participant to elicit a more in-depth understanding of this experience. The findings revealed that the insurance-context appears to be characterized by inconsistency, chaos, confusion, and a strong focus on profit and cost effectiveness as depicted by the themes Maelstrom, Co-dependent Liaisons, Implosion of Responsibility, Legislative Pluralism, External Trumping and Greed. The deleterious influence of this context on rehabilitation professionals manifested in several ways as represented by the themes Impotence, Cynicism, Going Through the Motions, and Betrayal. A metaphor of a virus was used to provide a context for understanding how rehabilitation professionals were infected by the stressors inherent in the unhealthy contextual environment of the insurance sector. The results of this study have important implications for informing future policy, practice and research within the rehabilitation industry. Clearly, the health of the insurance sector needs to improve to ensure the well-being of rehabilitation professionals such as those who participated in this study. Improved health of this sector must include a greater respect for the profession of rehabilitation. Also crucial to the improved health of the sector is consistency in legislation and procedures that underpin rehabilitation. In addition, rehabilitation professionals must accept responsibility for enhancing their core competencies if they are to inoculate themselves against the harmful influence of the broader insurance context. Strategies to inoculate rehabilitation professionals against the infiltration of these contextual stressors must include an understanding of business administration and policy. Finally, the findings suggest that unless the health of the sector and the rehabilitation professionals improve, poor rehabilitation outcomes are likely to continue to plague the insurance industry and the experience of work stress and turnover among rehabilitation professionals will remain unacceptably high.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services
Full Text

碩士
國立陽明大學
物理治療暨輔助科技學系
107
Background: Hip fracture represents a worldwide challenge in geriatric health care, because it would lead to functional decline and disability. However, previous studies mostly recruited the subjects from a single or a few medical institutions, rather than through a representative national database. Furthermore, to our best knowledge, no study investigated the complete rehabilitation course encompassing both inpatient and outpatient rehabilitation phases for the elderly patients with hip fracture surgery. It is necessary to conduct a study to explore the effect of rehabilitation on 3-Year readmission and mortality risk in elderly patients with hip fracture surgery through the national health database. This purposes of this were 1) to explore the utilization of rehabilitation in elderly patients with hip fracture surgery in Taiwan; 2) to explore the effect of rehabilitation on 3-year readmission or mortality (Event 1, E1) as well as mortality (Event 2, E2) risk in elderly patients with hip fracture surgery; 3) to explore the subgroups effects in terms of sex, surgery type, age, length of stay, and comorbidity (CCI); 4) to conduct a classification analysis for readmission causes. Methods : This study utilized the Longitudinal Health Insurance Database of one-million beneficiaries to investigate the relationship between rehabilitation and 3-year readmission and mortality risk in elderly patients with first-ever hip fracture surgery. The rehabilitation included 3 models: model 1 - whether received rehabilitation or not (yes/no), model 2 (pathway): none/ inpatient only/ outpatient only/ both inpatient and outpatient rehabilitation, and model 3 (times): none/1-3 times/ over 4 times. The study participants were confined to 4,522 patients aged 65 or above who admitted to the hospital due to hip fracture and received surgery between January 2001 and December 2008. Among those patients, 1,947 (43.1%) patients received rehabilitation (including inpatient and/or outpatient rehabilitation) while the other 2,575 (56.9%) patients didn’t. Each patient was followed up for 3 years. Chi-square test and one-way ANOVA were used to compare baseline characteristics between rehabilitation group and non-rehabilitation group. Multivariate Cox-proportional hazards regression models with adjustment for age group, sex, whether osteoporosis, surgery type, initial length of stay, comorbidity (CCI), and hospital characteristics were conducted to investigate the effects of rehabilitation on the risks of readmission or mortality (Event 1, E1)/ mortality (Event2, E2) during the follow-up period. Results: Among 1,947 patients who received rehabilitation, 1,496(76.8%) patients received inpatient rehabilitation, 752(38.6%) patients received outpatient rehabilitation, while 274 patients received both inpatient and outpatient rehabilitation. The majority (98.8%) of those who received rehabilitation got the treatment by physical therapists. Relevant to patients without rehabilitation, patients receiving rehabilitation had a lower risk of 3-year mortality (E2) (Hazard ratio, HR=.76; 95% CI=.66–0.88); with model 2 and model 3 revealed the same trend (HR=.63-.83, 95% CI=.49-.97). Particularly, “received both inpatient and outpatient rehabilitation” or ”rehabilitation of 4 times and above” could lower the E2 more effectively (HR=.63-.64, 95% CI=.46-.89). In contrast, no significant effect of rehabilitation on the 3-year “readmission or mortality” (E1) risk was found except for the increased risk with mode of “inpatient rehabilitation only” (HR=1.25, 95% CI=1.12-1.40). Subgroups analyses revealed that rehabilitation was beneficial to lower the 3-year mortality risk for most subgroups, especially in patients receiving operative internal fixation, aged 70 years or above, male, or patients with comorbidity. Discussion and Conclusions: This study demonstrated that the use of rehabilitation was associated with reduction of 3-year mortality risk (E2), and a dose-response relationship was found given the larger effect for mode of “receiving both inpatient and outpatient rehabilitation” and “rehabilitation of 4 times or above”. On the contrary, we found that received “only outpatient rehabilitation” was associated with increased 3-year “readmission or mortality” risk (E1). It was speculated that those patients who sought for rehabilitation intervention after discharge tended to have poor functional recovery which might inevitably increase their risks of subsequent “readmission or mortality”. Further study is anticipated to confirm the findings and explore the underlying reasons. We suggest that orthopedists should routinely refer their patients for rehabilitation intervention during acute hospitalization period, and continue to receive outpatient rehabilitation if necessary to ensure a better outcome. As a secondary data analysis from a medical claims database, the “patient selection bias” resulted from the non-randomized assignment of treatments and missing of some important covariates in the Cox-regression models were unavoidable. It is anticipated to incorporate the database from “Post-acute Care Plan” and “Long-term Care Plan 2.0” to examine the effect of rehabilitation and different models of rehabilitation on elderly patients with hip fracture surgery more thoroughly in the future.

In Germany, inpatient therapy for depression mainly takes place in either health insurance-financed psychiatric hospitals, or in pension insurance-financed, psychotherapy-focused, psychosomatic rehabilitation hospitals. In psychiatric hospitals, the diagnosis is made according to the International Classification of Diseases (ICD), and therapeutic attempts are made to achieve remission, whereas in rehabilitation hospitals, the International Classification of Functioning, Disability and Health (ICF) plays an essential diagnostic role. Accordingly, the main German pension insurance, Deutsche Rentenversicherung, has developed a rehabilitation therapy standard for depressive disorders. In this chapter, we focus on the psychotherapeutic inpatient rehabilitation for patients with depression based on an example of a specialized psychotherapeutic hospital. This example illustrates how psychotherapeutic inpatient rehabilitation can be tailored to the individual’s needs and may include any of the following therapeutic modalities: Cognitive Behavior Therapy (CBT), Schema Therapy, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), pharmacotherapy, group therapy for comorbid conditions, skills training, psychoeducation, occupational therapy (OT), movement therapy, physiotherapy, music therapy, social work, family work, and self-help groups. People with depression may benefit from this service model of psychosomatic inpatient rehabilitation beyond symptom remission, as it focuses on increasing people’s functional level as well as their quality of life.

The purpose defines health insurance as a form of social protection in the field of health care, which provides guarantees of medical care in case of loss of health for any reason, including in connection with illness or accident. There is a mechanism for providing health insurance through the formation of personal insurance funds designed to finance medical care under insurance programs. The directions of improvement of legislative regulation of health insurance are offered. The peculiarities of the formation of health insurance programs by insurance companies, ensuring effective cooperation with medical institutions are determined. Theoretical bases of medical insurance, study by domestic scientists, problems of introduction of medical insurance and prospects of introduction and development of medical insurance in Ukraine are covered. Results. Ukraine remains united a post-Soviet country where compulsory health insurance for all citizens has not been introduced. On the law why the order of formation and distribution of health insurance funds, mechanisms of cooperation is not fixed state and insurance companies in the field of insurance medicine. The above issues need further research and proposals for the development of health insurance in Ukraine in order to effectively ensure the financing of medicine and protection of citizens’ rights health care. The solution is especially important problems of health insurance in the process of health care reform. Value/originality. Compulsory health insurance can be provided by the implementation of insurance companies that have a license for such insurance. It should be noted that in many countries around the world, such services are provided, in particular, to certain categories of the population, and priority, expensive programs. A prerequisite for this insurance is the creation of preferential tax terms for insurance companies, guarantees of fulfillment of their obligations under compulsory health insurance. The next way is to form a fund of compulsory health insurance based on contributions from employers, workers and the state. The formation of such a fund is based on the interest of employers in the health of employees, as the main element of the production process. Objective necessity of formation of such fund also due to the provision of social funding th health insurance. Social health insurance provides to meet the needs of citizens in medical services, regardless of purchasing power. And for children, students, people of retirement age contributions will be paid by the state. To optimally determine the tax burden for employers and citizens, compulsory health insurance programs should include only basic medical services, especially outpatient treatment and hospital stay. The list of basic services in the development of health insurance programs should be includes the provision of basic drugs, ancillary medicines, providing medical rehabilitation in cases of severe illness or disability, special early diagnosis and disease prevention services.

A prototype of a pneumatic device for rehabilitation of the hand was designed, built and tested. Progressive impairment of hand function may result from a prolonged condition of hemiparesis, such as resulting from stroke. Reduced daily use of the affected limb, spasticity and contracture contribute to progressive impairment. Physical therapy attenuates the impairment in many patients, but regular sessions of physical therapy are difficult to maintain due to the associated costs, limited insurance coverage, and necessity of being at the clinic for each session. Systems or devices suitable for home-based therapy sessions would widen the accessibility of physical therapy to more patients. However, reported therapeutic systems appear to be expensive, heavy and complicated, thus limiting their suitability for widespread application in home settings. Recent reports of pneumatic based hand therapy systems suggest a platform for hand rehabilitation that would be simpler, lighter, less expensive, and have a lower risk of safety concerns. The design utilized in this project has the affected hand encased in a glove apparatus that has an embedded air bladder positioned ventral to each of the five digits on the palmer side of the hand, such that the bladder acts to assist extension of each finger and thumb as internal air pressure increases. Several alternative designs of glove-bladder combinations were designed, fabricated and tested. An electro-pneumatic regulator (SMC Corp. of America, Noblesville, IN) controlled the pressure of air to the bladders from an air compressor. The pneumatic regulator was controlled by a custom designed and assembled microcontroller (Arduino, open source) based control system. The microcontroller controlled solenoids that functioned as valves for the passage of air to the bladders from the pneumatic regulator, one solenoid for each of the 5 bladders in a glove. Tests were done to compare alternative glove-bladder designs. For a bladder corresponding to one digit, the relations between air pressure and the resulting torque were explored using a system of weights. Moreover, for constant pressure levels, the relations between angle of a digit and torque were explored. The pneumatic hand rehabilitation system developed in this project shows promise toward development of pneumatic hand therapy systems that would be suitable for home-based therapy.