Determining the Operating Costs of a Medical Surveillance Program for Copper Miners Exposed to High Altitude-Induced Chronic Intermittent Hypoxia in Chile Using a Combination of Microcosting and Time-Driven Activity-Based Costing.

BACKGROUND: Copper mining installations in Chile use a large number of workers who do their jobs at high altitudes, exposing them to the conditions of chronic intermittent hypobaric hypoxia. The Chilean Safety Association implements the surveillance program. OBJECTIVE: This organization, under the sponsorship of the Chilean Superintendency of Social Security, was interested in determining the costs involved in this program to support its decision-making processes and to improve its performance. METHODS: Direct operating costs of the Hypoxia Medical Surveillance Program were determined through on-site surveys applied to the organization's local agencies in charge. The microcosting method was used, quantifying personnel costs, consumables, and equipment and overhead costs. Time-driven activity-based costing was partially adapted for the allocation of personnel and equipment costs. Costs concerning activities, groups of activities and items, and average cost per exposed worker were determined. RESULTS: The annual costs of the program were $127 299.58. The highest costs corresponded to the assessment activities, which were $89 192.13, representing 60.06% of the total. The labor factor costs were $77 568.50, which represents 60.93% of the total. The average cost per worker in the program is $21.17. CONCLUSIONS: The partial adaptation of the time-driven activity-based costing method in combination with the microcosting method provides a suitable solution to determine the total costs of running a healthcare program of this kind. The information generated by this study will aid in the decision-making and management processes of the Hypoxia Medical Surveillance Program.

[Deterioration of Healthcare Service Quality Provided by Occupational Physicians Due to Dumping by Health Checkup and Switching Health Checkup Organizations].

INTRODUCTION: From 2007, competitive bidding for procurement became widely employed by the Japanese Government, and health check providers for government workers are selected every year by this method. Deterioration of health check quality due to excessive price competition is a serious concern. The National Federation of Industrial Health Organization (Zeneiren) conducted an investigative research on the contracting of health check providers and occupational physicians in workplaces in 2015-2016 in an effort to prevent low-cost but low-quality health checks. The report of the research is available on the homepage of Zeneiren. In this paper, we provide a brief overview of the report, and deterioration of health check quality due to dumping by and switching of health check providers is discussed from economic and legal viewpoints. METHOD: Information was obtained from articles in print and on the Internet. RESULTS: A questionnaire survey of health check providers revealed that excessive discounts due to both competitive bidding and demand from companies commissioning health checks occurred on a routine basis, and some providers were concerned about worsening business conditions in the future. In a separate questionnaire survey of occupational physicians, it was discovered that they were able to evaluate the quality of health checks, whereas administrative officials responsible for selecting the providers were seldom able to adequately evaluate the health check quality, resulting in contracting providers of questionable quality, which in turn caused considerable dissatisfaction on the part of occupational physicians. Moreover, when health check providers were switched, the reporting format of health check results changed. The physicians did not favor such a change because of the considerably increased workload involved in coordinating past and current data and the risk of decreased occupational health service quality. DISCUSSION: Dumping makes the management of health check providers very difficult and is a cause of loss of social capital. If health check providers of good quality withdraw from the market, the supply of high-quality health checks decreases. This corresponds to external diseconomy caused by dumping on the part of the health check providers and loss of social surplus (economic surplus). CONCLUSIONS: To avoid deterioration of occupational health service due to low-quality health checks and changes in the reporting format, occupational physicians must actively engage in the selection of health check providers of good quality.

[New regulations for inpatient treatment of the statutory accident insurance: From the perspective of a university medical center]. / Neuordnung des stationären Heilverfahrens der Gesetzlichen Unfallversicherung: Aus Sicht einer Universitätsklinik.

BACKGROUND: New regulations of the German statutory accident insurance for inpatient treatment have been introduced. The aims of the new regulations are to improve cost-effectiveness and the quality of medical care. The introduction of the injury type catalogue and the severe injuries type procedure (SAV) has led to a concentration of resources. The purpose of these innovations is an increase in the quality of treatment of patients with complex injuries. CONCLUSION: The introduction of the new regulations resulted in a centralization of medical care in order to optimize the quality of treatment of complex injuries from occupational accidents. Hence, the high demands concerning infrastructure and human resources expected of a level one university medical center are taken into account.

[The new treatment procedure of the German statutory accident insurance: From the perspective of a community hospital]. / Die neuen Heilverfahren der DGUV: Aus der Sicht eines Städtischen Krankenhauses.

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.

Inverting the pyramid of needs: positive psychology's new order for labor success / Invirtiendo la pirámide de las necesidades: la psicología positiva y la nueva lógica del éxito laboral

ANTECEDENTS: Positive psychologists claim to have demonstrated a causal relationship between happiness and life success, with the former accounting for why people usually end up better off in life than others, especially at workplace. METHOD: In this paper we will analyse the role that happiness-based repertoires and techniques provided by positive psychologists are playing in the current labor sphere. RESULTS: Positive psychologists' repertoires and techniques do not only meet the emerging demands derived from the changes in the notions of «work» and «worker» in the last decades, but also introduce a whole new logic in the construction of professional workers' subjectivity, according to which happiness becomes a necessary psychological state that workers must first achieve and develop in order to attain job success at work. DISCUSSION: This emerging logic does not only circumscribe to the labor sphere, but also reflects a broader cultural and economic phenomenon

ANTECEDENTES: los psicólogos positivos defienden haber demostrado una relación causal entre la felicidad y el éxito en la vida, siendo la primera la razón de por qué hay gente a la que le va mejor que a otra, especialmente en el ámbito del trabajo. MÉTODO: analizamos el papel que juegan los repertorios y las técnicas de la felicidad de los psicólogos positivos en el ámbito laboral actual. RESULTADOS: los repertorios y técnicas de los psicólogos positivos no solamente satisfacen las nuevas demandas laborales surgidas en las últimas décadas a raíz de las transformaciones en las nociones de «trabajo» y «trabajador», sino que también introducen una lógica completamente nueva de la construcción de la subjetividad de los trabajadores, de acuerdo con la cual la felicidad deviene en un estado psicológico necesario que todo trabajador debe alcanzar y desarrollar con el fin de tener éxito. DISCUSIÓN: esta lógica emergente, sin embargo, no se circunscribe únicamente al mundo laboral, sino que es síntoma de un fenómeno económico y cultural más amplio

A propósito del RD 843/2011 por el que se regula la actividad sanitaria de los Servicios de Prevención y sus modificaciones: ¿Problema o solución? / About the RD 843/2011 by which the activity of health prevention services and amended regulates: Problem or solution?

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Cooperation between the occupational health insurance and physicians practicing occupational dermatology: optimization potential in quality assurance.

BACKGROUND: Quality assurance is a task of the medical profession, but it is also a duty of the occupational health insurance (OHI). Data on the interaction quality between physicians practicing occupational dermatology and the OHI are limited. MATERIAL AND METHODS: An online survey was performed in 854 German members of the Working Group on Occupational and Environmental Dermatology in October 2013. Items included demographic data, a judgment on the cooperation between the dermatologists and OHI companies, an economic grading of the current compensation scheme, and prioritization of optimization tasks. RESULTS: 182 members (21.3 % of the invited population) participated in the survey. The cooperation with the OHI companies was judged as "very good" by 10.8 %, as "good" by 56.7  %, as "satisfactory" by 24.2 %, as "sufficient" by 7.0 % and as "inadequate" by 1.3 %. 93.4 % of the interviewed mentioned problems and improvement potentials in the cooperation of their practice or clinic with OHI companies. Main points of criticisms were reimbursement (44.7 %), followed by impairments of the treatment options (36.5 %) and the delay or scope of the treatment in the dermatologist's procedure (29.4 %). CONCLUSIONS: While most physicians practicing occupational dermatology give a positive judgment of their cooperation with OHI companies, quality optimization potentials exist regarding the reimbursement of dermatological services, especially regarding time-intensive counselling in the prevention of occupational skin diseases, in the enablement of diagnostic and therapeutic procedures according to current guidelines and in a timely preventive intervention to use the therapeutic window before chronification of skin diseases may occur.

Value of occupational medicine board certification.

OBJECTIVE: To assess the impact of occupational medicine board certification and career stage on practice characteristics. METHODS: Two hundred sixty occupational medicine physicians completed a questionnaire and 25 activity log descriptions about 72 items in 9 major domains. For each item, the percentage of activities involving the item and the percentage of physicians conducting the item at least once were calculated. Results were analyzed by board certification status and career stage. RESULTS: Board-certified physicians had more-diverse practice activities and skills. They were more involved in management and public health-oriented activities, with greater emphasis on toxicology and less on musculoskeletal disorders. The noncertified physicians received more payment from workers' compensation. Early-career physicians spent more time in direct injury/illness treatment, being paid by workers' compensation, and addressing musculoskeletal problems. CONCLUSIONS: Formal training confers advantages in practice diversity and population medicine orientation.

[Market oriented occupational medicine]. / Piaci viszonyok a foglalkozás-egészségügyben.

The history and the recent state of occupational medicine in Hungary, and its relation with governmental labor organizations are analyzed. In the past 20 years, large "socialist" factories were replaced by smaller companies employing fewer workers. They have been forced to establish contract with occupational health providers. Many of them offer primary care services, whereas family physicians having a board examination in occupational medicine are allowed to work in this field as well. The market of occupational medicine is less regulated, and ethical rules are not always considered. Undercutting prices is a common practice. The recent system could be improved by some regulations which should be respected. There is no reason to make rough changes establishing a new market for profit oriented insurance companies, and to allow employees and employers to work without specification neglecting international agreements. Occupational medicine should be supervised again by the health authorities instead of economists who have quite different, short-term priorities.

Occupational skin diseases.

Occupational skin diseases are the most commonly reported notifiable occupational diseases. In Germany, 23 596 out of a total of 71 263 reported occupational diseases in 2010 were classified as occupational skin diseases (BK No. 5101: "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease"). Contact dermatitis (allergic, irritant) of the hands is the most common skin disease and atopic skin diathesis is often an important co-factor. The number of work-related skin diseases is many times higher than the number of notified occupational dermatoses. This CME article explains the legal framework of occupational diseases, the tasks and obligations of the legal statutory work insurance. Typical allergens and irritants of high risk professions are also presented as are the important steps from diagnosis to compensation. Early prevention of occupational skin diseases is very important to avoid severe chronic hand eczema. Therefore the "dermatologist's report" is crucial. Other occupational dermatoses (outside of BK 5101) are briefly mentioned. In recent years the number of notifications of occupational skin cancer due to occupational UV-irradiation has increased. According to recent epidemiological findings, there is a significant and consistent positive association between occupational UV-irradiation and squamous cell carcinoma. Therefore, an important criterion for a new occupational disease is fulfilled.

Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services-ranging from primary care and preventive care to workers' compensation and disability management-within tomorrow's PCMH and ACO models.

[Which services do companies need to retain employability in their workforce?--help offered by the German Pension Insurance]. / Welche Hilfen benötigen Betriebe und Unternehmen beim Erhalt der Beschäftigungsfähigkeit ihrer Mitarbeiter--Was kann die Rentenversicherung tun?

German Pension Insurance as a provider of services in rehabilitation has reacted to demographic changes in society, both strategic and practical. The implementation of services for companies including support of company return to work management and prevention services for employees with specific health-related burdens offer the chance to identify an endangerment of earning capacity at an early stage. Workplace-orientated medical rehabilitation increases the focus on the job and the workplace in rehabilitation under the pension insurance scheme, both in selecting the right service for a client as well as in the service itself. Employers, employees and pension insurance together benefit from close cooperation.

[Occupational asthma: an underestimated pathology ]. / Asma occupazionale: una patologia sottostimata.

The occupational allergens are estimated to determine 1 out 10 cases of asthma in adult workers. In Italy very low cases are compensated by the Italian National Insurance Against Professional Disease (INAIL), that legally recognized 90 cases in 1996 and only 9 cases in 2000. A real negative trend in making diagnosis and compensating workers for occupational asthma is due to three main causes. (1) Delayed diagnosis. Lack of protocols or lack of accuracy in applying them. Scarce collaboration of the general practitioners. (2) Unsatisfactory bill on compensation that misunderstands moderate asthma under drug control and asthma with scarce symptoms and occasional therapy. (3) Lack of prevention in industrial medicine. Occupational doctors play a role more relevant in legal activities than in clinical ones.

[On health protection for workers in Permsky area].

The article covers analysis of regional parameters of occupational and industrially mediated morbidity, economic and organizational aspects of workers' health protection. The authors justified measures to industrial medicine system implementation.