ABSTRACT
L'hypertension artérielle est une maladie à forte progression reste un problème de santé publique. Mais, les pratiques de sa prise en charge se heurtent à différents obstacles. Cette recherche questionne les problèmes qui caractérisent les pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d'Abomey-Calavi au Bénin. Pour y parvenir, nous avons opté pour une analyse basée sur les méthodes quantitatives et qualitatives. L'échantillon est constitué de 130 personnes enquêtées. De l'analyse des résultats collectés, des difficultés éprouvées entre patients et agents de santé dans la prise en charge de l'hypertension artérielle, se caractérise par le manque de relation soignant-soigné. De même, 90% des enquêtés estiment avoir peu de ressources humaines qualifiées et du faible pouvoir d'achat des patients pour faire face aux coûts élevés du traitement de l'hypertension (86,75%). Ainsi, le manque de plateau technique et les frais de consultations spécialisées posent problèmes y compris les suivis de l'éducation hygiéno-diététique. Cet état de fait compromet les pratiques de prise en charge et les formations globales que le système soin est supposé assurer aux usagers qui le fréquentent. Ces résultats suggèrent l'urgence de formations pour le renforcement des capacités pour repérer la précarité et la réorganisation des mesures de prise en charge de l' hypertension artérielle dans le périmètre sanitaire béninois.
Arterial hypertension remains a rapidly growing public health problem. However, management practices face a number of obstacles. This research questions the problems that characterize arterial hypertension management practices at the Centre Hospitalier et Universitaire d'Abomey-Calavi in Benin. To achieve this, we opted for an analysis based on quantitative and qualitative methods. The sample consisted of 130 respondents. From the analysis of the results collected, of the difficulties experienced between patients and health workers in the management of arterial hypertension, most of those surveyed claimed to have a complexity that characterizes the training of health workers. Similarly, 90% of respondents felt that they had few non-cardiologist practitioners, and that patients had little purchasing power to meet the high costs of treating hypertension (86.75%). As a result, the cost of specialized consultations and complementary examinations poses a problem, including follow-up health and diet education. This state of affairs compromises management practices and the comprehensive training that the healthcare system is supposed to provide for its users. These results suggest the urgent need for training to identify precariousness, and the reorganization of hypertension management measures within the Beninese health perimeter.
Subject(s)
Surveys and Questionnaires , Fees and ChargesABSTRACT
La motivation des agents de santé à travers le paiement à temps et complet constitue l'un des éléments clés pour atteindre de bonne couverture vaccinale. Notre objectif était de décrire le paiement électronique utilisé lors de la campagne rubéole-rougeole et d'apprécier la satisfaction du personnel de santé. Nous avons réalisé une étude transversale à visée analytique qui s'est déroulée en Côte d'Ivoire du 15 janvier au 18 février 2019. La population d'étude était constituée des acteurs impliqués à la fois dans la campagne de vaccination contre la rougeole- rubéole en 2018 et dans le paiement électronique. Une recherche documentaire et des entretiens structurés ont permis le recueil des données. Les données ont été analysées à partir du logiciel R studio© version 2021. Le système assurant le paiement électronique se composait des autorités sanitaires, d'un opérateur privé de téléphonie mobile, d'un partenaire technique et financier et des agents de santé bénéficiaires. Un système de critères d'identification, des listes de validation et de vérification à plusieurs niveaux de la pyramide sanitaire a été mis en place. Un peu moins de trois quarts des acteurs du niveau primaire ont été satisfaits par ce mode de paiement. Le paiement électronique constitue un procédé pour améliorer le paiement des agents de santé durant les campagnes de vaccination. Des leçons d'un tel système de paiement devraient être tirées pour un déploiement à grande échelle.
Motivating healthcare workers through timely and complete payment is one of the key elements to achieve high vaccination coverage. Our objective was to describe the use of electronic payment during the measles-rubella campaign and assess the satisfaction of healthcare personnel. We conducted a cross-sectional analytical study in Côte d'Ivoire from January 15 to February 18, 2019. The study population consisted of individuals involved in both the measles-rubella vaccination campaign in 2018 and electronic payment. Data collection was done through documentary research and structured interviews. The data were analyzed using R Studio© software version 2021. The electronic payment system involved health authorities, a private mobile network operator, a technical and financial partner, and the beneficiary healthcare workers. A system of criteria for identifying lists, validation, and multilevel verification within the healthcare pyramid was established. Just under three-quarters of primarylevel actors were satisfied with this payment method. Electronic payment presents an opportunity to improve healthcare worker payment during vaccination campaigns. Lessons from such a payment system should be drawn for large-scale deployment.
Subject(s)
Humans , Male , Female , Personal Satisfaction , Delivery of Health Care , Electronics, Medical , Fees and ChargesABSTRACT
BACKGROUND@#There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants.@*METHODS@#We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression.@*RESULTS@#A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions.@*CONCLUSIONS@#The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Length of Stay , Fees and Charges , Arthroplasty, Replacement, Knee/economics , China , Databases, Factual , InpatientsABSTRACT
Background: To control the spread of coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it is necessary to adequately identify and isolate infectious patients particularly at the work place. Real time polymerase chain reaction (RT-PCR) assay is the recommended confirmatory method for the diagnosis of SARS-CoV-2 infection. The aim of this study was to determine the prevalence of SARSCoV-2 infection in Burkina Faso and to use the initial cycle threshold (Ct) values of RT-PCR as a tool to monitor the dynamics of the viral load. Methodology: Between September 2021 and February 2022, oropharyngeal and/or nasopharyngeal swab samples of consecutively selected COVID-19 symptomatic and apparently healthy workers from the Wahgnion mining site in the South-western Burkina Faso who consented to the study were collected according to the two weeks shift program and tested for SARS-CoV-2 using RT-PCR assay. Patients positive for the virus were followed-up weekly until tests were negative. Association of the initial RT-PCR Ct values with disease duration was assessed by adjusted linear regression approach. Two-sided p value < 0.05 was considered statistically significant. Results: A total of 1506 (92.9% males) participants were recruited into the study, with mean age and age range of 37.1ï±8.7 and 18-68 years respectively. The overall prevalence of SARS-CoV-2 infection was 14.3% (216/1506). Of the 82 patients included in the follow-up study, the longest duration of positive RT-PCR test, from the first positive to the first of the two negative RT-PCR tests, was 33 days (mean 11.6 days, median 10 days, interquartile range 8- 14 days). The initial Ct values significantly correlated with the duration of RT-PCR positivity (with ß=-0.54, standard error=0.09 for N gene, and ß=-0.44, standard error=0.09 for ORF1ab gene, p<0.001). Participants with higher Ct values corresponding to lower viral loads had shorter viral clearance time than those of lower Ct values or higher viral loads. Conclusion: Approximately 1 out of 7 tested miners had SARS-CoV-2 infection and the duration of their RT-PCR tests positivity independently correlated with the initial viral load measured by initial Ct values. As participants with lower initial Ct values tended to have longer disease duration, initial RT-PCR Ct values could be used to guide COVID-19 patient quarantine duration particularly at the work place.
Contexte: Pour contrôler la propagation de la maladie à coronavirus 19 (COVID-19) causée par le syndrome respiratoire aigu sévère coronavirus-2 (SRAS-CoV-2), il est nécessaire d'identifier et d'isoler de manière adéquate les patients infectieux, en particulier sur le lieu de travail. Le test de réaction en chaîne par polymérase en temps réel (RT-PCR) est la méthode de confirmation recommandée pour le diagnostic de l'infection par le SRAS-CoV-2. Le but de cette étude était de déterminer la prévalence de l'infection par le SRAS-CoV-2 au Burkina Faso et d'utiliser les valeurs du seuil initial du cycle (Ct) de la RT-PCR comme outil de suivi de la dynamique de la charge virale. Méthodologie: Entre septembre 2021 et février 2022, des écouvillonnages oropharyngés et/ou nasopharyngés de travailleurs symptomatiques COVID-19 et apparemment en bonne santé sélectionnés consécutivement du site minier de Wahgnion dans le sud-ouest du Burkina Faso qui ont consenti à l'étude ont été prélevés selon les deux programme de quart de semaines et testé pour le SRAS-CoV-2 à l'aide d'un test RT-PCR. Les patients positifs pour le virus ont été suivis chaque semaine jusqu'à ce que les tests soient négatifs. L'association des valeurs Ct initiales de la RT-PCR avec la durée de la maladie a été évaluée par une approche de régression linéaire ajustée. Une valeur p bilatérale < 0,05 a été considérée comme statistiquement significative. Résultats: Un total de 1506 participants (92,9% d'hommes) ont été recrutés dans l'étude, avec un âge moyen et une tranche d'âge de 37,1 à 8,7 ans et de 18 à 68 ans, respectivement. La prévalence globale de l'infection par le SRAS-CoV-2 était de 14,3% (216/1506). Sur les 82 patients inclus dans l'étude de suivi, la plus longue durée de test RT-PCR positif, du premier test positif au premier des deux tests RT-PCR négatifs, était de 33 jours (moyenne 11,6 jours, médiane 10 jours, intervalle interquartile 8-14 jours). Les valeurs Ct initiales étaient significativement corrélées à la durée de positivité de la RT-PCR (avec ß=-0,54, erreur standard=0,09 pour le gène N et ß=-0,44, erreur standard=0,09 pour le gène ORF1ab, p<0,001). Les participants avec des valeurs de Ct plus élevées correspondant à des charges virales plus faibles avaient un temps de clairance virale plus court que ceux avec des valeurs de Ct plus basses ou des charges virales plus élevées. Conclusion: Environ 1 mineur testé sur 7 était infecté par le SRAS-CoV-2 et la durée de la positivité de ses tests RTPCR était indépendamment corrélée à la charge virale initiale mesurée par les valeurs Ct initiales. Comme les participants avec des valeurs Ct initiales inférieures avaient tendance à avoir une durée de maladie plus longue, les valeurs Ct initiales de la RT-PCR pourraient être utilisées pour guider la durée de la quarantaine des patients COVID19, en particulier sur le lieu de travail.
Subject(s)
Humans , Male , Female , Follow-Up Studies , Workplace , Diagnosis , Fees and Charges , Real-Time Polymerase Chain Reaction , Miners , SARS-CoV-2 , COVID-19 , NasopharynxABSTRACT
Abstract In this study, the manufacturing process of lamivudine (3TC) and zidovudine (AZT) tablets (150+300 mg respectively) was evaluated using statistical process control (SPC) tools. These medicines are manufactured by the Fundação para o Remédio Popular "Chopin Tavares de Lima" (FURP) laboratory, and are distributed free of charge to patients infected with HIV by the Ministry of Health DST/AIDS national program. Data of 529 batches manufactured from 2012 to 2015 were collected. The critical quality attributes of weight variation, uniformity of dosage units, and dissolution were evaluated. Process stability was assessed using control charts, and the capability indices Cp, Cpk, Pp, and Ppk (process capability; process capability adjusted for non-centered distribution; potential or global capability of the process; and potential process capability adjusted for non-centered distribution, respectively) were evaluated. 3TC dissolution data from 2013 revealed a non-centered process and lack of consistency compared to the other years, showing Cpk and Ppk lower than 1.0 and the chance of failure of 2,483 in 1,000,000 tablets. Dissolution data from 2015 showed process improvement, revealed by Cpk and Ppk equal to 2.19 and 1.99, respectively. Overall, the control charts and capability indices showed the variability of the process and special causes. Additionally, it was possible to point out the opportunities for process changes, which are fundamental for understanding and supporting a continuous improvement environment.
Subject(s)
Tablets/analysis , Zidovudine/agonists , HIV/pathogenicity , Lamivudine/agonists , Patients/classification , Total Quality Management/organization & administration , Fees and Charges/statistics & numerical data , Laboratories/classification , Manufactured Materials/supply & distributionABSTRACT
A falsa coletivização é um fenômeno crescente no mercado brasileiro de planos e seguros de saúde. Ela decorre diretamente de decisões regulatórias que afetam o setor, especialmente as diferenças entre regras aplicáveis a contratos individuais e coletivos. O objetivo deste trabalho foi analisar a evolução recente do fenômeno sob três aspectos: (i) a expansão desse tipo de contrato, simultânea à redução de planos individuais; (ii) o diferencial acumulado de reajustes para os falsos coletivos; (iii) a sua judicialização e o tratamento dado ao tema pelo Poder Judiciário. Foram utilizados dados da Agência Nacional de Saúde Suplementar, desagregados por empresa, entre 2014 e 2019; do banco de dados de Notas Técnicas de Registro de Produto da agência, entre 2015 e 2019; e dados primários produzidos pela análise de acórdãos do Tribunal de Justiça de São Paulo, proferidos em 2018 e 2019. Os resultados evidenciaram o crescimento do fenômeno dos "falsos coletivos", associado à gradual redução dos planos individuais. Demonstraram, também, o sistemático reajuste das mensalidades acima do teto definido pela Agência Nacional de Saúde Suplementar para planos individuais. A análise de acórdãos mostrou que o entendimento da questão pelo Poder Judiciário não é uniforme, nem em termos do resultado do julgamento, nem de sua fundamentação jurídica. Os resultados apoiam a interpretação de que esses contratos permitem às operadoras burlar aspectos relevantes da regulação do setor, impor reajustes superiores e, quando reclamadas judicialmente, escamotear a legislação consumerista.
False collectivization is a growing phenomenon in the Brazilian health insurance market, stemming directly from regulatory decisions that affect the sector, especially the diferences between the rules applicable to individual and collective contracts. Hence, this paper sought to analyze the recent evolution of this phenomenon under three aspects: (i) expansion of this type of contract, simultaneous to the disappearance of individual private health plans; (ii) premium increases for "false collectives"; (iii) its judicialization and treatment in the jurisprudence. Data was collected from the Brazilian Regulatory Agency for Private Health Insurance and Plans, detailed by company, between 2014 and 2019; the agency's Product Registration Technical Notes database, between 2015 and 2019; and primary data produced by analyzing rulings by the São Paulo Court of Justice, issued in 2018 and 2019. Results show the growth of "false collectives," associated with the gradual disappearance of individual private health plans. They also demonstrate the gap between premium increases and the ceiling set by the Brazilian Regulatory Agency for Private Health Insurance and Plans for individual private health plans. Analysis of the rulings reveal that the Judiciary's understanding on the matter is not uniform, neither in terms of the outcome, nor of its legal reasoning. These findings support the interpretation that such contracts allow insures to circumvent relevant aspects of the sector's regulation, to impose higher premiums and, when contested in court, to evade consumer legislation.
Subject(s)
Fees and Charges , Health's JudicializationABSTRACT
Abstract The aims of the present study were to estimate the free-of-charge acquisition of psychotropic drugs among Brazilian adults; analyze the distribution of psychotropics according to their presence on the Relação Nacional de Medicamentos Essenciais (RENAME [National List of Essential Medicines]) and acquisition according to the source of funding (free of charge or direct payment); and estimate the proportion of free-of-charge psychotropic drugs according to therapeutic class and presence on the RENAME. This study involved the analysis of data from the 2014 National Survey on the Accessibility, Use and Promotion of the Rational Use of Medicines considering psychotropic drugs used by the adult population (≥20 years; n = 32,348). The prevalence of the acquisition of free-of-charge psychotropic drugs was 53.3% and 64.6% of these drugs were on the RENAME. Among the psychotropic drugs acquired by direct payment, 70.8% were not on the national list. Regarding free-of-charge acquisition according to the therapeutic class and presence on the RENAME, differences were found for antidepressants, anxiolytics and antipsychotics (p <0.05). In conclusion, the most used psychotropic medicines were listed in the RENAME, but free-of-charge acquisition was not provided for all of them
Subject(s)
Psychotropic Drugs , Drugs, Essential/classification , Access to Essential Medicines and Health Technologies , Population/genetics , Pharmacoepidemiology/statistics & numerical data , National Drug Policy , Fees and Charges/statistics & numerical dataABSTRACT
Esta pesquisa teve como objetivo conhecer as principais dificuldades enfrentadas pelos psicólogos no processo de estabelecimento dos seus honorários referente aos serviços de psicologia clínica na cidade de Caruaru/PE. Foi executada através de métodos qualitativos, sendo utilizada a entrevista semidirigida para coleta dos dados e na sistematização dos dados utilizamos a análise de conteúdo de Bardin. Participaram da pesquisa três psicólogas que residem e trabalham na cidade referida. Ficou evidente que as orientações sobre o estabelecimento dos honorários na prática clínica ou inexistiram ou foram inconsistentes; quando o assunto são as dificuldades enfrentadas ao estabelecer o valor da sessão percebemos certa ansiedade quando necessitam negociar o valor com o paciente devido à falta de instrução. Ao final, percebemos que as vivências práticas que facilitaram o manejo do dinheiro na relação, foram as trocas de experiência entre os colegas, a flexibilização do valor a partir da necessidade real do cliente e principalmente da forma de pagamento. Concluímos que se faz necessário sensibilizar as instituições de ensino de psicologia e seus professores para sistematizar discussões sobre o tema, apesar de compreendermos que não existe consenso sobre o assunto e que precisamos fomentar mais pesquisas nesta área para proporcionar um maior suporte teórico.
This research aimed to study the main difficulties faced by psychologists in the process of establishing their fees for clinical psychology services in the city of Caruaru / PE. It was performed using qualitative methods, using semi--directed interview for data collection and tabulation using Bardin content analysis. Three psychologists living and working in this city participated in the study. It became obvious that the guidelines on the establishment of fees in clinical practice either did not exist or were inconsistent when the subject faced difficulties in establishing the cost of the session. We perceived anxiety when negotiation with the patient was required and this was attributed to a lack of education. In the end, we realized that the practical experiences that facilitated the management of money in the relationship were the exchange of experience among colleagues, the flexibility needed due to client's financial issues and also payment format. We conclude that it is necessary to educate psychology teaching institutions and their teachers to systematize discussions about the subject although we understand that there is no consensus on the subject and we need to encourage more research in this area to provide greater theoretical support.
Esta investigación tuvo como objetivo conocer las principales dificultades enfrentadas por los psicólogos en el proceso de establecer sus honorarios rela-cionados con los servicios de psicología clínica en la ciudad de Caruaru / PE. Fue realizada a través de métodos cualitativos, siendo utilizada la entrevista semidirigida para la recolección de datos y en la sistematización de los datos se utilizó el análisis de contenido de Bardin. Participaron de la investigación tres psicólogas que residen y trabajan en la ciudad citada. Fue evidente que las orientaciones sobre el establecimiento de los honorarios en la practica clínica o no existieron o fueron inconsistente; cuando el asunto son las dificultades enfrentadas al establecer el valor de la sesión se notó cierta ansiedad cuando necesitan negociar el valor con el paciente debido a falta de instrucción. Al final, fue percibido que las vivencias practicas que facilitaron el manejo del dinero en la relación, fueron los intercambios de experiencia entre los colegas, la flexibilización del valor a partir de la necesidad real del cliente y principal-mente la forma de pagamento. Se concluyo que es necesario sensibilizar las instituciones de enseñanza de psicología y sus profesores para sistematizar discusiones sobre el tema, a pesar de comprender que no existe consenso sobre el asunto y que es necesario fomentar más investigaciones en esta área para proporcionar un soporte teórico mayor.
Subject(s)
Humans , Female , Adult , Middle Aged , Psychotherapy/economics , Fees and Charges , Psychology/education , Psychology/ethics , Surveys and Questionnaires , Qualitative ResearchABSTRACT
Subject(s)
Humans , Cardiovascular Diseases , Drug Costs , Fees and Charges , Firefighters , Health Expenditures , Hospitalization , International Classification of Diseases , Korea , Mental Disorders , Musculoskeletal Diseases , Myocardial Ischemia , National Health Programs , Occupational Groups , Outpatients , Police , Prevalence , Stomach NeoplasmsABSTRACT
Background: Fee splitting is a global pandemic in the health-care industry, whereby financial and nonfinancial inducements are offered to health-care practitioners in exchange for guaranteed patient referral, continuous patronage, or preferential usage/prescription of the payer's products. Methods: We surveyed 280 medical doctors from August 2017 to October 2017 to assess their knowledge, perception, and attitude toward fee-splitting using self-administered questionnaires.Results: The majority (89%) of our respondents indicated that they were aware of the existence of fee-splitting in the Nigerian health-care industry. About 34% accept rebates, while 70% admitted to knowing other colleagues who accept rebates. The amount received as rebates was â¤20% of the cost of an investigation. More than half of the respondents (52%) opined that the practice is a nationwide phenomenon. An astonishing 78% of respondents either did not know (61%) or asserted wrongly (17%) that the practice is not a violation Nigerian Medical Council rules. Only 46% affirmed that the practice is unethical. Compared to private hospitals, fee-splitting is less in public hospitals. Sixty-one percent noted that other health-care workers (besides physicians) are also involved. The primary allures of fee-splitting were a quest for an extra source of income (64%), poor/irregular salaries (60%), ignorance of its illegality (56%), and greed (47%). The identified deleterious consequences were unnecessary investigations/procedures, inflated health-care cost, quackery, delayed treatment/prolonged hospital stay, beclouded clinical judgment, and negative public perception.Conclusion: Stricter regulatory enforcement and continuous ethics education are needed to disrupt the widespread fee-splitting culture
Subject(s)
Ethics, Medical , Fees and Charges , Lakes , NigeriaABSTRACT
PURPOSE: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.
Subject(s)
Humans , Deglutition , Deglutition Disorders , Endoscopes , Fees and Charges , Fluoroscopy , Phonation , Pyriform Sinus , Vocal Cord Dysfunction , Vocal Cords , Weights and MeasuresABSTRACT
Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.
Subject(s)
Humans , Dermatitis, Atopic , Education , Electronic Mail , Fees and Charges , Korea , Medical Staff , National Health Programs , Nutritionists , Patient Education as Topic , Pharmacists , PsychologyABSTRACT
Several studies have reported adequate patient transfer to higher level hospitals according to the risk for improving perinatal outcomes. According to these reports, countries across the world divide the levels of maternal care on the basis of the assessment of hospital facilities and medical services as well as the assessment of high-risk pregnancies while evaluating the cases of and risks associated with maternal care that can be addressed by these hospitals at each level. Because the level of and policies on maternal care vary across countries, we aimed to evaluate risk assessments and introduction of treatment facility classifications in different countries. In Korea, birth rate is declining and the number of elderly pregnant women is increasing, whereas the number of hospitals that can deliver a baby and care for mothers at high risk is decreasing. We, therefore, need to establish an infrastructure for medically vulnerable areas, a localization center, and a medical personnel supplement. Moreover, establishing detailed guidelines and criteria for different levels of maternal care is necessary. The new guidelines will also need to supplement the policies on the requirement of well-trained obstetricians and of low medical insurance fee.
Subject(s)
Aged , Female , Humans , Birth Rate , Classification , Fees and Charges , Insurance , Korea , Maternal-Child Health Services , Mothers , Patient Transfer , Pregnancy, High-Risk , Pregnant Women , Prenatal Care , Risk AssessmentABSTRACT
OBJECTIVES: This study aimed to estimate the financial budget of light-curing composite resin fillings based on the expanded coverage of the National Health Insurance Service (NHIS), called “Moon Care.” METHODS: The estimated population with dental caries and the amount of light-curing composite resins used were determined. The fees for the resin fillings per tooth were considered for the calculations. The expected budget for the next five years for children and adolescents aged 5–12 and 5–19 years were calculated. RESULTS: During the first year of the coverage, the budget for children and adolescents aged <19 years was estimated to be 201.8 billion South Korean won (5–9 years, 17.9 billion South Korean won; 10–14 years, 76.6 billion South Korean won; and 15–19 years, 107.3 billion South Korean won). The total budget for the next five years for children and adolescents aged <19 years was estimated at 946.4 billion South Korean won. Likewise, the budget for children aged <12 years during the first year of the coverage was estimated at 63.9 billion South Korean won (5–9 years, 17.9 billion South Korean won and 10–12 years, 46 billion South Korean won), and the total budget for the next five years was estimated at 315.9 billion South Korean won. CONCLUSIONS: Government healthcare plans should be established based on treatment needs and financial estimations. All the items in the NHIS, including the light-curing composite resin filling, should be considered based on their contribution to oral health promotion. Furthermore, in the long term, the coverage for preventive health services should be included in the health insurance.
Subject(s)
Adolescent , Child , Humans , Budgets , Composite Resins , Delivery of Health Care , Dental Caries , Fees and Charges , Insurance, Health , National Health Programs , Oral Health , Preventive Health Services , ToothABSTRACT
The Korean hospitalist system was introduced in 2016. The new inpatient care system that provides direct care from a specialist required great efforts from various parties to implement successfully. This study outlines the implementation of the Korean hospitalist system and the development strategies based on pilot studies. The definition of the Korean hospitalist includes two elements which are 1) hospitalist is a physician who is in charge of a patient from admission to discharge and 2) hospitalist should stay in the hospitalist ward, where a hospitalist provides medical services to patients at their point of needs. The purpose of the Korean hospitalist system is to provide high-quality care and to ensure the safety of admitted patients. Due to a gap in the healthcare workforces in hospitals caused by changes in the residents' working hours and training period of the residents, the implementation of a new system was inevitable to provide care for patients. The result of private and public pilot studies indicated that hospitals, physicians, and patients are keen to have the hospitalist system in place. Also, those stakeholders agreed that reasonable and accurate fee-schedules for hospitalist services would enhance the service system. Within the current system, hospitals are reimbursed for providing the service, while patients pay out-of-pocket. Therefore, the service can only be applied to a patient who agrees to pay the additional fee for the service. As the Korean medical system is facing a paradigm shift, the Korean hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients.
Subject(s)
Humans , Delivery of Health Care , Fees and Charges , Hospitalists , Inpatients , Patient Safety , Pilot Projects , SpecializationABSTRACT
PURPOSE: This study investigated the optimal strategy to minimize budgetary constraints on National Health Insurance (NHI) services, while maximizing the number of diabetic macular edema (DME) patients who receive anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS: We estimated the potential budget impact of anti-VEGF treatments in DME patients based on perceived upcoming changes in reimbursement fees over the next 5 years (2018–2022). Four scenarios were evaluated: (1) current anti-VEGF treatment patterns, (2) the hypothetical reimbursement fee, (3) the introduction of a new molecule similar to current anti-VEGF treatments, and (4) the prescription of an off-label drug, bevacizumab. The number of patients, anti-VEGF treatments, and medical costs for each scenario were calculated using claims data from the Korean NHI system and anti-VEGF prescription data from a single hospital. RESULTS: The potential budget impact of anti-VEGF injections in patients with DME over the next 5 years was estimated to be about 97.7 billion and 106.2 billion KRW for scenarios 1 and 2, respectively. In scenario 3, in which a biosimilar product to anti- VEGF is used, the estimated budget of the NHI system would be approximately 98.4 billion KRW. If an off-label drug is reimbursed, roughly 79.5 billion KRW will be required for the NHI system's budget. CONCLUSIONS: If the revised fee structure for AMD patients is similarly applied to anti-VEGF injections for DME patients, the NHI fiscal requirements will increase disproportionately over the next 5 years compared to current reimbursement conditions. Given the growth of DME patients in toda's patient population, the use of a biosimilar or off-label drug is a financially viable alternative to reduce the overall burden on the NHI system.
Subject(s)
Humans , Bevacizumab , Budgets , Endothelial Growth Factors , Fees and Charges , Macular Edema , National Health Programs , Prescriptions , Ranibizumab , Vascular Endothelial Growth Factor AABSTRACT
BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.
Subject(s)
Humans , Academies and Institutes , Fee-for-Service Plans , Fees and Charges , Hospices , Hospitals, General , Insurance , Palliative Care , RewardABSTRACT
OBJECTIVES: Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.METHODS: The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2–13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.RESULTS: As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.CONCLUSIONS: The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.