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1.
Gen Dent ; 68(1): 56-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859664

RESUMO

The purpose of this retrospective, observational study was to characterize the amounts and types of healthcare industry payments made to dental care providers in 2017. Data were collected from the Open Payments database of the US Centers for Medicare & Medicaid Services. Dentists were classified as providing general services or services in 1 of 9 specialties recognized by the American Dental Association (prior to the recognition of dental anesthesiology). The value and nature of each payment made to providers were recorded, and descriptive statistics were calculated. Distributions across dental specialties were compared with analyses of variance. In 2017, US dentists received a total of 321,627 industry payments totaling $110,750,601. The most money was spent on service fees ($37,333,870; 33.7%), followed by consulting fees ($12,983,013; 11.7%) and royalties and licenses ($11,426,776; 10.3%). Each provider received a median payment of $63.27 (range, $0.21-$22,931,027.12) spread over 2 payments (range, 1-285). Participation rates among dental specialists ranged from 19% to 62%, and the highest rates were found among orthodontists (61.8%), oral and maxillofacial surgeons (55.7%), and periodontists (54.6%). The greatest median payments per provider were made to specialists in oral and maxillofacial radiology ($187.52), periodontics ($127.31), and oral and maxillofacial surgery ($123.39). The mean number (P < 0.01) and amount of payments (P < 0.01) per provider differed significantly across all specialties. The majority of dentists in this study received less than $200; however, the distribution of payments was positively skewed by a few top earners. The effect of these payments on clinical practice remains to be determined.


Assuntos
Conflito de Interesses , Economia em Odontologia , Indústrias/economia , Idoso , Odontologia , Honorários e Preços , Setor de Assistência à Saúde , Humanos , Indústrias/ética , Medicare , Padrões de Prática Médica/economia , Estudos Retrospectivos , Estados Unidos
2.
Tech Vasc Interv Radiol ; 22(3): 162-164, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31623757

RESUMO

A sound understanding of billing and coding is essential to start a successful interventional radiology endoscopy practice. While the codes utilized are similar to gastrointestinal and genitourinary endoscopy codes, physicians and institutional coders need to be familiar with the codes used for these types of procedures in the interventional radiology setting. The following manuscript gives a brief overview of aspects relating to credentialing, billing, and coding in interventional radiology endoscopy.


Assuntos
Credenciamento , Current Procedural Terminology , Endoscopia , Honorários e Preços , Custos de Cuidados de Saúde , Radiografia Intervencionista , Mecanismo de Reembolso , Competência Clínica , Credenciamento/normas , Endoscopia/classificação , Endoscopia/economia , Endoscopia/normas , Honorários e Preços/normas , Custos de Cuidados de Saúde/normas , Humanos , Radiografia Intervencionista/classificação , Radiografia Intervencionista/economia , Radiografia Intervencionista/normas , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/normas
3.
Mar Pollut Bull ; 149: 110561, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542600

RESUMO

This study investigates conditions under which differentiating port fees based on vessels' environmental performance could be an additional driver for cruise-ship owners to invest in green technologies. Our case study on liquefied natural gas (LNG) as fuel for a cruise ship shows that port-based incentives could help reduce emissions to air and drive uptake of green technologies. Assuming an average rebate of EUR 1500 per port visit, the accumulated rebates globally for our case study ship exceed EUR 400,000 per year. Applying a rebate of nearly EUR 4800 per visit as currently offered in Norwegian ports, and assuming 50% of ports globally adopt the scheme, gives a cost benefit of EUR 700,000 per year, reducing the LNG technology payback time up to one year. Our case study also shows that significantly reducing ship emissions in ports will bring social benefits through reduced risks of loss of life, health and wellbeing.


Assuntos
Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/métodos , Honorários e Preços/classificação , Navios/economia , Poluição do Ar/análise , Poluição do Ar/prevenção & controle , Análise Custo-Benefício , Gás Natural/análise , Emissões de Veículos/análise , Emissões de Veículos/prevenção & controle
5.
Spine (Phila Pa 1976) ; 44(16): 1162-1169, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374001

RESUMO

STUDY DESIGN: A systematic review. OBJECTIVE: The aim of this study was to determine the association between study outcomes and the presence of a conflict of interest (COI) in the lumbar disc arthroplasty (LDA) literature. SUMMARY OF BACKGROUND DATA: Previous studies have evaluated the efficacy of LDA as a surgical alternative to arthrodesis. As investigators may have financial relationships with LDA device companies, it is important to consider the role of COI on study outcomes. METHODS: A systematic review was performed to identify articles reporting clinical outcomes of LDA. Any financial COIs disclosed were recorded and confirmed through Open Payments and ProPublica databases. Study outcomes were graded as favorable, unfavorable, or equivocal. Pearson Chi-squared analysis was used to determine an association between COI and study outcomes. Favorable outcomes were tested for an association with study characteristics using Poisson regression with robust error variance. RESULTS: Fifty-seven articles were included, 30 had a financial COI, while 27 did not. Ninety percent of the conflicted studies disclosed their COI in the article. Studies with United States authors were more likely to be conflicted (P = 0.019). A majority of studies reported favorable outcomes for LDA (n = 39). Conflicted studies were more likely to report favorable outcomes than nonconflicted studies (P = 0.020). Articles with COIs related to consultant fees (P = 0.003), research funding (P = 0.002), and stock ownership (P < 0.001) were more likely to report favorable outcomes. CONCLUSION: This study highlights the importance for authors to accurately report conflicting relationships with industry. As such, orthopedic surgeons should critically evaluate study outcomes with regard to potential conflicts before recommending LDA as a surgical option to their patients. LEVEL OF EVIDENCE: 3.


Assuntos
Artroplastia , Conflito de Interesses , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Bases de Dados Factuais , Revelação , Honorários e Preços , Humanos , Pesquisadores , Estados Unidos
6.
N Z Vet J ; 67(6): 306-314, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31319781

RESUMO

Aims: To describe the demographics of and predictors for pet ownership, reasons for visiting a veterinarian, and pet-related expenditure in pet owners in New Zealand. Methods: A cross-sectional online survey was conducted from 18-22 June 2015 using a permission-based panel of New Zealand residents aged ≥18 years. Questions included demographics of respondents, number of pets and reasons for owning or not owning pets, number of visits and reasons for visiting a veterinarian, and pet-related expenditure. Results: Of the 1,572 respondents who completed the survey, 1,013 (64.4%) owned ≥1 pet. Of these, 443 owned dogs, 696 cats, 32 horses, 103 birds, 55 rabbits, and 159 owned fish. Companionship was the most common reason for getting dogs, cats, and birds; horses were mostly owned as a hobby, rabbits to provide fun for children, and fish as a source of relaxation. The majority of dog, cat, and rabbit owners considered their pets to be family members; horse owners almost equally considered their horses a hobby or a family member. The odds of pet ownership increased for respondents from a rural region, having a higher household income, having children and being female. Overall, 711/1,013 (70.2%) pet-owning respondents had taken ≥1 animal to the veterinarian in the previous year, with the most common reasons being for vaccination or annual check-ups or health issues. Respondents who considered their pets trusted companions, had a higher income, and owned dogs or cats compared with other species, were most likely to have taken their pet to a veterinarian. The greatest pet-related expenditure for all species was food. The median yearly veterinary expenditure was $200-499 by dog owners, $100-199 by cat owners, and <$100 by horse, bird, rabbit, and fish owners. The best source of information for pet-related issues was considered to be veterinarians by 724/1,001 (72.3%) owners, and the internet by 509/1,001 (50.8%) owners. Conclusions: Among survey respondents, pet ownership was common and pets filled a variety of roles in the household. Pet owners reported spending considerable amounts of money on their pets each year, but some of them may be underutilising veterinary services despite veterinarians being considered as valuable sources of information about pet-related issues.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Propriedade , Animais de Estimação , Medicina Veterinária/economia , Bem-Estar do Animal , Animais , Custos e Análise de Custo , Estudos Transversais , Honorários e Preços , Humanos , Nova Zelândia , Médicos Veterinários , Medicina Veterinária/estatística & dados numéricos
7.
Orv Hetil ; 160(27): 1057-1063, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31264470

RESUMO

The health care renumeration poses a great challenge for both politicians and policymakers. During the beginning of the 1990s, following the end of communism in Hungary, the reform of health care began with the introduction of the primary health care (PHC), specifically with general practitioner (GPP)/family medicine (FM) care. The basis of the renumeration was the age-adjusted capitation built upon the free choice of doctors, while social security renumeration was built on a mixed system. Several pros and cons have been highlighted, but the underlying principle has proved to be simple and effective. Comparison of the European and Hungarian characteristics, analysis of data in the present patient care report as well as in the years preceding the release of the aforementioned document, these confirm that the method of capitation-based remuneration is a fundamental, easy, and unmanipulable method. It places minimal weight on social security and comes with little costs. Orv Hetil. 2019; 160(27): 1057-1063.


Assuntos
Capitação , Medicina de Família e Comunidade/economia , Planos de Pagamento por Serviço Prestado/organização & administração , Honorários e Preços , Honorários Médicos , Atenção Primária à Saúde/economia , Clínicos Gerais , Humanos , Hungria , Risco Ajustado
8.
Vnitr Lek ; 65(5): 338-347, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163966

RESUMO

This study examined compliance with the criteria of transparency and best practice in scholarly publishing defined by COPE, DOAJ, OASPA and WAME in Biomedical Open Access journals indexed in Journal Citation Reports (JCR). 259 Open Access journals were drawn from the JCR database and on the basis of their websites their compliance with 14 criteria for transparency and best practice in scholarly publishing was verified. Journals received penalty points for each unfulfilled criterion when they failed to comply with the criteria defined by COPE, DOAJ, OASPA and WAME. The average number of obtained penalty points was 6, where 149 (57.5%) journals received 6 points and 110 (42.5%) journals 7 points. Only 4 journals met all criteria and did not receive any penalty points. Most of the journals did not comply with the criteria declaration of Creative Commons license (164 journals), affiliation of editorial board members (116), unambiguity of article processing charges (115), anti-plagiarism policy (113) and the number of editorial board members from developing countries (99). The research shows that JCR cannot be used as a whitelist of journals that comply with the criteria of transparency and best practice in scholarly publishing.


Assuntos
Acesso à Informação , Publicação de Acesso Aberto , Publicações Periódicas como Assunto , Honorários e Preços , Humanos , Editoração
10.
Niger J Clin Pract ; 22(6): 745-749, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187756

RESUMO

Background: Screening for cervical cancer improves outcome. This comes at an economic price which some may not be able to afford. Objective: To evaluate the influence of user fees on the utilization of cervical cancer screening services in Port Harcourt. Materials and Methods: A cross sectional study of clients presenting for cervical cancer screening. Data on the number, socio-demographic characteristics, distance from screening center following 1 month of free cancer screening and 7 months of user fee introduction, was collated and analyzed using SPSS version 20 statistical software. Results are presented in percentages, tables and charts with test of significance set at P < 0.05. Results: Of the 167 women who presented for cervical cancer screening during the study period, the mean age was 42.08 ± 8.9 years and range was 20-70 years. The average parity of patients was 2.83 ± 2.24. Clients' utilization of cervical cancer screening facilities was negatively affected by the introduction of user fees P < 0.001). There is no association between the distance of patients' home from the hospital and the utilization of facility (X2 = 0.24, P = 0.887). There was sustained decrease in number of clients with the introduction of fees. Conclusion: The introduction of user fees had a negative impact on the utilization of cervical cancer screening facilities. Eradicating user fee and improving the socioeconomic status of patients may improve the utilization of screening services.


Assuntos
Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Honorários e Preços , Neoplasias do Colo do Útero/diagnóstico por imagem , Adulto , Idoso , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Nigéria , Fatores Socioeconômicos , Adulto Jovem
12.
Dermatol Online J ; 25(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31046905

RESUMO

WeChat is a closed social networking platform that allows users to connect privately, providing instant text, photo sharing, voice, and video calls. It is now the most popular mobile chat app in China. The widespread use and ease of establishing technology made WeChat an ideal platform for healthcare, in which it has many uses that include scheduling, follow up, and post-procedure monitoring. In addition, one may make payments and handle prescriptions via e-pharmacy. Dermatologists are often looking for a secure and easy way to use mobile applications to share clinical images and to obtain photographs from patients. We aim to provide an overview of WeChat and its current applications for healthcare and dermatology.


Assuntos
Assistência à Saúde/métodos , Dermatologia , Aplicativos Móveis , Redes Sociais Online , China , Serviços Comunitários de Farmácia , Honorários e Preços , Humanos , Fotografação , Videoconferência
13.
Int J Equity Health ; 18(1): 63, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053077

RESUMO

BACKGROUND: Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of pocket (OOP) with only 3.4% related to premiums for private insurance. In 2014, Household OOP Expenditure on health accounted for 52.8% of total health expenditure. OOP is known to be regressive and to impact negatively on households' living standards. OBJECTIVES: This paper aims to examine trends in OOP in Mauritius, to assess its impacts through an analysis of key indicators of financial protection, namely catastrophic health expenditure (CHE) and impoverishment due to OOP health expenditure. It also aims to predict core determinants of CHEs. METHODS: Household Budget Surveys (HBS) of 2001/2002, 2006/2007 and 2012 were the primary source data. CHE and impoverishment were used to assess financial hardships resulting from OOP health payments. The incidence of CHE was estimated at three threshold levels (10,25 and 40%), using the budget share and the capacity to pay approaches. Impoverishment due to OOP was measured by changes in the incidence of poverty and intensity of poverty using the US$ 3.1 international poverty line. Logistic regression analysis was used to identify determinants of CHE. FINDINGS: Household CHE increased from 5.78% in 2001/02 to 8.85% in 2012 and 0.61% in 2001/02 to 1.25% in 2012, for 10 and 40% thresholds, respectively. The incidence of CHE was significantly higher in urban areas compared to rural areas. The highest levels of CHEs were among households' heads, who are retired rising from 1.62% in 2001/02 to 3.71% in 2012, followed by households' head who are widowed from 2.29% in 2001/02 to 2.63% in 2012 and homemakers from 2.12% in 2001/02 to 2.57% in 2012 at the 40% threshold. The share of households pushed below the poverty line due to OOP dropped from 0.4% in 2001/02 to 0.2% in 2006/07 before rising to 0.34% in 2012. In 2012, poverty gap occurred only among households under poorest quintile 1 (0.24%) and quintile 2 (0.03%). Overall poverty gap dropped from 0.08% in 2001/02 to 0.05% in 2012. Logistic regression analysis revealed that the odds ratio of facing CHE were significant only among households with heads being retired and with a presence of an elderly member in the household. CONCLUSION: Despite the rise in incidence of CHE between 2001 and 2012 the impact of OOP on the level of impoverishment and poverty gap has not been significant.


Assuntos
Doença Catastrófica/economia , Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Participação no Risco Financeiro , Adolescente , Adulto , Orçamentos , Criança , Pré-Escolar , Características da Família , Honorários e Preços/estatística & dados numéricos , Feminino , Humanos , Masculino , Maurício , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30987264

RESUMO

This paper examines the capacity determination factors of medical services at a national level through the analysis of a mathematical model that maximizes social welfare, which consists of the consumption of private goods and the medical capacity provided by the society. A sensitivity analysis is conducted to investigate the impact of these factors on the medical capacity provided. Furthermore, a case example based on the data provided by the government is presented to discuss the results derived from the theoretical analysis. The results of the sensitivity analysis indicate that individual disposable income, the medical expenditure for each treatment, the level of premium payments, and substitution parameters have a positive impact on medical capacity, while the medical costs and preference parameter negatively affect medical capacity. The results of the correlation analysis based on the data of the case example are consistent with the findings of the theoretical analysis.


Assuntos
Seguro Saúde/economia , Programas Nacionais de Saúde/organização & administração , Honorários e Preços , Humanos , Modelos Organizacionais , Programas Nacionais de Saúde/economia
15.
J Med Libr Assoc ; 107(2): 238-243, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31019393

RESUMO

Background: There is growing demand for specialized services in academic libraries, including supporting systematic reviews and measuring research impact. Study Purpose: The John W. Scott Health Sciences Library implemented a fee-based pilot project for the Faculty of Nursing for one year to test a fee-based model for specialized services, to evaluate its sustainability and scalability for the longer term, and to assess the feasibility of extending this service model to other health sciences faculties. Case Presentation: We describe the development and delivery of the fee-based service model. Through a team-based approach, we successfully provided specialized services including mediated literature searching, research support, and research impact analyses to the Faculty of Nursing. Discussion: Despite some challenges in developing and implementing the fee-based service model, our pilot project demonstrated demand for fee-based specialized services in the health sciences and suggests potential for this unique service model to continue and expand.


Assuntos
Honorários e Preços , Serviços de Biblioteca/organização & administração , Alberta , Humanos , Bibliotecas Médicas/economia , Bibliotecas Médicas/organização & administração , Serviços de Biblioteca/economia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Escolas de Enfermagem , Universidades
16.
Stud Health Technol Inform ; 258: 70-74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30942717

RESUMO

BACKGROUND: To make patient care data more accessible for research, German university hospitals join forces in the course of the Medical Informatics Initiative. In a first step, the administrative data of university hospitals is made available for federated utilization. Project-specific de-identification of this data is necessary to satisfy privacy laws. OBJECTIVE: We want to make a statement about the population uniqueness of the data. By generalizing the data, we try to reduce uniqueness and improve k-anonymity. METHODS: We analyze quasi-identifying attributes of the Erlangen University Hospital's billing data regarding population uniqueness and re-identification risk. We count individuals per equality class (k) to measure uniqueness. RESULTS: Because of the diagnoses and procedures being particularly unique in combination with sex and age of the patients, the data set is not anonymized in matters of k-anonymity with k > 1 . We are able to reduce population uniqueness with generalization and suppression of unique domains. CONCLUSION: To create k-anonymity with k > 1 while still maintaining a particular utility of the data, we need to apply further established strategies of de-identification.


Assuntos
Anonimização de Dados , Hospitais Universitários , Informática Médica , Honorários e Preços , Humanos , Manutenção , Privacidade
17.
JAMA Netw Open ; 2(3): e190932, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901047

RESUMO

Importance: Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood. Objectives: To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists. Design, Setting, and Participants: A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non-facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018. Main Outcomes and Measures: Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings. Results: A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, -1458 to -644; P < .001), collected a mean of $143 610 less in revenue (95% CI, -$185 528 to -$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, -2.23 to -0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, -506 to -341; P < .001), collected a mean of $26 735 less in revenue (95% CI, -$31 910 to -$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, -1.77 to -0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, -$52 379 to -$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, -$522 663 to -$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, -$14.13 to -$2.86; P = .003) than men in the NFB setting. Conclusions and Relevance: This study suggests that female radiation oncologists submit fewer Medicare charges, are reimbursed less per charge they submit, and receive lower Medicare payments overall compared with male radiation oncologists. Even among similarly productive radiation oncologists, women in this study still collected less revenue than men. Further research is required to understand the sex-based barriers to economic advancement within radiation oncology.


Assuntos
Honorários e Preços/estatística & dados numéricos , Medicare/economia , Padrões de Prática Médica , Radio-Oncologistas , Feminino , Humanos , Masculino , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Radio-Oncologistas/economia , Radio-Oncologistas/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos
19.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(2): 137-145, mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182460

RESUMO

Antecedentes y objetivo: Las tarifas por acto médico y los hábitos de asistencia privada de los dermatólogos apenas han sido objeto de estudio, al menos en nuestro entorno inmediato. Con el presente trabajo pretendemos describir hábitos de prestación de servicios, medios de cobro, promoción y fijación de tarifas de los dermatólogos que realizan asistencia privada en España. Secundariamente, buscamos analizar las diferencias por sección territorial, edad y sexo. Materiales y métodos: Estudio descriptivo transversal a partir de un cuestionario on-line con un total de 31 preguntas dirigido exclusivamente a dermatólogos con asistencia privada en España, abierto a respuestas del 17 de mayo al 5 de junio de 2018. Los datos fueron analizados comparando por sección territorial, sexo y edad. Resultados: Se recibió un total de 234 respuestas, paritarias en cuanto a sexo y proporcionadas en cuanto a las secciones territoriales de la Academia Española de Dermatología y Venereología (AEDV). Pudieron constatarse algunas diferencias por sección territorial, edad y sexo. Destacaban las tarifas sistemáticamente menores de las dermatólogas, incluso tras ajustar por factores de confusión mediante modelos de regresión. Conclusiones: Quedan descritas características de la asistencia privada en Dermatología en España. El hecho de que haya tarifas más baratas entre las dermatólogas requiere de un estudio más detallado, probablemente mediante técnicas de investigación cualitativa


Background and objective: Per-visit fees and the characteristics of private practice in dermatology have been studied very little, at least in Spain. This study aims to describe how dermatologists in private practice in Spain provide services, collect payment, promote their services, and establish fees. We also analyze differences by region, age, and sex. Materials and methods: We performed a descriptive, cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain. The questionnaire was open for responses from May 17 to June 5, 2018. The data were analyzed by comparing region, sex, and age. Results: A total of 234 questionnaires were returned, with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology (AEDV). Some differences were found for region, age, and sex. The fees of female dermatologists were consistently lower, even after adjusting for confounding factors by means of regression models. Conclusions: We have described the characteristics of private dermatology practice in Spain. Charging of lower fees by female dermatologists requires more detailed study, probably using qualitative research techniques


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dermatologia/economia , Prática Privada/economia , Prática Privada/estatística & dados numéricos , Honorários e Preços , Honorários Médicos/estatística & dados numéricos , Espanha , Estudos Transversais
20.
Am J Emerg Med ; 37(5): 928-932, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30733103

RESUMO

OBJECTIVE: As nurse practitioners (NPs) and physician assistants (PAs) become an integral part of delivering emergency medical services, we examined the involvement of NPs and PAs who billed independently in emergency departments (EDs). METHODS: We used Medicare provider utilization and payment data from 2012 to 2016 to conduct a retrospective analysis. We examined the changes in the number of each clinician type who billed independently for four common emergency services (CPT codes: 99282-5), the change in their service volume, and the change in their average number of services billed. RESULTS: Between 2012 and 2016, the proportion of NPs and PAs billing independently increased from 18% to 22% for ED visits of low severity (99282), 23% to 29% for visits with moderate severity (99283), 21% to 27% for visits with high severity (99284), 18% to 24% for visit with the highest severity (99285), and 23% to 29% across all four services. The proportion of services provided by emergency physicians decreased from 66% to 63% across all four services, and from 11% to 9% for internists and family physicians. The number of NPs, PAs billing independently, and emergency physicians increased by 65%, 35% and 12% respectively. CONCLUSIONS: NPs and PAs are increasingly billing emergency services of all levels of severity, independent of physicians. This trend is driven by a growing number of NPs and PAs independently billing services, despite a relatively stable number of emergency physicians (excepting the decline in rural areas), and diminished involvement of family physicians and internists in EDs.


Assuntos
Serviço Hospitalar de Emergência , Honorários e Preços/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Medicina de Emergência , Mão de Obra em Saúde , Humanos , Medicare , Médicos , Índice de Gravidade de Doença , Estados Unidos
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