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4.
Environ Sci Pollut Res Int ; 26(29): 29799-29809, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407261

RESUMO

The economics of death and dying highlighted that environmental factors negatively influence healthcare sustainability. Therefore, this study conducted a system-based literature review to identify the negative externality of environmental damages on global healthcare reforms. Based on 42 peer-reviewed papers in the field of healthcare reforms and 12 papers in the field of environmental hazards, we identified 25 factors associated with death and dying and 15 factors associated with health-related damages across the world respectively. We noted that environmental factors are largely responsible to affect healthcare sustainability reforms by associating with the number of healthcare diseases pertaining to air pollutants. The study suggests healthcare practitioners and environmentalists to devise long-term sustainable healthcare policies by limiting highly toxic air pollutants through technology-embodied green healthcare infrastructure to attained efficient global healthcare recovery.


Assuntos
Poluição do Ar/economia , Assistência à Saúde/economia , Reforma dos Serviços de Saúde/economia , Modelos Econômicos , Poluição do Ar/efeitos adversos , Poluição do Ar/prevenção & controle , Atitude Frente a Morte , Política de Saúde/economia , Humanos , Desenvolvimento Sustentável/economia
5.
Inquiry ; 56: 46958019872348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31455126

RESUMO

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians' roles as the agents of Chinese patients? The marketization approach of China's economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians' ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.


Assuntos
Reforma dos Serviços de Saúde/tendências , Hospitais Públicos/organização & administração , Planos de Incentivos Médicos/economia , Médicos/economia , China , Reforma dos Serviços de Saúde/economia , Hospitais Públicos/economia , Humanos
6.
Med Care ; 57(8): 584-591, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31295188

RESUMO

BACKGROUND: The effects of Medicare payment reforms aiming to improve the efficiency and quality of care by establishing greater financial accountability for providers may vary based on the extent and types of other coverage for their patient populations. Providers who are more resource constrained due to a less favorable payer mix face greater financial risks under such reforms. The impact of the expanded Medicare dialysis prospective payment system (PPS) on quality of care in independent dialysis facilities may vary based on the extent of higher payments from private insurers available for managing increased risks. OBJECTIVES: To evaluate whether anemia outcomes for dialysis patients in independent facilities differ under the Medicare PPS based on facility payer mix. DESIGN: We examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009-2014 among facilities with differing levels of employer insurance (EI). We performed similar analyses of facilities affiliated with large dialysis organizations, whose practices were not expected to change based on facility-specific payer mix. RESULTS: Among independent facilities, similar modeled trends in low hemoglobin for all 3 facility EI groups in 2009-2010 were followed by increased low hemoglobin during 2012-2014 for facilities with lower EI (P<0.01). Post-PPS standardized blood transfusion ratios were 9% higher for lower EI versus higher EI independent facilities (P<0.01). Among large dialysis organizations facilities, there was no divergence in low hemoglobin by payer mix under the PPS. CONCLUSIONS: There is evidence of poorer quality of care for anemia under the PPS in independent facilities with lower versus higher EI. Provider responses to payment reform may vary based on attributes such as payer mix that could have implications for health disparities.


Assuntos
Anemia/terapia , Reforma dos Serviços de Saúde/organização & administração , Medicare/organização & administração , Sistema de Pagamento Prospectivo/organização & administração , Diálise Renal/economia , Adolescente , Adulto , Idoso , Anemia/economia , Anemia/etiologia , Eritropoetina/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Hemoglobinas/análise , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Sistema de Pagamento Prospectivo/economia , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Diálise Renal/normas , Estados Unidos , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 512, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337396

RESUMO

BACKGROUND: The synthetic control method (SCM) is a useful tool in providing unbiased analysis on the policy effect in real-world health policy evaluations. Through controlling for a few confounding factors, we aim to apply SCM in analyzing the impact of the pricing reform on medical expenditure structure in Jiangsu Province, China. METHODS: We constructed a synthetic control for Zhenjiang, a city where the reform was piloted in Jiangsu, by selecting weights on those potential control units to define a linear combination of the control outcomes to replicate the counterfactual as if the intervention is in absence. The policy effect was measured by the differences in the percentage of drug expenditure among average outpatient and inpatient care cost per visit in the post-policy period between Zhenjiang and its synthetic control. We also examined the significance of the estimated results by performing placebo tests, and cross-validated the results with a difference-in-differences analysis. RESULTS: The medical pricing reform was found to be effective in reducing the drug expenditure proportions in both outpatient and inpatient care by an estimated mean level of 7.7 and 3.2% (or 16.3 and 9.2% relative decrease to their 2012 levels) respectively. This reform effect was estimated to be significant in the placebo tests and was further confirmed by a cross-validation. CONCLUSION: We conclude that the pricing reform in public hospitals has significantly reduced drug expenditure incurred in both outpatient and inpatient care. This study also highlights the applicability of SCM method as an effective tool for health policy evaluation using publicly available data in the context of Chinese healthcare system.


Assuntos
Comércio , Reforma dos Serviços de Saúde/economia , Gastos em Saúde/tendências , Política de Saúde , Hospitais Públicos , China , Assistência à Saúde , Hospitalização , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais
10.
J Health Polit Policy Law ; 44(5): 789-806, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31199867

RESUMO

The Delivery System Reform Incentive Payment (DSRIP) program, an increasingly utilized payment strategy to foster population health management by hospitals and outpatient providers, may sometimes generate financial and operational hardships for safety net hospitals (SNHs). The authors utilized a hospital survey and stakeholder interviews to examine impacts of the New Jersey DSRIP program, particularly focusing on its participatory structure that extended eligibility to all hospitals, and specific effects on SNHs. They found that the New Jersey DSRIP fulfilled its primary objective of conditioning receipt of Medicaid supplementary payments on quality and reporting of care by hospitals. It also provided an impetus to ongoing hospital-directed initiatives and introduced new areas of focus, including behavioral health and obesity. However, stakeholders reported that program implementation was not sensitive to specific constraints, priorities, and resource needs of SNHs. Some of the policies relating to outpatient partnerships, reporting of quality metrics, and monitoring low-income populations were perceived to have placed disproportionate burdens on SNHs. Despite appearing to meet its primary goals, the New Jersey DSRIP experience reveals a critical need to be responsive to problems faced by SNHs so as to limit their short-term transition costs and maintain financial viability for serving their patient populations.


Assuntos
Medicaid/economia , Gestão da Saúde da População , Reembolso de Incentivo , Provedores de Redes de Segurança/economia , Reforma dos Serviços de Saúde/economia , Serviços de Saúde/economia , New Jersey , Estados Unidos
11.
BMC Health Serv Res ; 19(1): 329, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122226

RESUMO

BACKGROUND: The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China. METHODS: Patient discharge records (n = 1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs. RESULTS: A small number of tertiary hospitals (n = 75, 12.41%) shared 51.71% (n = 770,823) of all admitted cases while a large number of primary/unrated hospitals (n = 321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR = 1.13) and those with a lower level of insurance entitlements (OR = 1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees). CONCLUSION: The level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.


Assuntos
Hospitalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitais , Humanos , Lactente , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transferência de Pacientes/economia , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Adulto Jovem
12.
BMC Health Serv Res ; 19(1): 231, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992013

RESUMO

BACKGROUND: Considering catastrophic health expenses in rural households with hospitalised members were unproportionally high, in 2013, China developed a model of systemic reform in Sanming by adjusting payment method, pharmaceutical system, and medical services price. The reform was expected to control the excessive growth of hospital expenditures by reducing inefficiency and waste in health system or shortening the length of stay. This study analyzed the systemic reform's impact on the financial burden and length of stay for the rural population in Sanming. METHODS: A total of 1,113,615 inpatient records for the rural population were extracted from the rural new cooperative medical scheme (NCMS) database in Sanming from 2007 to 2012 (before the reform) and from 2013 to 2016 (after the reform). We calculated the average growth rate of total inpatient expenditures and costs of different medical service categories (medications, diagnostic testing, physician services and therapeutic services) in these two periods. Generalized linear models (GLM) were employed to examine the effect of reform on out-of-pocket (OOP) expenditures and length of stay, controlling for some covariates. Furthermore, we controlled the fixed effects of the year and hospitals, and included cluster standard errors by hospital to assess the robustness of the findings in the GLM analysis. RESULTS: The typical systemic reform decreased the average growth rate of total inpatient expenditures by 1.34%, compared with the period before the reform. The OOP expenditures as a share of total expenditures showed a downward trend after the reform (42.34% in 2013). Holding all else constant, individuals after the reform spent ¥308.42 less on OOP expenditures (p < 0.001) than they did before the reform. Moreover, length of stay had a decrease of 0.67 days after the reform (p < 0.001). CONCLUSIONS: These results suggested that the typical systemic hospital reform of the Sanming model had some positive effects on cost control and reducing financial burden for the rural population. Considering the OOP expenditures as a share of total expenditures was still high, China still has a long way to go to improve the benefits rural people have enjoyed from the NCMS.


Assuntos
Gastos em Saúde , Hospitalização/economia , Hospitais Rurais/economia , Adulto , Idoso , China/epidemiologia , Controle de Custos , Feminino , Reforma dos Serviços de Saúde/economia , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Saúde da População Rural/economia
13.
Bull World Health Organ ; 97(4): 250-251, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940980

RESUMO

Four decades after the declaration of Alma Ata, Kazakhstan still struggles to provide basic health care to its citizens. This may now be changing. Andrey Shukshin reports.


Assuntos
Reforma dos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Registros Eletrônicos de Saúde , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/métodos , Acesso aos Serviços de Saúde , Humanos , Cazaquistão , Cobertura Universal do Seguro de Saúde/economia
14.
Inquiry ; 56: 46958019842001, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31014152

RESUMO

The Patient Protection and Affordable Care Act (PPACA) has provided access to health care for millions of people in the United States. One of the most beneficial aspects of the PPACA is the obesity screening and counseling provision. Currently, it is estimated that over 39% of US adults are obese. Research has linked sleep disturbances to obesity and obesity-related behaviors. The purpose of this article is to advocate for evidence-based care through the inclusion of sleep disturbance screening and management under the PPACA obesity screening and counseling provision. An in-depth policy analysis of the PPACA was conducted to examine the feasibility of adding sleep screenings to the obesity screening and counseling provision available under current law. Findings suggest that the adoption of this policy would require stakeholder advocacy and educational reform. Implementation of the policy would require additional economic investments, but the long-term savings could be significant. A campaign to raise awareness regarding the association between sleep disturbance and obesity among the public and health care professionals would be essential. Policy implementation would require interprofessional collaboration when performing sleep disordered screening and management. Preventative health care for individuals who have not previously accessed the health care system has the potential to socially and economically benefit society if policies provide for evidence-based care. Sleep screening and counseling is essential under the PPACA to adequately address the US obesity crisis.


Assuntos
Aconselhamento , Programas de Rastreamento , Obesidade/epidemiologia , Patient Protection and Affordable Care Act/economia , Formulação de Políticas , Sono/fisiologia , Reforma dos Serviços de Saúde/economia , Humanos , Estados Unidos/epidemiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-30917496

RESUMO

High out-of-pocket (OOP) payments for chronic disease care often contribute directly to household poverty. Although previous studies have explored the determinants of impoverishment in China, few published studies have compared levels of impoverishment before and after the New Health Care Reform (NHCR) in households with members with chronic diseases (hereafter referred to as chronic households). Our study explored this using data from the fourth and fifth National Health Service Surveys conducted in Shaanxi Province. In total, 1938 households in 2008 and 7700 households in 2013 were included in the analysis. Rates of impoverishment were measured using a method proposed by the World Health Organization. Multilevel logistic modeling was used to explore the influence of the NHCR on household impoverishment. Our study found that the influence of NHCR on impoverishment varied by residential location. After the reform, in rural areas, there was a significant decline in impoverishment, although the impoverishment rate remained high. There was little change in urban areas. In addition, impoverishment in the poorest households did not decline after the NHCR. Our findings are important for policy makers in particular for evaluating reform effectiveness, informing directions for health policy improvement, and highlighting achievements in the efforts to alleviate the economic burden of households that have members with chronic diseases.


Assuntos
Doença Crônica/economia , Reforma dos Serviços de Saúde/economia , Pobreza/estatística & dados numéricos , China , Características da Família , Feminino , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
19.
Fam Syst Health ; 37(1): 74-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30920263

RESUMO

INTRODUCTION: Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care. METHOD: This paper offers a primer on the current state of health care spending in the United States, an overview of public and private payers, and the challenges each faces in paying for integrated care. DISCUSSION: Future journal articles in the FSH Policy and Management Department will describe key payment policy and management opportunities for integrated care payment reform. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/normas , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/métodos , Alfabetização em Saúde , Sistema de Pagamento Prospectivo/tendências , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Reforma dos Serviços de Saúde/tendências , Humanos , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Estados Unidos
20.
BMJ Open ; 9(1): e022345, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30782678

RESUMO

INTRODUCTION: In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries. METHODS AND ANALYSIS: The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory. ETHICS AND DISSEMINATION: The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.


Assuntos
Reforma dos Serviços de Saúde/economia , Planejamento em Saúde/organização & administração , Política de Saúde , Cobertura Universal do Seguro de Saúde/organização & administração , Burkina Faso , Cabo Verde , República Democrática do Congo , Programas Governamentais/economia , Reforma dos Serviços de Saúde/organização & administração , Humanos , Relações Interinstitucionais , Libéria , Luxemburgo , Níger , Formulação de Políticas , Projetos de Pesquisa , Togo
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