ABSTRACT
The rapid cost escalation and vast supplier-induced demands in the Chinese health care system are well-known to the health policy research community. The existing literature tends to explain the pervasive overprovision of care by financial incentives of hospitals and physicians. Behind this is a series of misaligned perverse incentives embedded in the Chinese health system for decades. With a survey of public hospital physicians in a city of Guangdong, this study re-veals that the overprovision of care, especially overprescription, is not solely driven by economic incentives, but also by physicians’ motive of avoiding potential disputes with patients, reflecting defensive medical behaviors. The survey was con-ducted in December 2013, which selected 504 licensed physicians by random sampling. The regression analysis suggests that low income and the perceived imbalance between efforts and rewards indeed contribute to physicians’ motivation of de-fensive medicine. In the meantime, their past experiences of medical disputes with patients are also found significantly as-sociated with defensive behaviors. This study has revealed the critical impacts of the escalating tension between doctors and patients in distorting physician’ behaviors, and lays out policy recommendations.
ABSTRACT
Payment system reforms have become an important part of Chinese healthcare reforms, and global budget has been seen as a major trend. Based on the practice and data of four pilot hospitals in Beijing which have implemented the global budget, this paper focuses on analyzing the effects of implementation on the following aspects and provides references for policy improvements: medical services, average medical cost, total health expenditure, medical cost structure, average length of stay and out-of-pocket expense percentages.
ABSTRACT
The Korean medical community has recently faced political conflicts with the government in the implementation of the Korean diagnosis-related groups (DRG) payment system. This study found that scientific evidence is insufficient so far to support the claim that the DRG results in lower medical expenses without sacrificingthe quality of health care. There is no 'free lunch' and 'free DRG' as well. Unreasonable and compulsory implementation of the Korean DRG may give rise to an unwanted burden to both the Korean people and medical community. The economic burden of the patient is unlikely to decrease after Korean DRG application, given the lack of scientific and political evidence for this possibility. We can expect that the systems will be effective in holding down medical expenses in the long term. However, it will not be practical without the reduction of medical expenses by means such as reducing hospitalization service and other medical service amount. The enforcement of the Korean DRG payment system appears to be one of the typical cases of excessive state intervention in health policy in the history of Korea.
Subject(s)
Humans , Cost Control , Diagnosis-Related Groups , Health Policy , Hospitalization , Korea , Quality of Health CareABSTRACT
This paper intends to answer the following research question: On which extent are these measures effective and efficient with regard to Cost-containment in health care? A descriptive study is done starting from a revision of the published literature in the European Union member states. With the objective of responding to this question, a description of what health is and also what health care is, which its components of costs in health are, what is understood by Health Technology Assessment and which are their applications and the utility of that this tool represents to control the costs in health. It is described in the health output measurement and which are the mostly used tools to measure the gain in health of the patients after doing an intervention on him/her in the System of health. A description of the diverse components of Costs-containment is done, which of these are used, how they are used, what impact they have on health systems and finally, it concludes that one of the best tools for the cost-containment is the products that the agencies/offices of Health Technology Assessment generate, products generated from researching interventions on health, assessing its effectiveness, its scientific evidence and the impact on the populations health. It is worth mentioning that the products of the Health Technology Assessment Agencies are a fundamental tool for the decision making in the health systems.
Este artículo pretende responder la siguiente pregunta de investigación: ¿Hasta qué punto las acciones en salud son eficaces y eficientes para controlar los costos? Se realizó este trabajo a partir de una revisión de la literatura publicada en los países miembros de la Unión Europea. Con el objetivo de responder esta pregunta se realiza una descripción de lo que es salud y el cuidado de la salud, cuáles son sus componentes de costos en salud, qué se entiende por evaluación de tecnología en salud y cuáles son sus aplicaciones y la utilidad que esta herramienta representa para controlar los costos en salud. Se describe la medición de los resultados (outputs) en salud y cuáles son las herramientas más utilizadas para medir la ganancia en salud de los pacientes luego de efectuar una intervención en el Sistema de Salud. Se realiza una descripción de los diversos componentes de contención de costos, cuáles de estos son los más utilizados, cómo se utilizan, qué impacto tienen en los sistemas de salud; y se concluye que una de las mejores herramientas para la contención de costos son los productos que genera las agencias o las oficinas de Evaluación de tecnologías en salud, generados a partir de la investigación de las intervenciones en salud, evaluando su efectividad, evidencia científica y el impacto en la salud de la población. Es de anotar que los productos de las Agencias de Evaluación de Tecnologías en Salud son una herramienta fundamental para la toma de decisiones en los sistemas de salud.
Subject(s)
Cost Control , TechnologyABSTRACT
A major share of the hospital budget gets consumed in maintaining its pharmacy services. The cost consumption pattern of different group of medicines is directly related to the prescription load and prescription pattern. The Medical Officers and specialists of the hospital have got all important role in rational prescription in term of current therapeutics and saving on over prescription. A study carried out in a tertiary level super-speciality hospital indicated that the total cost of medicine per OPD day and cost of antibiotics work out to be Rs. 45291 and Rs. 11974 on an average, respectively. The average cost per prescription of OPD was up to Rs. 123.75.
ABSTRACT
Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
Subject(s)
Humans , Anesthesia , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholelithiasis , Cost Control , Health Expenditures , Hospital Charges , Inpatients , Insurance, Health , Korea , SpecializationABSTRACT
The united states adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses: (l) The PPS decelerated the increase in the hospital expenditure (part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the part A expenditure were greater than losses in the part B expenditure. The dependent variables are per capita hospital expenditure, per capita part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows: (l) The annual increase in the per capita part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significant (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita part B expenditure was accelerated by $l.73 (t=l.91) after the implementation of the PPS. (3) The increase in the total Medicine expenditure per capita was reduced by $4.26(t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.
Subject(s)
Humans , Cost Savings , Diagnosis-Related Groups , Health Care Costs , Health Expenditures , Inflation, Economic , Medicare , Outpatients , Prospective Payment System , United StatesABSTRACT
The variation in resource utilization for hospitalized patients who had a group of similar disease -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utilization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs: the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs; the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs; the ratio of the maximum and the minimum among the mean LOS of hospitals was greater than 2 in 82 KDRGs; the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.