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At least 1,531 records · Page 85Linked to original sources
PubMed1995

[Overview, analysis and evaluation of the 1995 public health structural law and the federal social care law from the viewpoint of the trauma surgery department of a university clinic. Measures for preparation of a new reimbursement system and documentation requirements].

All doctors in Germany are required to cooperate in the implementation of the health system reform and the new system for reimbursement of the hospitals to limit the negative consequences to the patients. It would be absolutely wrong to leave the medical services of the insurance companies to define the diagnosis-related groups and determine the charges. The revision of the health system is beneficial in that it supports the economical independence of hospital departments. It is a good idea for them to be paid by results; however, there are no established methods of measuring results or efficacy in medicine. Germany is about 10 years behind the USA in this, so that our country is not yet ready for this reform. Hospital departments do have the freedom to make economic decisions, being heavily dependent on the insurances and the government, because most people who work in hospital are paid from these sources. Departments of trauma or orthopaedic surgery are disadvantaged by the reform, because of the number and kind of diagnosis related groups and the method of reimbursement. This leads to a profit-oriented system of medical documentation, with possible upcoding of diagnoses in future. The present health reform most probably will not increase the efficiency of hospitals; it will not be possible to attain cost reductions with the same level of medical care. The reduced reimbursement will force doctors to cut down their expenses and restrict diagnostic and therapeutic procedures. On the other hand the administration sector in hospitals and insurances will expand dramatically in future.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed2001

Direct costs-of-illness of patients with diabetes mellitus in Taiwan.

The purpose of the present study was to examine the characteristics of healthcare costs for diabetic patients in Taiwan. The study analyzed claim data from the Bureau of National Health Insurance for the period from July 1997 to June 1998. There were 536159 documented diabetic patients who were treated within the universal healthcare system in Taiwan during this study period. The annual number of visits of these diabetic patients was 6.2% of the total outpatient visits of all patients due to all causes during the one-year study period. Diabetes-related problems were the causes of 25.2% of outpatient visits among diabetic patients, while 74.8% of visits were for causes unrelated to diabetes. The distribution of treatment for the diabetic patients was by oral hypoglycemic agents 88.3%, insulin only 6.9%, and a combination of insulin and oral agents 4.8%. Diabetic patients accounted for 4,724,711 hospital inpatient days during the study period, which was 22.1% of the total inpatient days in Taiwan. Of the inpatient admissions, 13.9% were for diabetes as the principal cause, 23.4% were for diabetes-related disease, and 62.7% were for causes unrelated to diabetes. The direct costs of healthcare for the documented diabetic patients was 11.5% of the total costs of healthcare in Taiwan, and was 4.3 times higher than the average costs of care for non-diabetic individuals.

Ambulatory Care↗
PubMed1993

The history and principles of managed competition.

Managed competition in health care is an idea that has evolved over two decades of research and refinement. It is defined as a purchasing strategy to obtain maximum value for consumers and employers, using rules for competition derived from microeconomic principles. A sponsor (either an employer, a governmental entity, or a purchasing cooperative), acting on behalf of a large group of subscribers, structures and adjusts the market to overcome attempts by insurers to avoid price competition. The sponsor establishes rules of equity, selects participating plans, manages the enrollment process, creates price-elastic demand, and manages risk selection. Managed competition is based on comprehensive care organizations that integrate financing and delivery. Prospects for its success are based on the success and potential of a number of high-quality, cost-effective, organized systems of care already in existence, especially prepaid group practices. As it is outlined here, managed competition as a means to reform the U.S. health care system is compatible with Americans' preferences for pluralism, individual choice and responsibility, and universal coverage.

Competitive Medical Plans↗
PubMed1989

Human immunodeficiency virus infection in emergency department patients. Epidemiology, clinical presentations, and risk to health care workers: the Johns Hopkins experience.

In a study to assess the impact of the human immunodeficiency virus epidemic on The Johns Hopkins Hospital Emergency Department, we found 152 (6.0%) of 2544 consecutive patients to have human immunodeficiency virus infection, an absolute increase of 0.8% from the previous year. Of the 57 patients with a known history of infection, 49.1% had no insurance vs 36.0% of seronegative patients. Infected patients were three times more likely to be admitted as seronegative patients. Overall, health providers followed universal precautions during 44.0% of interventions. In patients with profuse bleeding, adherence fell to 19.5%. The most common reasons given by providers for not following precautions were insufficient time to put on protective attire and interference with procedural skills. We conclude that the human immunodeficiency virus epidemic has a major impact on emergency services and that strategies need to be developed for appropriate use of emergency resources and also for maximizing provider protection.

Adolescent↗
PubMed1970

CMA's proposal for a voluntary, universally available Health Benefits Program. A socio-economic report of the Bureau of Research and Planning, California Medical Association.

The May 4, 1970 issue of the American Medical News contains an article on a report released in April by the British Medical Association following a two-year study of the British National Health Service. Although the BMA study is oriented to the specific program as it has evolved in Great Britain since 1946, its main thrust is in the development of a system of voluntary health insurance which would provide for greater consumer choice, based upon nationally determined guidelines and regulations. BMA's recommendations would have the NHS utilize a combination of tax-supported and voluntary-supported mechanisms in providing medical services to various segments of the population, based upon categories of illness and income levels. Since the BMA proposal as reported in the AMA News parallels in some respects the one approved by the CMA House of Delegates and submitted to the AMA House of Delegates for its consideration, the reader will be interested in seeing the concept for a Voluntary Universally Available Health Benefits Program, independently developed by the California Medical Association. It is interesting to note that the CMA proposal attempts to avoid many of the problems with which the NHS has been identified, and at the same time would establish a single, coherent, integrated approach for development over the next decade, incorporating public programs into a unified system of medical care which utilizes the multiplicity of voluntary health insurance approaches and mechanisms.

California↗
PubMed1990

Medically uninsured children in the United States: a challenge to public policy.

This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."

Adolescent↗
PubMedDate not supplied

Trend analysis of surgery revenues at Osaka University Hospital.

To identify medical and administrative revenue trends at a surgical center, for use in strategic planning, an off-line data processing system utilizing coding sheets was developed. Data on 66,402 surgical procedures performed at the Osaka University Hospital Surgical Center between 1966 and 1981 were processed to study trends in revenues. Trend analysis shows that (a) revenues at the surgical center have been increasing year by year; (b) technical charges, such as operation and anesthesia fees, have increased with each revision of the medical remuneration system of Japanese government health insurance; and (c) the length of time patients stay in the operating room has gradually increased.

Computers↗
PubMed1998

Access to health information and support: a public highway or a private road?

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information "haves" and "have-nots." This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes.

Delivery of Health Care↗
PubMed2005

Third party purchasing of health services: patient choice and agency.

Health care provision is almost universally characterised by third party purchasing in which the provider of health services is reimbursed by an agency (public or private insurer), rather than the patient. We show how a purchaser can manage the incentives that patient choice gives rise to by its own choice of monitoring arrangement. Even though patients are ignorant about their exact medical conditions and insulated from the costs of health care, they can help alleviate incentive problems due to asymmetric information through the choices that they make about whether to be treated. We show that if patients are responsive to variations in treatment, it can be worthwhile to base payment on the health outcome achieved rather than upon the treatment delivered. Outcomes-based payments may also be preferable where services are supplied by not-for-profit agencies who are intrinsically concerned with patient welfare.

Choice Behavior↗
PubMed2006

Impact of bariatric surgery on cardiovascular and musculoskeletal morbidity.

BACKGROUND: Obesity is currently recognized as a global epidemic. According to recent statistics, the prevalence of obesity increased from 13.8% of the Canadian population in 1978-1979 to 23.1% in 2004, and the prevalence of morbid obesity increased from .9% in 1978-1979 to 2.7% in 2004. Obesity is a known risk factor for highly prevalent chronic diseases, including cardiovascular and musculoskeletal disorders. The objective of the study was to assess the impact of bariatric surgery on cardiovascular and musculoskeletal morbidity. METHODS: This was an observational study that compared a cohort of 1035 morbidly obese patients treated with bariatric surgery at the Centre for Bariatric Surgery, McGill University Health Centre with a matched cohort of 5746 morbidly obese nonsurgically treated controls. Data were obtained from the Quebec provincial health insurance database (Régie de l'Assurance Maladie du Québec). Morbidity indicators included diagnoses or treatment for cardiovascular or musculoskeletal disorders. RESULTS: Patients who underwent bariatric surgery had a significant 62% mean reduction in excess weight and 32% mean reduction in body mass index (P < .001). Compared with the matched controls, patients who had undergone bariatric surgery had significantly lower rates of diagnoses and treatments related to cardiovascular and musculoskeletal conditions. CONCLUSIONS: These results indicate that bariatric surgery is effective in reducing weight and significantly reduces the risk of cardiovascular and musculoskeletal morbidity.

Bariatric Surgery↗
PubMed2005

[Immigration of dentists and its effects on the dental profession in Hungary].

There were a very remarkable ethnic and demographic shift in the social composition of dental health care providers in Hungary after the collapse of the old regime in 1989. Hungary is surrounded by states with large ethnic Hungarian minorities blocked in their free migration up to the late 1980's. Although the non-educated members of the Hungarian diaspora did not leave these areas in mass numbers, a great number of highly educated people (among them preeminently health care professionals) moved to the mother state mainly for economic reasons. Dentistry comparing to other medical professions has a special financial advantage because of the considerable share of private financing in the Hungarian dental business. Unfortunately, no statistical analysis was made on the impact of this professional migration in the last 15 years. The present article based on a cross-sectional survey conducted at the end of 2004 demonstrates the proportion of immigrants (mean 7.81 %) among the total number of dental health care providers (5670 to a 10.2 million population) There are 2764 area bounded solo practices contracted to the National Health Insurance (NHI), the other 2907 professionals are engaged in the free market business, and/or they are public employees of the universities with dental faculty as well. As expected, the share of immigrants is higher in NHI-practices, but it varies in a wide range (1.9 - 23.6%) amidst the different counties (19 units plus the capital). Nevertheless, the immigrants may also participate in the free market segment of the dentistry. The variations can be explained by geographic, internal migrational and local economic reasons.

Adult↗
PubMed2003

The ongoing debate over Medicare: understanding the philosophical and policy divides.

This Article examines the evolution and status of Medicare, as well as the myriad current efforts to reform this longstanding entitlement. The author analyzes why healthcare financing for the elderly follows an administered pricing, fee-for-service model, while the working population generally obtains its insurance under a competitive market model. As a non-means-tested program modeled after Social Security, Medicare embraces both a universal entitlement philosophy of government-provided basic health services, and a need-based entitlement philosophy of caring for the Medicare-eligible elderly.

Aged↗
PubMed2000

A preliminary study on the knowledge and attitudes of physicians at two university hospitals towards the medical insurance system of Japan.

In this preliminary study, we surveyed the physicians at two academic hospitals on their knowledge of and attitudes toward the medical insurance system in Japan. Most of the physicians had not read the "Ministerial Ordinance on Insurance Medical Institutions' and Insurance Medical Doctors' Medical Treatment under Health Insurance." Of the 433 physicians who filled out the questionnaire completely, 34% had either not read or rarely read the "Medical Fee Point List." Most (89.1%) of the physicians knew that there is a stepwise reduction in the hospitalization fee as the length of a patient's hospital stay increases. However, approximately 30% did not know the stipulation of obtaining an informed consent from the patient prior to blood transfusion. As for the right of patients to see their medical care remuneration statements, which was decided by the government in 1997, 26.8% of the physicians did not know this rule. Physicians who had read the "Ministerial Ordinance on Medical Treatment," were more likely to read the "Medical Fee Point List" frequently; were more likely to know the stipulation about diminishing hospitalization fee; were more likely to know that an informed consent must be obtained prior to blood transfusion; and were more likely to know that patients had a right to see their medical care remuneration statements. The longer the clinical experience of the physician, the more likely that the physician had read the "Ministerial Ordinance on Medical Treatment" and know the other stipulations well. In these two academic hospitals, it is important to establish educational seminars for physicians on the guidelines of the medical insurance system so that physicians will become familiar with the medical insurance system quickly.

Attitude of Health Personnel↗