Time is money: general practitioners' reflections on the fee-for-service system.

BACKGROUND: Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs' reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions. METHODS: We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis. RESULTS: We identified three main themes related to GPs' reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs' decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees. CONCLUSIONS: GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs' gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments.

A Groundbreaking Insight Into Primary Care Physiotherapists' Remuneration.

Introduction Physiotherapy in Greece, as part of primary health care (PHC), faces sound imbalances: reduced quality, productivity, and efficiency, along with rather inflexible remuneration schemes. This study is aimed at reporting the attitude and perceptions of Greek PHC physiotherapists toward their current remuneration and also at identifying any other preferable remuneration schemes. Methods A stratified proportional sampling study was undertaken, using an anonymous, electronic survey. The participants were 250 self-employed physiotherapists running their business in Central and Eastern Macedonia and Thrace, being also contracted with the National Organisation for Healthcare Provision (EOPYY). The sample size stands for 34% of the population with a circa 5% margin of error. Results Nearly 9/10 physiotherapists (84%) underline that remuneration falls short of their productivity, leading to reduced job satisfaction. Moreover, their remuneration does not motivate them to provide services of higher quality (46%), while 58% of them stated that they are forced to claim informal fees. There is no clear desire regarding the remuneration scheme, but nearly » of physiotherapists revealed their preference for the cost-per-case philosophy combined with co-payments. Conclusion The majority of physiotherapists believe that their current remuneration does not reflect their productivity nor the quality of their services and, therefore, informal payments arise. The preference of physiotherapists lies between cost-per-case fees and patient co-payments, which, however, favors supplier-induced demand and access inequalities, respectively. Hence, policymakers should revise the current remuneration scheme and overcome its deficiencies without creating new ones.

Self-care in New Zealand: The role of the community pharmacy.

Self-care is a growing area in community pharmacy globally. In a time where people are taking control over their own health care, the question of the degree of self-care available from community pharmacies is pertinent. New Zealand is a country that has publicly funded healthcare; with over 1000 community pharmacies catering to a population of 5 million people. Despite the availability and accessibility of community pharmacies, much remains unknown about how self-care is offered in community pharmacies and the extent to which it is provided. In addition to this lack of clarity, is the current period of reorganisation occurring in the New Zealand healthcare system. The current changes involve dis-establishing district health boards (DHBs) and unifying the New Zealand health system into one streamlined system. It leads us to question whether this move will change funding allocations and health priorities as well as how they affect service provision in community pharmacy. While research has shown that New Zealand is paving the way in medicines reclassification making medicines more accessible, other research shows a fragmentation exists in services provided by community pharmacies in the area of self-care. This article will highlight what is currently known about self-care in New Zealand, the gaps that exist and the current challenges in this area.

Health expenditure: how much is spent on health and care worker remuneration? An analysis of 33 low- and middle-income African countries.

OBJECTIVES: To assess the amount spent on health and care workforce (HCW) remuneration in the African countries, its importance as a proportion of country expenditure on health, and government involvement as a funding source. METHODS: Calculations are based on country-produced disaggregated health accounts data from 33 low- and middle-income African countries, disaggregated wherever possible by income and subregional economic group. RESULTS: Per capita expenditure HCW remuneration averaged US$ 38, or 29% of country health expenditure, mainly coming from domestic public sources (three-fifths). Comparable were the contributions from domestic private sources and external aid, measured at around one-fifth each-23% and 17%, respectively. Spending on HCW remuneration was uneven across the 33 countries, spanning from US$ 3 per capita in Burundi to US$ 295 in South Africa. West African countries, particularly members of the West African Economic and Monetary Union (WAEMU), were lower spenders than countries in the Southern African Development Community (SADC), both in terms of the share of country health expenditure and in terms of government efforts/participation. By income group, HCW remuneration accounted for a quarter of country health expenditure in low-income countries, compared to a third in middle-income countries. Furthermore, an average 55% of government health expenditure is spent on HCW remuneration, across all countries. It was not possible to assess the impact of fragile and vulnerable countries, nor could we draw statistics by type of health occupation. CONCLUSIONS: The results clearly show that the remuneration of the health and care workforce is an important part of government health spending, with half (55%) of government health spending on average devoted to it. Comparing HCW expenditure components allows for identifying stable sources, volatile sources, and their effects on HCW investments over time. Such stocktaking is important, so that countries, WHO, and other relevant agencies can inform necessary policy changes.

Global landscape of community pharmacy services remuneration: a narrative synthesis of the literature.

Community pharmacists form a vital part of the health system all around the globe. Pharmacy remuneration models are aimed to ensure that pharmacies are sustained, and pharmacists could provide cost-effective services to the patients. This review summarizes the pharmacy services remuneration systems from different parts of the globe. Some countries have well-established reimbursement systems that recognize and compensate community pharmacies for their services, others are in the process of expanding the scope of reimbursable services. It further concludes by highlighting the ongoing efforts to incorporate pharmacist-provided services into reimbursement schemes and the need for standardized and consistent approaches to pharmacy remuneration globally.

The impact of funding models on the integration of Ontario midwives: a qualitative study.

BACKGROUND: Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada's largest province, Ontario. Funding models have been identified as one of the main barriers. METHODS: Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal 'integration' as circumstances in which midwives' knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. RESULTS: We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives' scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. CONCLUSIONS: Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.

Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn? / Desempenho e condições de trabalho dos fisioterapeutas nas unidades de terapia intensiva brasileiras durante a pandemia da COVID-19. O que aprendemos?

ABSTRACT Objective: To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration. Methods: An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units. Results: A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment. Conclusion: Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.

RESUMO Objetivo: Descrever o papel dos fisioterapeutas na assistência a pacientes com suspeita ou diagnóstico da COVID-19 internados em unidades de terapia intensiva no Brasil em relação a: formação técnica, tempo de trabalho, prática assistencial, condições de trabalho e remuneração. Métodos: Foi realizado um inquérito transversal analítico com questionário eletrônico distribuído aos fisioterapeutas que atuavam no atendimento de pacientes com COVID-19 em unidades de terapia intensiva brasileiras. Resultados: Foram preenchidos 657 questionários por fisioterapeutas das cinco regiões do país, sendo que 85,3% trabalhavam em unidades de terapia intensiva adulto, 5,4% em neonatal, 5,3% em pediátrica e 3,8% em unidades de terapia intensiva mista (pediátrica e neonatal). Nas unidades de terapia intensiva com um fisioterapeuta disponível 24 horas por dia, os fisioterapeutas trabalharam com mais frequência (90,6%) na montagem, titulação e monitoramento da ventilação não invasiva (p = 0,001). A maioria das UTIs com fisioterapia 12 horas por dia (25,8%) não aplicou nenhum protocolo comparativamente às unidades de terapia intensiva com fisioterapia 18 horas por dia (9,9%) e às de 24 horas por dia (10,2%) (p = 0,032). A maioria dos entrevistados (51,0%) recebia remuneração de duas a três vezes o salário mínimo, e apenas 25,1% recebiam pagamento adicional por trabalhar com pacientes com suspeita ou diagnóstico da COVID-19; 85,7% deles não enfrentaram falta de Equipamentos de Proteção Individual. Conclusão: As unidades de terapia intensiva com fisioterapeutas 24 horas por dia apresentaram maiores porcentagens de protocolos e ventilação não invasiva para pacientes com COVID-19. A utilização de recursos específicos variou entre os tipos de unidades de terapia intensiva e hospitais e em relação às condições de trabalho dos fisioterapeutas. Este estudo mostrou que a maioria dos profissionais tinha pouca experiência em terapia intensiva e baixa remuneração.

Emergency Physicians' Experience-Remuneration (E-R) Mismatch: A Canadian Healthcare Irony.

Conventional wisdom suggests that in almost every profession, the most experienced and educated employees are remunerated at a higher rate than the less experienced ones. For example, new-graduate hires most commonly start at the bottom of the pay scale. No profession could reflect the importance of experience and the need for mastery of skills more than emergency medicine (EM), where a split-second decision could mean the difference between life and death. In Canada, however, EM physicians are remunerated as per a common pay scale that does not consider the length of their education, training, or years of practice. Such an unfair experience-remuneration mismatch (E-R mismatch) could lead to job dissatisfaction, burnout, and switching to other specialties. Given the current EM physician shortage in Canada, the E-R mismatch among such physicians could negatively impact patient care and the health system as a whole and prolong the already long wait times. The aim of this editorial is to shed light on this flaw in the Canadian healthcare system and lead to change toward a fair pay system. The creation of a professional and experience-based hierarchy among Canadian EM physicians should be considered a matter of urgency for those developing health-related legislation.

[Initiative for a shift from inpatient to outpatient treatment]. / Ambulantisierung.

A shift from inpatient to outpatient treatment is necessary to offset the severe lack of nursing staff in Germany. A central role is played by the catalogue announced for outpatient surgical procedures, which will contain many formerly inpatient procedures. Context factors have been defined to make the decision for inpatient treatment more reproducible. In the end, the remuneration of outpatient procedures will decide whether the infrastructural changes will be successful in daily practice.

Identifying the Most Effective Recruitment Strategy Using Financial Reimbursements for a Web-Based Peer Network Study With Young People Aged 16-18 Years: Protocol for a Randomized Controlled Trial.

BACKGROUND: Peers are an important determinant of health and well-being during late adolescence; however, there is limited quantitative research examining peer influence. Previous peer network research with adolescents faced methodological limitations and difficulties recruiting young people. OBJECTIVE: This study aims to determine whether a web-based peer network survey is effective at recruiting adolescent peer networks by comparing 2 strategies for reimbursement. METHODS: This study will use a 2-group randomized trial design to test the effectiveness of reimbursements for peer referral in a web-based cross-sectional peer network survey. Young people aged 16-18 years recruited through Instagram, Snapchat, and a survey panel will be randomized to receive either scaled group reimbursement (the experimental group) or fixed individual reimbursement (the control group). All participants will receive a reimbursement of Aus $5 (US $3.70) for their own survey completion. In the experimental group (scaled group reimbursement), all participants within a peer network will receive an additional Aus $5 (US $3.70) voucher for each referred participant who completes the study, up to a maximum total value of Aus $30 (US $22.20) per participant. In the control group (fixed individual reimbursement), participants will only be reimbursed for their own survey completion. Participants' peer networks are assessed during the survey by asking about their close friends. A unique survey link will be generated to share with the participant's nominated friends for the recruitment of secondary participants. Outcomes are the proportion of a participant's peer network and the number of referred peers who complete the survey. The required sample size is 306 primary participants. Using a multilevel logistic regression model, we will assess the effect of the reimbursement intervention on the proportion of primary participants' close friends who complete the survey. The secondary aim is to determine participant characteristics that are associated with successfully recruiting close friends. Young people aged 16-18 years were involved in the development of the study design through focus groups and interviews (n=26). RESULTS: Participant recruitment commenced in 2022. CONCLUSIONS: A longitudinal web-based social network study could provide important data on how social networks and their influence change over time. This trial aims to determine whether scaled group reimbursement can increase the number of peers referred. The outcomes of this trial will improve the recruitment of young people to web-based network studies of sensitive health issues. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44813.

Increasing capitation in mixed remuneration schemes: Effects on service provision and process quality of care.

Many health systems apply mixed remuneration schemes for general practitioners, but little is known about the effects on service provision of changing the relative mix of fee for services and capitation. We apply difference-in-differences analyses to evaluate a reform that effectively reversed the mix between fee for services and capitation from 80/20 to 20/80 for patients with type 2 diabetes. Our results show reductions in provision of both the contact services that became capitated and in other non-capitated (still-billable) services. Reduced provision also occurred for guideline-recommended process quality services. We find that the effects are mainly driven by patients with co-morbidities and by general practitioners with high income, relatively many diabetes patients, and solo practitioners. Thus, increasing capitation in a mixed remuneration schemes appears to reduce service provision for patients with type 2 diabetes monitored in general practice with a risk of unwanted quality effects.

What do pharmacy users think of free pharmacy services? Investigating pharmacy users' perceptions, attitudes and willingness to pay for free healthcare from pharmacies.

Background: Evidence exists of pharmacists providing free or partially subsidised clinical services in order to meet patient healthcare needs. Little is known about how patients perceive the quality and importance of such unfunded services to their healthcare. Objectives: To explore pharmacy user perspectives about unfunded services such as their valuation, why they chose to access these services from the pharmacy as well as their willingness to pay should pharmacies need to start charging for the provision of such services owing to budgetary constraints. Methods: This study was nested in a larger nationwide study where 51 pharmacies were recruited across fourteen locations across New Zealand . Semi-structured interviews were conducted with patients who had accessed unfunded services in community pharmacies. Patients were followed up to identify their percieved health outcomes resulting from accessing the unfunded service. Results: A total of 253 patient interviews were conducted on-site across 51 pharmacies in New Zealand. Two main themes were identified pertaining to (1) patient-provider relationship and (2) Willingness to pay. A total of fifteen different considerations were found to influence pharmacy users' decisions to access health services from the pharmacy. It was found that 62.8% of patients were willing to pay for unfunded services and the majority paying NZD$10. Conclusion: Patients positively rate these services and largely deem them important for their healthcare. Willingness to pay for services were also variable between patients and were dependant on the type of service accessed.

Primary care services and emergency department visits in blended fee-for-service and blended capitation models: evidence from Ontario, Canada.

INTRODUCTION: It is well-known that the way physicians are remunerated can affect delivery of health care services to the population. Fee-for-service (FFS) generally leads to oversupply of services, while capitation leads to undersupply of services. However, little evidence exists on the link between remuneration and emergency department (ED) visits. We fill this gap using two popular blended models introduced in Ontario, Canada: the Family Health Group (FHG), an enhanced/blended FFS model, and Family Health Organization (FHO), a blended capitation model. We compare primary care services and rates of emergency department ED visits between these two models. We also evaluate whether these outcomes vary by regular- and after-hours, and patient morbidity status. METHODS: Physicians practicing in an FHG or FHO between April 2012 and March 2017 and their enrolled adult patients were included for analyses. The covariate-balancing propensity score weighting method was used to remove the influence of observable confounding and negative-binomial and linear regression models were used to evaluate the rates of primary care services, ED visits, and the dollar value of primary care services delivered between FHGs and FHOs. Visits were stratified as regular- and after-hours. Patients were stratified into three morbidity groups: non-morbid, single-morbid, and multimorbid (two or more chronic conditions). RESULTS: 6184 physicians and their patients were available for analysis. Compared to FHG physicians, FHO physicians delivered 14% (95% CI 13%, 15%) fewer primary care services per patient per year, with 27% fewer services during after-hours (95% CI 25%, 29%). Patients enrolled to FHO physicians made 27% more less-urgent (95% CI 23%, 31%) and 10% more urgent (95% CI 7%, 13%) ED visits per patient per year, with no difference in very-urgent ED visits. Differences in the pattern of ED visits were similar during regular- and after-hours. Although FHO physicians provided fewer services, multimorbid patients in FHOs made fewer very-urgent and urgent ED visits, with no difference in less-urgent ED visits. CONCLUSION: Primary care physicians practicing in Ontario's blended capitation model provide fewer primary care services compared to those practicing in a blended FFS model. Although the overall rate of ED visits was higher among patients enrolled to FHO physicians, multimorbid patients of FHO physicians make fewer urgent and very-urgent ED visits.

Remuneration, Job Satisfaction, and Performance of Health Workers During the COVID-19 Pandemic Period at the Dr. Soetomo Hospital Surabaya, Indonesia.

Purpose: One of the hospital management issues that has not been studied much during the COVID-19 Pandemic is the relationship between health workers' performance, job satisfaction and remuneration. This study aims to examine the relationship between remuneration, job satisfaction and the employee performance during 2019-2021. Materials and Methods: This study applied an employee satisfaction survey at a General Academic Hospital between 2019-2021. The population and samples were 716 employees. The data collection were based on the personnel database, remuneration database, and the annual Employee Satisfaction Survey Database for the period 2019-2021 at General Academic Hospital of Dr. Soetomo, Surabaya, Indonesia. Results: The results of the correlation test between Employee Satisfaction, Remuneration, and Performance based on employee performance objectives showed an insignificant positive correlation between the remuneration variable and satisfaction based on The Job Itself; very weak significant positive correlation between remuneration variable and Satisfaction based on Pay; a very weak significant positive correlation between the remuneration variable and Satisfaction based on Promotion; very weak significant positive correlation between remuneration variable and satisfaction based on supervision; significant positive correlation between remuneration variable and satisfaction based on coworkers; There is a significant positive correlation between remuneration and performance variables. Conclusion: The correlation between remuneration and employee satisfaction based on the Job Description Index shows that the components of the job itself, and coworkers have a positive but not significant relationship, while the components of pay, promotion, and supervision have a positive and significant relationship. Employees satisfaction with performance achievement have a positive and significant relationship, especially job satisfaction based on pay and supervision, but there is also a positive and insignificant relationship related to job satisfaction based on the job itself, promotion, and co-workers.

[Outpatient parathyroid gland operations in the German system-Feasible and useful?] / Ambulante Nebenschilddrüsenoperationen im deutschen System ­ Möglich und sinnvoll?

BACKGROUND: In 2019 approximately 7500 procedures were carried out for parathyroid diseases in Germany (Statistisches Bundesamt 2020, https://www.destatis.de/DE/ ). All operations were performed as inpatient procedures. The catalogue of outpatient procedures for 2023 does not include operations on the parathyroid glands. OBJECTIVE: Which conditions are prerequisites for parathyroid surgery on an outpatient basis? MATERIAL AND METHODS: Published data on outpatient parathyroid surgery were analyzed with respect to the underlying disease, procedures performed and patient-specific circumstances. RESULTS: Initial operations for localized sporadic primary hyperparathyroidism (pHPT) seem to be suitable for outpatient surgery, provided that affected patients fulfil the general prerequisites for an outpatient operation. The procedures focused parathyroidectomy and unilateral exploration can be carried out using local or general anesthesia and have a very low risk for postoperative complications. The organization of the day of the operation and the postoperative treatment of the patient should be organized within a detailed standard of procedure. The remuneration for an outpatient parathyroidectomy is not included in the German outpatient surgery catalogue and is therefore currently not adequately financially reimbursed. CONCLUSION: In selected patients a limited initial intervention for primary hyperparathyroidism can be safely performed on an outpatient basis; however, the present German reimbursement modalities have to be revised so that the cost of these outpatient operations can be adequately covered.

Tabela de procedimentos de enfermagem: análise do escopo e respaldo em resoluções do conselho federal / Table of nursing procedures: analysis of the scope and support in federal council resolutions / Tabla de procedimientos de enfermería: analizar el alcance y el respaldo de las resoluciones del consejo federal

RESUMO Objetivo: analisar o escopo e respaldo da tabela de procedimentos de enfermagem a partir de resoluções do Conselho Federal de Enfermagem de 2005 a 2021. Método: estudo documental quantitativo, realizado no site do Conselho Federal de Enfermagem a fim de identificar as resoluções publicadas entre 2005 e 2021. A análise, conduzida em três etapas de triagem, abrangeu resoluções situadas entre os números 301/2005 e 673/2021, relacionadas à tabela de procedimentos honorários mínimos da enfermagem. Resultados: em comparação, a resolução n. 673/2021 amplia a tabela de procedimentos de enfermagem da Resolução n. 301/2005 em quatro áreas de atividades e acresce-a em 34 procedimentos, totalizando 174 procedimentos de enfermagem, respaldados por 48 resoluções vigentes. Conclusão: a ampliação de procedimentos da enfermagem, respaldada por fundamentação legal, reforça a faceta empreendedora do enfermeiro. Este aspecto, ao ser indicado, pode instigar uma reflexão e reconhecimento por parte da categoria em expandir sua atuação.

ABSTRACT Objective: To analyze the scope and support of the nursing procedures table based on resolutions of the Federal Nursing Council from 2005 to 2021. Method: A quantitative documentary study was carried out on the Federal Nursing Council website to identify the resolutions published between 2005 and 2021. The analysis, conducted in three screening stages, covered resolutions between No. 301/2005 and 673/2021 related to the table of minimum fee procedures for nursing. Results: In comparison, resolution No. 673/2021 extends the table of nursing procedures in Resolution No. 301/2005 in four areas of activity and adds 34 procedures, totaling 174 nursing procedures, backed by 48 current resolutions. Conclusion: The expansion of nursing procedures, supported by legal grounds, reinforces the entrepreneurial side of nurses. This aspect, when pointed out, can instigate reflection and recognition on the part of the category to expand its activities.

RESUMEN Objetivo: analizar el alcance y el apoyo de la tabla de procedimientos de enfermería basada en las resoluciones del Consejo Federal de Enfermería de 2005 a 2021. Método: estudio documental cuantitativo realizado en la página web del Consejo Federal de Enfermería para identificar las resoluciones publicadas entre 2005 y 2021. El análisis, realizado en tres fases de cribado, abarcó las resoluciones comprendidas entre los números 301/2005 y 673/2021, relacionadas con la tabla de procedimientos de honorarios mínimos de enfermería. Resultados: en comparación, la resolución n. 673/2021 amplía la tabla de procedimientos de enfermería de la Resolución n. 301/2005 en cuatro áreas de actividad y añade 34 procedimientos, con un total de 174 procedimientos de enfermería, respaldados por 48 resoluciones vigentes. Conclusión: la expansión de los procedimientos de enfermería, respaldada por fundamentos jurídicos, refuerza la faceta empresarial del enfermero. Este aspecto, cuando se señala, puede suscitar la reflexión y el reconocimiento por parte de la categoría para ampliar sus actividades.

[Inguinal hernia operations-Always outpatient?] / Leistenhernienoperationen ­ immer ambulant?

Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.

Investigating the provision, nature and associated costs of unfunded pharmacy services: A nationwide study.

BACKGROUND: There is increasing evidence of pharmacists providing free or partially subsidised patient-focused services in order to meet healthcare needs. Limited information exists about the types of unfunded services and their value. OBJECTIVES: (1) Identify the types of unfunded services provided nationally in New Zealand (NZ) and (2) Determine the costs associated with service provision. METHODS: A continuous observation time-motion study was conducted across New Zealand to characterise the provision of unfunded pharmacy services and the labour costs associated with their provision. The time-motion study spanned one business day (between seven to eight hours) in each participating pharmacy. The primary investigator (YA) spent one business day in each participating pharmacy (n = 51) and recorded details about the patient-focused services that were provided. Details included the type of service provided, approximate duration of the service and out-of-pocket costs borne by the patient. RESULTS: A total of 660 observations of unfunded services were recorded across the 51 pharmacies where 360 observation hours were carried out. Twenty-three types of unfunded services were identified, where minor ailments accounted for over half of the total observations. Labour costs associated with service provision were variable. CONCLUSION: Pharmacies across New Zealand are providing patient-focused services for which no funding is being provided.

Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment): a systematic review and meta-analysis

Purpose: In Brazil, healthcare services traditionally follow a fee-for-service (FFS) payment system, in which each medical procedure incurs a separate charge. An alternative reimbursement with the aim of reducing costs is diagnosis related group (DRG) remuneration, in which all patient care is covered by a fixed amount. This work aimed to perform a systematic review followed by meta-analysis to assess the effectiveness of the Budled Payment for Care Improvement (BPCI) versus FFS. Methods: Our work was performed following the items of the PRISMA report. We included only observational trials, and the primary outcome assessed was the effectiveness of FFS and DRG in appendectomy considering complications. We also assessed the costs and length of hospital stay. Meta-analysis was performed with Rev Man version 5.4. Results: Out of 735 initially identified articles, six met the eligibility criteria. We demonstrated a shorter hospital stay associated with the DRG model (mean difference = 0.39; 95% confidence interval ­ 95%CI ­ 0.38­0.40; p < 0.00001; I2 = 0%), however the hospital readmission rate was higher in this model (odds ratio = 1.57; 95%CI 1.02­2.44, p = 0.04; I2 = 90%). Conclusions: This study reveals a potential decrease in the length of stay for appendectomy patients using the DRG approach. However, no significant differences were observed in other outcomes analysis between the two approaches.

Moonlighting and physician residents' compensation: is it all about money? A cross-sectional Brazilian study

ABSTRACT BACKGROUND: Moonlighting is a largely discussed, however under-explored, subject among physician residents. OBJECTIVES: To analyze the frequency of moonlighting and its related factors. DESIGN AND SETTING: This cross-sectional study enrolled medical residents from all geographical regions of Brazil. METHODS: A web-based structured closed-ended survey was applied that explored the frequency and type of moonlighting, residency programs characteristics, and psychological distress. The questionnaire was published on social networks. RESULTS: The completion rate was 71.4% (n = 1,419) and 37.7% were males aged 28.8 ± 3.2 (mean ± standard deviation) years, and 571 (40.2%) were post-graduate year (PGY) 1. There were residents from 50 medical specialties (the most common training area was clinical, 51.9%). A total of 80.6% practiced moonlighting, with an average weekly workload of 14.1 ± 9.4 h, usually overnight or in weekend shifts. Factors related to it were being PGY-2 or higher (adjusted odds ratio = 3.90 [95% confidence interval = 2.93-5.18], logistic regression), lower weekly residency duty hours (0.98 [0.97-0.99]), and a higher salary (1.23 [1.08-1.40]). In contrast, perception of a "fair/adequate" compensation was influenced by age (1.02 [1.01-1.02]), not being single (1.05 [1.01-1.10]), and residency duty hours (1.51 [1.22-1.88]). Depression, anxiety, diurnal somnolence scores, and work-personal life conflicts were not correlated with moonlighting status. CONCLUSION: Moonlighting frequency is high, and it is related to higher PGY, briefer residency duty hours, and the perception that remuneration should be higher. This study provides insights into the motivations for moonlighting and effort-reward imbalance.