Research on the typical modes of medical alliances in China / 中华医院管理杂志

By means of analysis of related national policies on medical alliances, and investigation of their current development in China, the authors summarized the conceptual category of existing medical alliances. Typical cases were selected for comparative analysis in terms of urban medical groups, medical communities, specialized alliances and telemedicine collaboration networks. In view of such setbacks found as lack of health services, ambiguity of power and duties of stakeholders, and low penetration rate of composite medical insurance payment, as well as lack of effective incentives and poor online diagnosis and treatment mechanism, the authors recommended on development of medical alliances in respect of framework improvement and mechanism optimization among others.

Atención en salud basada en el valor: retos y oportunidades / Value-based health care: challenges and opportunities / Assistência médica baseada em valor: desafios e oportunidades

La atención en Salud Basada en el Valor es un modelo de atención re-ciente, innovador, dirigido a garantizar mejores resultados en salud para la población atendida, paralelo a un uso óptimo de los recursos. Para su implementación, dicho modelo propone una serie de principios, los cua-les son analizados dentro del presente documento. Para esto, se tiene en cuenta no sólo sus características fundamentales, sino también, su facti-bilidad, posibles barreras y oportunidades. Los principios revisados son: unidades integradas de atención, medición de resultados en salud y cos-tos, plataformas tecnológicas, modelos de pago centrados en la atención, sistemas integrados de atención y expansión geográfica. Adicionalmente, se incluyen la atención centrado en el paciente y el trabajo en equipo co-mo componentes fundamentales de este modelo también

Value-based Health Care is a recent, innovative delivering healthcare model which has emerged as a cost-effective alter-native to provide superior health outcomes for patients while decreasing inefficiencies in the system. For its successful im-plementation this model provides a set of principles which are revised in the present article, providing insights on their feasibility, challenges and opportunities. The principles revised here are: Integrated Practice Units, Health Outcomes and Cost Measurement, Value-based Payments, enabling health systems platforms, and efficient allocation of resources. Along with the-se, a person-centered approach and stakeholders' participation and engagement have been also revised as key components of the model.

A assistência médica baseada em valor é um modelo de assis-tência inovador que visa garantir melhores resultados de saúde para a população atendida e o uso ideal dos recursos. Para sua implementação, propõe-se uma série de princípios anali-sados neste documento, uma análise na qual são levadas em consideração as características fundamentais, viabilidade, pos-síveis barreiras e oportunidades que esse modelo pode gerar. Os princípios revisados são: unidades de atendimento integra-das, mensuração de resultados de saúde e custo, plataformas tecnológicas, modelos de pagamento focados na geração de valor, sistemas / redes de atendimento integrados e expansão geográfica. Além disso, o atendimento centrado no paciente e o trabalho em equipe são incluídos como componentes funda-mentais deste modelo.

Austeridade, predominância privada e falha de governo na saúde / Brazilian healthcare in the context of austerity: private sector dominant, government sector failing

Resumo O trabalho apresenta os argumentos favoráveis à intervenção governamental no financiamento e na regulação na área de saúde. Descreve o arranjo organizacional do sistema de saúde brasileiro para refletir sobre a agenda da austeridade proposta para o país. Com base na literatura da economia da saúde, o artigo discute a hipótese de que o setor saúde no Brasil funciona sob a dominância privada. Utiliza as categorias de análise das despesas nacionais com saúde. Os dados são analisados por meio de estatística descritiva. A comparação internacional dos indicadores de despesas com saúde mostra que a participação do gasto público brasileiro na saúde é pouco expressivo. Os gastos por desembolso direto são elevados e comprometem a equidade. O setor de planos privados de saúde desempenha um papel crucial na provisão e no financiamento. Ao contrário da crença da agenda da austeridade, a despesa pública não pode ser constrangida porque o governo tem fracassado na provisão adequada de serviços aos pobres. O artigo argumenta que, como a Constituição não vetou a atuação do segmento privado, os interesses com maior capacidade de vocalização foram bem sucedidos em impor as suas preferências na configuração do setor.

Abstract This paper presents the arguments in favor of government intervention in financing and regulation of health in Brazil. It describes the organizational arrangement of the Brazilian health system, for the purpose of reflection on the austerity agenda proposed for the country. Based on the literature in health economics, it discusses the hypothesis that the health sector in Brazil functions under the dominance of the private sector. The categories employed for analysis are those of the national health spending figures. An international comparison of indicators of health expenses shows that Brazilian public spending is a low proportion of total spending on Brazilian health. Expenditure on individuals' health by out-of-pocket payments is high, and this works against equitability. The private health services sector plays a crucial role in provision, and financing. Contrary to the belief put forward by the austerity agenda, public expenditure cannot be constrained because the government has failed in adequate provision of services to the poor. This paper argues that, since the Constitution did not veto activity by the private sector segment of the market, those interests that have the greatest capacity to vocalize have been successful in imposing their preferences in the configuration of the sector.

Effect of Different Medical Insurance Payments on the Hospital Performance Index / 现代医院

Objective To analyze the effect of different medical insurance payments on medical expenses so as to provide some suggestions for Guangdong Provincial Department of Offsite Medical Insurance Administration in its future policy-making.Methods An statistic analysis was conducted of medical expenses among patients who chose different medical insurance payments and their average length of stay.Results Medical expenses and average length of stay were statistically different among patients who chose different payments.Conclusion The medicare reimbursement′s inclusion of prevention and diagnosis should be recommended to establish a flexible referral system, reinforce the payments reform and increase the efficiency of social security funds.

Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change / 예방의학회지

OBJECTIVES: To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. METHODS: This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. RESULTS: The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. CONCLUSIONS: The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

Can Health Technology Assessment (HTA) provide a solution to tackle the increasing health-care expenditure in India.

The private health-care system in India is effective but expensive. Due to the absence of a comprehensive and well-penetrated insurance scheme that caters to the majority of the Indian population, most of the private health care consultations are out-of-pocket (OOP), and this is pushing many people to poverty. In this article, we describe the concept of health technology assessment (HTA), and review its possible role in improving the health-care system in India. We additionally comment on its present status and possible role of its implementation in the Indian context.

O dinheiro sacrifical / Sacrifice money

Neste artigo o autor aborda o dinheiro postulando-o como morto-vivo. Este tipo de objeto não é mero receptor passivo de projeção, e sim gerador de efeitos subjetivantes e dessubjetivantes nos indivíduos e na trama social. Com uma descrição sucinta do dinheiro se postula uma origem sacrifical do mesmo e se assevera que o dinheiro por si mesmo implica posições sadomasoquistas para o próprio sujeito e para o entorno social. Finalmente, mostra como o valor masoquista se faz presente no intercâmbio econômico durante os tratamentos analíticos.

In this paper it is said that the money is considered as a dead-living object. Such kind of objects are not passive recipients of projection but have subjectivism or de-subjectivism effects on the individuals and the social context. After a brief description of money as sacrificial source it is postulate that money carries itself carries violence and masochism. Moreover, money is thought of as the major vehicle of masochism that society has created. Finely it is shown how masochistic value is present in the economic exchange during the analytical treatments.

Pagamento por serviços ambientais contribuindo para a saúde ambiental, uma análise em nível local / Payments for environmental services that contribute to environmental health, a local level analysis

O presente artigo tem como objetivo propor que os mecanismos de pagamentos por serviços ambientais sejam utilizados como uma contribuição para a melhoria da saúde ambiental, partindo do nível local e discutindo a relação entre as mudanças trazidas por esses mecanismos e a melhoria da saúde ambiental. O campo de estudo foi o município de Rio Grande da Serra (SP), com 100% de seu território em área de proteção de mananciais, com população em alta vulnerabilidade social e localizado na Região Metropolitana de São Paulo, Brasil. Foi conduzido em três fases: i) revisão da literatura; ii) coleta de dados; e iii) análise do conjunto. As informações relativas à saúde ambiental do município foram disponibilizadas por parte da prefeitura municipal de Rio Grande da Serra e coletadas junto à Cetesb, IBGE e Datasus, sendo posteriormente analisadas para a obtenção de um grupo de serviços ambientais com capacidade de contribuir para a melhoria da saúde ambiental em nível local. Concluiu-se que os serviços ambientais com maior capacidade de melhoria nessa área são a regulação climática, seguida por controle de erosão e retenção de sedimentos, aprovisionamento de água e benefícios culturais e recreacionais...

This paper aims to propose that the mechanisms for Payments of Environmental Services are used as a contribution to the improvement of environmental health, based on the local level. It seeks to discuss the relationship between the changes brought by these mechanisms and the improvement of environmental health. The studied area was the city of Rio Grande da Serra, São Paulo state, with 100% of its territory in watershed protection area, population in high social vulnerability and in the Metropolitan Region of São Paulo, Brazil. The study was conducted in three steps: i) a literature review; ii) data collection; e iii) analysis of data. The information about the local environmental health was provided by the Municipality of Rio Grande da Serra and collected at CETESB, IBGE and DATASUS, being later analyzed in order to define a group of environmental services capable of contributing to the improvement of environmental health at the local level. It concludes that the environmental services with greater capacity to improve environmental health are climate regulation, followed by erosion control and sediment retention, supply of water and recreational and cultural goods...

The Financial Mechanism of American Medicaid and the Medical Expenditure Expansion / 中国卫生经济

Objective: Analysis on the financial influences of for Medicaid expenditure expansion. Methods: Using Economics analysis to study the relation between the method of Federal Medicaid grants and scope of States Medicaid. Results and Conclusion:The design of transfer payment motivated the states government to pursue maximizing Federal grants , which led to the medical expenditure expansion. The Policy aims on establishing unify Medicaid policy in the nation and all grants raised from the Federal government.

The Impact of Universal Coverage Policy on Catastrophic Health Payments in Thailand / 中国卫生经济

Before 2002, the three existing basic medical security systems of Thailand covered 30% of the population, and the surplus population participated in the universal coverage(UC)policy of medical security system which promulgated in 2002. Since the implement of UC policy, it has improved the equity of medical service application and health financing, reduced Catastrophic Health Payments and low-income groups have obtained more benefits. The incidence rate of Catastrophic Health Payments decreased and the spending burden of catastrophic health expenditure in low-income groups decreased from 6.11%(2000)to 4.65%(2002).

Impact of a Service Provider Incentive Payment Scheme on Quality of Reproductive and Child-health Services in Egypt.

A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance- based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

Cost analysis for the management of acute coronary syndrome using different quality of care indicators

OBJECTIVE: This study determined the economic burden for nonfatal uncomplicated acute coronary syndrome (ACS) using 100% compliance to certain a) non-invasive or b) invasive and non-invasive diagnostic and therapeutic interventions with class I recommendations in the American College of Cardiology-American Heart Association (ACC-AHA) clinical practice guidelines for ACS in three tertiary hospitals using the societal perspective. It also determined the costs using the patient perspective in the setting of one private tertiary hospital. METHODS: This study was a cost analysis that included a) costs of patient resources, b) production losses, and c) costs of other resources or sectors, from hospitalization to one month post-discharge for ACS. Several models were constructed due to variations in the costs of diagnostic and therapeutic interventions in the three settings. RESULTS: Using the societal perspective, one model for non-invasive options yielded the following (costs as of January 31, 2009): hospital A, Php87,014 - 124,799; hospital B, Php75,592 - 96,072; hospital C, Php71,969 - 92,148. Excluding fibrinolytic therapy, the lowest total cost would be Php65,000. However, if coronary angiography was added to the models for hospital C, the cost was Php107,154 - 134,574 (coronary angiography was not available in hospitals A and B). Using the patient perspective, the adjusted mean cost for the model which used the least expensive medication was Php96,421 (Standard Deviation = 34,076). CONCLUSION: The economic burden for nonfatal uncomplicated ACS may range from Php65,000 - 134,574.