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2.
J Surg Res ; 244: 599-603, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31536845

RESUMO

BACKGROUND: Section 6002 of the Affordable Care Act, commonly referred to as "The Sunshine Act," is legislation designed to provide transparency to the relationship between physicians and industry. Since 2013, medical product and pharmaceutical manufacturers were required to report any payments made to physicians to the Centers for Medicare and Medicaid Services (CMS). We predicted that most clinical faculty at our institution would be found on the Open Payments website. We elected to investigate payments in relationship to divisions within the department of surgery and the level of professorship. METHODS: All clinical faculty (n = 86) within the department of surgery at our institution were searched within the database: https://openpaymentsdata.cms.gov/. The total amount of payments, number of payments, and the nature of payments (food and beverage, travel and lodging, consulting, education, speaking, entertainment, gifts and honoraria) were recorded for 2017. Comparison by unpaired t-test (or ANOVA) where applicable, significance defined as P < 0.05. RESULTS: Of the 86 faculty studied, 75% were found within the CMS Open Payments database in 2017. The mean amount of payment was $4024 (range $13-152,215). Median amount of payment was $434.90 (range $12.75-152,214.70). Faculty receiving outside compensation varied significantly by division and academic rank (P < 0.05). Plastic surgery had the highest percentage of people receiving any form of payment ($143-$1912) and GI surgery had the largest payments associated with device management ($0-$152,215). The variation seen by rank was driven by a small number of faculty with receipt of large payments at the associate professor level. The median amount of payment was $428.53 (range $13.97-2306.05) for assistant professors, $5328.03 (range $28.30-152,214.70) for Associate Professors, and $753.82 (range $12.75-17,708.65) for full professors. CONCLUSIONS: Reporting of open payments to CMS provides transparency between physicians and industry. The significant relationship of division and rank with open payments database is driven by relatively few faculty. The majority (94%) received either no payments or less than $10,000.


Assuntos
Centros Médicos Acadêmicos , Conflito de Interesses/economia , Revelação/estatística & dados numéricos , Indústria Farmacêutica , Docentes de Medicina/economia , Cirurgiões/economia , Alabama , Conflito de Interesses/legislação & jurisprudência , Bases de Dados Factuais , Revelação/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Docentes de Medicina/ética , Docentes de Medicina/legislação & jurisprudência , Docentes de Medicina/estatística & dados numéricos , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/legislação & jurisprudência , Humanos , Patient Protection and Affordable Care Act , Cirurgiões/ética , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Estados Unidos
3.
Semin Vasc Surg ; 32(1-2): 30-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540654

RESUMO

Vascular surgery is a specialty discipline highlighted by a lifelong learning process from which new endovascular devices and techniques will continue to emerge. Industry partnerships can provide a safe learning environment for trainees, with a focus on maximizing learning opportunities during fellowship or residency. Unlike other surgical specialties, vascular surgery empowers its trainees to become competent in both open and image-guided endovascular interventions, requiring two unique skill sets to become a contemporary vascular surgeon. Due to the rapid growth of technology and innovations, industry partnerships enhance and maximize the learning experience of the trainee by often providing the products, education, research support, and financial assistance. This can come in the form of innovative and educational activities, including simulation, exposure to thought leaders, attendance at conferences and workshops, and one-on-one assistance with cases. In this article, we review the role that industry can serve in vascular education to support budding vascular surgeons through exposure and repetition as they lay down the fundamentals of their careers.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Setor de Assistência à Saúde , Relações Interinstitucionais , Parcerias Público-Privadas , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Comportamento Cooperativo , Currículo , Educação de Pós-Graduação em Medicina/economia , Setor de Assistência à Saúde/economia , Humanos , Parcerias Público-Privadas/economia , Apoio à Pesquisa como Assunto , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/economia
4.
Health Policy Plan ; 34(7): 529-543, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31377775

RESUMO

West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.


Assuntos
Fraude/estatística & dados numéricos , Setor de Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Absenteísmo , África Ocidental , Fraude/economia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/ética , Pessoal de Saúde/economia , Humanos , Roubo/estatística & dados numéricos
5.
Georgian Med News ; (291): 126-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418745

RESUMO

The article examines the issue of public procurement in the healthcare sector through the prism of the Association Agreement with the EU. The emphasis is on the ensuring mutual access to the markets of public procurement of the EU and Ukraine on the basis of planned and consistent approximation of Ukrainian legislation in the field of public procurement to the EU acquis in the field of public procurement. The purpose of this article is to identify the peculiarities of the reform in the field of public procurement in Ukraine, to search for drawbacks in the administrative legislation of Ukraine, which is governing public procurement in the healthcare sector in the context of Ukraine's implementation of the Association Agreement with the EU, and to justify its improvement. The subject of research is the social relations that arise in the implementation of public procurement in the field of health. The methodological basis of the conducted research is the general methods of scientific cognitivism as well as concerning those used in legal science: methods of analysis and synthesis, formal logic, comparative law, statistical methods etc The following main directions of reforming the system of public procurement were established. It has been proved that CPO functioning on the national level of government in the form of a state-owned enterprise under the control of one of the relevant ministries is non-feasibility. The advantages of the ProZorro electronic procurement system and the state of implementation of the provisions of the EU Directives on 2014/23/ EU, 2014/24/ EU, 2014/25/EU, 2014/55/EU into the administrative legislation of Ukraine have been identified. It has been found that in March, 2015 centralized procurement system for medicines and medical products was changed in Ukraine to use the funds of the State Budget of Ukraine for the purchase of medicines and medical products with the involvement of international specialized organizations. On December 21, 2018 the Verkhovna Rada (Supreme Council) of Ukraine put amendments into the Law of Ukraine "On Public Procurement". The attention is paid to the novelties of this Law. It has been found that the legislation of Ukraine has such shortcomings: 1) in Ukraine the issue of clear distribution of functions of the authorities authorized to carry out control in the field of public procurements remains unresolved; 2) the norms of the Law contradict each other; 3) the problems of creating effective mechanisms for the formation of the nomenclature of medicines still remain, as well as their supplies to healthcare institutions.


Assuntos
Assistência à Saúde/legislação & jurisprudência , União Europeia , Setor de Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/economia , Setor de Assistência à Saúde/economia , Humanos , Ucrânia
8.
BMC Infect Dis ; 19(1): 539, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217003

RESUMO

BACKGROUND: There is a pressing need for systematic approaches for monitoring how much TB treatment is ongoing in the private sector in India: both to cast light on the true scale of the problem, and to help monitor the progress of interventions currently being planned to address this problem. METHODS: We used commercially available data on the sales of rifampicin-containing drugs in the private sector, adjusted for data coverage and indication of use. We examined temporal, statewise trends in volumes (patient-months) of TB treatment from 2013 to 2016. We additionally analysed the proportion of drugs that were sold in combination packaging (designed to simplify TB treatment), or as loose pills. RESULTS: Drug sales suggest a steady trend of TB treatment dispensed by the private sector, from 18.4 million patient-months (95% CI 17.3-20.5) in 2013 to 16.8 patient-months (95% CI 15.5-19.0) in 2016. Overall, seven of 29 states in India accounted for more than 70% of national-level TB treatment volumes, including Uttar Pradesh, Maharashtra and Bihar. The overwhelming majority of TB treatment was dispensed not as loose pills, but in combination packaging with other TB drugs, accounting for over 96% of private sector TB treatment in 2017. CONCLUSIONS: Our findings suggest consistent levels of TB treatment in the private sector over the past 4 years, while highlighting specific states that should be prioritized for intervention. Drug sales data can be helpful for monitoring a system as large, disorganised and opaque as India's private sector.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Setor de Assistência à Saúde/tendências , Tuberculose/tratamento farmacológico , Setor de Assistência à Saúde/economia , Humanos , Índia , Rifampina/uso terapêutico
9.
Cien Saude Colet ; 24(3): 705-714, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892493

RESUMO

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Assuntos
Atitude do Pessoal de Saúde , Odontologia/organização & administração , Odontólogos/estatística & dados numéricos , Satisfação no Emprego , Bioética , Estudos Transversais , Odontólogos/economia , Odontólogos/psicologia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Humanos , Seguro Saúde/economia , Setor Privado/economia , Setor Privado/organização & administração , Autonomia Profissional , Inquéritos e Questionários
10.
Global Health ; 15(1): 25, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922344

RESUMO

BACKGROUND: The launch of Global Health Initiatives in early 2000' coincided with the end of the war in Burundi. The first large amount of funding the country received was ear-marked for human immunodeficiency virus (HIV) and immunization programs. Thereafter, when at global level aid effectiveness increasingly gained attention, coordination mechanisms started to be implemented at national level. METHODS: This in-depth case study provides a description of stakeholders at national level, operating in the health sector from early 2000' onwards, and an analysis of coordination mechanisms and stakeholders perception of these mechanisms. The study was qualitative in nature, with data consisting of interviews conducted at national level in 2009, combined with document analysis over a 10 year-period. RESULTS: One main finding was that HIV epidemic awareness at global level shaped the very core of the governance in Burundi, with the establishment of two separate HIV and health sectors. This led to complex, nay impossible, inter-institutional relationships, hampering aid coordination. The stakeholder analysis showed that the meanings given to 'coordination' differed from one stakeholder to another. Coordination was strongly related to a centralization of power into the Ministry of Health's hands, and all stakeholders feared that they may experience a loss of power vis-à-vis others within the development field, in terms of access to resources. All actors agreed that the lack of coordination was partly related to the lack of leadership and vision on the part of the Ministry of Health. That being said, the Ministry of Health itself also did not consider itself as a suitable coordinator. CONCLUSIONS: During the post-conflict period in Burundi, the Ministry of Health was unable to take a central role in coordination. It was caught between the increasing involvement of donors in the policy making process in a so-called fragile state, the mistrust towards it from internal and external stakeholders, and the global pressure on Paris Declaration implementation, and this fundamentally undermined coordination in the health sector.


Assuntos
Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Cooperação Internacional , Conflitos Armados , Burundi/epidemiologia , Governo , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Pesquisa Qualitativa , Participação dos Interessados
11.
Eur J Health Econ ; 20(5): 751-762, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30796552

RESUMO

Although cost-effectiveness analysis has a long tradition of supporting healthcare decision-making in Sweden, there are no clear criteria for when an intervention is considered too expensive. In particular, the opportunity cost of healthcare resource use in terms of health forgone has not been investigated empirically. In this work, we therefore seek to estimate the marginal cost of a life year in Sweden's public healthcare sector using time series and panel data at the national and regional levels, respectively. We find that estimation using time series is unfeasible due to reversed causality. However, through panel instrumental variable estimation we are able to derive a marginal cost per life year of about SEK 370,000 (EUR 39,000). Although this estimate is in line with emerging evidence from other healthcare systems, it is associated with uncertainty, primarily due to the inherent difficulties of causal inference using aggregate observational data. The implications of these difficulties and related methodological issues are discussed.


Assuntos
Análise Custo-Benefício , Setor de Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Setor Público/economia , Anos de Vida Ajustados por Qualidade de Vida , Humanos , Expectativa de Vida , Fatores Socioeconômicos , Suécia
12.
Am Econ Rev ; 109(2): 473-522, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30707004

RESUMO

We evaluate the consequences of narrow hospital networks in commercial health care markets. We develop a bargaining solution, "Nash- in-Nash with Threat of Replacement," that captures insurers' incentives to exclude, and combine it with California data and estimates from Ho and Lee (2017) to simulate equilibrium outcomes under social, consumer, and insurer- optimal networks. Private incentives to exclude generally exceed social incentives, as the insurer benefits from substantially lower negotiated hospital rates. Regulation prohibiting exclusion increases prices and premiums and lowers consumer welfare without significantly affecting social surplus. However, regulation may prevent harm to consumers living close to excluded hospitals.


Assuntos
Setor de Assistência à Saúde/economia , Reembolso de Seguro de Saúde/economia , Seguro Saúde/economia , Programas de Assistência Gerenciada/economia , Modelos Econômicos , Negociação , California , Controle de Custos , Hospitais , Humanos , Estados Unidos
13.
Int J Health Serv ; 49(2): 237-259, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30678522

RESUMO

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.


Assuntos
Recessão Econômica , Setor de Assistência à Saúde/economia , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Setor de Assistência à Saúde/organização & administração , Gastos em Saúde , Política de Saúde , Humanos , Modelos Econométricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Portugal
14.
Value Health ; 22(1): 69-76, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661636

RESUMO

BACKGROUND: It is uncertain whether consolidation in health care markets affects the quality of care provided and health outcomes. OBJECTIVES: To examine whether changes in market competition resulting from acquisitions by two large national for-profit dialysis chains were associated with patient mortality. METHODS: We identified patients initiating in-center hemodialysis between 2001 and 2009 from a registry of patients with end-stage renal disease in the United States. We considered two scenarios when evaluating consolidation from dialysis facility acquisitions: one in which we considered only those patients receiving dialysis in markets that became substantially more concentrated to have been affected by consolidation, and the other in which all patients living in hospital service areas where a facility was acquired were potentially affected. We used a difference-in-differences study design to examine the associations between market consolidation and changes in mortality rates. RESULTS: When we considered the 12,065 patients living in areas that became substantially more consolidated to have been affected by consolidation, we found a nominally significant (8%; 95% confidence interval 0%-17%) increase in likelihood of death after consolidation. Nevertheless, when we considered all 186,158 patients living in areas where an acquisition occurred to have been affected by consolidation, there was no observable effect of market consolidation on mortality. CONCLUSIONS: Decreased market competition may have led to increased mortality among a relatively small subset of patients initiating in-center hemodialysis in areas that became substantially more concentrated after two large dialysis acquisitions, but not for most of the patients living in affected areas.


Assuntos
Comércio , Competição Econômica , Custos de Cuidados de Saúde , Setor de Assistência à Saúde/economia , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Garantia da Qualidade dos Cuidados de Saúde/economia , Diálise Renal/economia , Instituições de Assistência Ambulatorial/economia , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Propriedade/economia , Sistema de Registros , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
16.
Gac Sanit ; 33(5): 462-467, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30143246

RESUMO

OBJECTIVE: This paper presents a methodology to optimize, using Altman's Z-Score for private companies, the prediction of private companies of the Spanish health sector entering a situation of bankruptcy. METHOD: The proposed method consists of the application of genetic algorithms (GA) to find the coefficients of the formula of the chain of ratios proposed by Altman in the version of the score for private companies which optimize the prediction for Spanish private health companies, maximizing sensitivity and specificity, and thereby reducing type I and type II errors. For this purpose, a sample of 5,903 companies from the Spanish private health sector obtained from the database of the Iberian Balance Analysis System (SABI) between 2007 and 2015 was used. RESULTS: The results show that the predictive model obtained with the AG presents greater accuracy, sensitivity and specificity than that proposed by Altman for private companies with both test data and all sample data. CONCLUSIONS: The most important finding of this study was to establish a methodology that can identify the optimized coefficients for the Altman Z-Score, which allows a more accurate prediction of bankruptcy in Spanish private healthcare companies.


Assuntos
Algoritmos , Falência , Setor de Assistência à Saúde/economia , Setor Privado/economia , Inteligência Artificial , Previsões , Humanos , Espanha
17.
Environ Sci Pollut Res Int ; 26(4): 3196-3207, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29270899

RESUMO

The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.


Assuntos
Poluição Ambiental , Setor de Assistência à Saúde/organização & administração , Hospitais/normas , Modelos Teóricos , Gerenciamento de Resíduos/normas , Tomada de Decisões , Poluição Ambiental/análise , Poluição Ambiental/prevenção & controle , Setor de Assistência à Saúde/economia , Humanos , Gerenciamento de Resíduos/economia
18.
Int J Health Plann Manage ; 34(1): e21-e33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30370564

RESUMO

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Setor de Assistência à Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Recessão Econômica , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/métodos , Setor de Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Humanos , Portugal , Setor Privado/organização & administração , Saúde Pública , Setor Público/organização & administração
19.
J Surg Res ; 233: 41-49, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502279

RESUMO

BACKGROUND: The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among surgical specialties, and to identify geographic distribution of payments. MATERIALS AND METHODS: We included all reported industry payments in the Centers for Medicare and Medicaid Services' Open Payments Program in the United States, 2014-2015. Multivariable regression fixed effects panel analysis of total payments was conducted among surgeons, adjusting for surgeon specialty, payor type, payment category, and state. A geographic heat map was created. RESULTS: Of 2,097,150 subjects meeting criteria, 1,957,528 (45.66%) were physicians. The mean standard deviation (SD) payment overall was $232.64 ($6262.00), and the state with the highest mean (SD) payment was Vermont at $2691.61 ($11,508.40). Surgeons numbered 153,916 (7.86%). The specialty with the highest mean (SD) payment was orthopedic surgery at $2811.50 ($33,632.71, P < 0.001). Among 2,097,150 subjects meeting criteria, in multivariable regression fixed effects panel analysis, orthopedic compared to general surgeons were significantly likely to receive more industry payments (beta $1065.34 [95% CI $279.00-1851.00, P = 0.008), even controlling for payor, payment type, and state. Significant geographic disparities in payment were noted as 12 states received the top mean ($24.52-$500,000.00), leaving seven states with the lowest ($0.00-$12.56). CONCLUSIONS: There are significant differences in industry payments to surgeons versus nonsurgeons and among surgical specialties, as well geographic distribution of payments. These data may prompt further investigation into trends and their causality and effects on research and practice.


Assuntos
Setor de Assistência à Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Especialidades Cirúrgicas/economia , /estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Setor de Assistência à Saúde/estatística & dados numéricos , Setor de Assistência à Saúde/tendências , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/tendências , Análise Espacial , Especialidades Cirúrgicas/estatística & dados numéricos , Especialidades Cirúrgicas/tendências , Estados Unidos
20.
Geriatr Nurs ; 40(3): 296-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30528039

RESUMO

Despite cumulative and integrative evidence of registered nurse (RN) staffing on nursing home residents' outcomes worldwide, few studies integrate the effects of residents' case mix, healthcare markets, and nurse staffing on psychotropic-medication use and weight loss in Korea. This article examined the relationship between nurse staffing and residents' quality-of-care outcomes, controlling for long-term healthcare market characteristics in Korea. Using a multilevel cross-sectional design, a disproportionate stratified random sampling was used. Of 87 nursing homes contacted, 60 agreed to participate. Weighted linear regression was used to test the hypotheses. RN hours per resident day (HPRD) had a statistically significant positive impact on reducing the number of residents with psychotropic medication (ß = - .331, p = .008). Greater RN HPRD positively marginally related to fewer residents with cognitive impairment (ß = - 0.201, p = .139). Higher turnover of RN staff related to decreased proportions of residents with weight loss (ß = - .331 p = .008). Policymakers should cautiously consider requiring mandatory nurse staffing in nursing homes in Korea, where it is still acceptable to have certified nurse aids as substitutes for RNs.


Assuntos
Enfermeiras e Enfermeiros/provisão & distribução , Casas de Saúde/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Estudos Transversais , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Humanos , Assistentes de Enfermagem/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/economia , Reorganização de Recursos Humanos/estatística & dados numéricos , República da Coreia
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