Estimating the productivity of radiologists in Brazil: the search for a benchmark / Estimativa da produtividade de radiologistas brasileiros: a busca por um padrão de referência

Abstract Objective: To determine the average productivity of radiologists, as measured by number of reports issued per 6-h shift, evaluating variables that could affect the results. Materials and Methods: This was a study utilizing an online questionnaire sent to radiologists affiliated with the Brazilian College of Radiology and Diagnostic Imaging. The questions were related to the demographic profile and professional practice characteristics (form of remuneration, primary imaging method employed, and subspecialty) of the radiologists, as well as their individual productivity (average personal productivity) and the productivity considered reasonable in a 6-h shift. The association between productivity and the practice characteristics of the radiologists was determined by using Poisson regression to calculate the prevalence ratio. Results: A total of 510 radiologists completed the questionnaire. The great majority of the respondents (84%) reported that their remuneration is directly related to their productivity. The productivity varied according to the subspecialty, work environment, and remuneration model. Conclusion: We demonstrated that the productivity of radiologists is associated with the characteristics of their employment. We hope that this study will encourage other studies aimed at evaluating the productive capacity of the radiologists in Brazil, addressing the various functions they perform in their daily routine, including activities other than issuing reports.

Resumo Objetivo: Estimar a produtividade média dos radiologistas brasileiros em número de laudos emitidos por período de trabalho de seis horas, analisando variáveis que possam influenciar os resultados. Materiais e Métodos: Pesquisa realizada por meio de questionários online respondidos por radiologistas brasileiros afiliados ao Colégio Brasileiro de Radiologia e Diagnóstico por Imagem. As questões incluíram dados demográficos e profissionais dos radiologistas (forma de remuneração, método de imagem de atuação e subespecialidade) e a produtividade individual e a considerada razoável em um período de seis horas de trabalho. A associação entre a produtividade e as características de trabalho dos radiologistas foi calculada pela razão de prevalência, por meio da regressão de Poisson. Resultados: Ao todo, 510 radiologistas responderam ao questionário. A grande maioria dos respondedores (84%) relatou que a sua remuneração está diretamente relacionada à produtividade. A produtividade variou em função da subespecialidade de atuação, ambiente de trabalho e modelo de remuneração. Conclusão: Demonstramos a associação entre a produtividade do radiologista e as características relacionadas à forma de trabalho. Esperamos que este estudo impulsione outras pesquisas que avaliem a capacidade produtiva do radiologista brasileiro, considerando as diversas funções exercidas por este profissional em sua rotina de trabalho, contemplando outras atividades, além da emissão de laudos.

Pagos por desempeño para mejorar el estado nutricional infantil: impacto de los convenios de apoyo presupuestario en tres regiones peruanas con alta prevalencia de desnutrición crónica infantil, 2010-2014 / Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014

RESUMEN Objetivos. Estimar el impacto de un esquema de pago por desempeño, denominado convenios de apoyo presupuestario, aplicado por el Gobierno a las tres regiones con mayores tasas de desnutrición crónica infantil (DCI) en 2008, Apurimac, Ayacucho y Huancavelica, sobre indicadores de cobertura de servicios de cuidado infantil (vacunación, controles de crecimiento y desarrollo infantil, suplemento de hierro) y del estado nutricional del niño (desnutrición, anemia, diarrea). Mediante estos convenios se transferían recursos a los presupuestos de dichas regiones condicionados al cumplimiento de compromisos de gestión y metas de cobertura con el objetivo de mejorar el estado nutricional infantil. Materiales y métodos. A partir de los datos de la Encuesta Demográfica y de Salud Familiar de 2008 a 2014, se compara la evolución en los indicadores evaluados de una muestra de niños que residen en los ámbitos donde se suscribieron los convenios y una muestra de control, mientras los convenios estuvieron vigentes y en los años posteriores para reportar el estimador de diferencias en diferencias del impacto promedio de los convenios Resultados. se encuentran impactos positivos sobre el incremento de coberturas de vacunas del esquema básico y de la vacuna rotavirus y, a través de ellos, en la reducción de la ocurrencia de diarrea y desnutrición. Conclusiones. el esquema habría sido efectivo en activar la cadena mayor cobertura de vacunas y menor DCI, pero no parece mejorar la cobertura de otras prestaciones como las atenciones de crecimiento y desarrollo del niño y entrega de suplementos de hierro al niño y gestante.

ABSTRACT To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Materials and methods. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. Results. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. Conclusions. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

Payment reform for the improvement of primary care in Korea

Strengthening primary care has always been a major policy issue in most developed countries to achieve the health care system's goals, and policy makers continuously try to use payment system as an effective tool to improve overall performance of primary care. In this paper, we examined the various payment methods and growing trends in primary care payment system in some developed countries. Overall, a common form of payment for primary care doctors is a blend of fee-for-service (FFS), capitation, and pay-for-performance (P4P). In addition, many countries are still in the way of many new trials to find the right way to provide primary care service effectively, to meet the complex health care needs of populations. In Korea, primary care system is not well-established, and other institutional arrangements are not in good conditions for primary care, either. FFS, which is a dominant payment method in Korea, is not favorable for achieving good attributes of primary care. Mixing various payment components, like capitation, P4P to current FFS is essential to provide the optimal incentive structures for primary care physicians. Also, new models to encourage doctor-patient relationships with appropriate P4P mechanisms could be used as an early step in reforming primary care payment system gradually.

Financial incentives for generic drugs: case study on a reimbursement program / Incentivos financeiros para medicamentos genéricos: estudo de caso sobre programa de reembolso

Objective: To discuss the use of financial incentives in choice of medication and to assess the economic results concerning the use of financial incentives to promote the use of genetic medication in lieu of reference drugs in a company with a reimbursement program. Methods: A case study was carried out in a large supermarket. The data was obtained in the company responsible for managing medication. The study reached 83,625 users between August 2005 and July 2007. The data was submitted to regressions in order to analyze trends and hypothesis tests to assess differences in medication consumption. The results were compared with general data regarding medication consumption of five other organizations and also with data about the national consumption of generic medication in Brazil. Results: The use of financial incentives to replace brand medications for generics, in the company studied, increased the consumption of generic drugs without reducing the company expenses with the reimbursement programs. Conclusions: This study show the occurrence of unplanned results (increase in the consumption of medications) and the positive consequences of the reimbursement program concerning access to medication.

Objetivo: Discutir o uso de incentivos financeiros na escolha de medicamentos e avaliar os resultados econômicos do uso de incentivos financeiros na indução da substituição de medicamentos de referência por genéricos em empresa com programa de reembolso. Métodos: Foi realizado estudo de caso, em um grande supermercado. Os dados foram obtidos na empresa responsável pelo gerenciamento de medicamentos, a pesquisa atingiu 83.625 beneficiários entre Agosto de 2005 e Julho de 2007. Os dados foram submetidos a regressões para analisar tendências, e testes de hipóteses para avaliar diferenças nos consumos. Os resultados foram comparados com os dados gerais de consumo de medicamentos de outras cinco organizações e também com o consumo nacional de genéricos no Brasil. Resultados: A adoção de incentivos financeiros para a substituição dos medicamentos de referência por genéricos, na empresa estudada, aumentou o consumo de genéricos sem reduzir os gastos da empresa com o reembolso dos mesmos. Conclusões: Este trabalho mostrou a ocorrência de resultados não planejados (aumento do consumo de medicamentos) e as consequências positivas dos sistemas de reembolso para o acesso aos medicamentos.