Prediction of Prolonged Length of Stay for Stroke Patients on Admission for Inpatient Rehabilitation Based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set: A Study from 50 Centers in China.

BACKGROUND This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. MATERIAL AND METHODS In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. RESULTS Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646-0.752) and calibration (χ²=11.66; P=0.308). CONCLUSIONS The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.

[Integrated Health Care in cardiology: have all players used their opportunities?]. / Integrierte Versorgung in der Kardiologie: Haben alle ihre Chancen genutzt?

From the view of one of the largest public health insurance companies, in this paper it is outlined that Integrated Health Care provides opportunities to influence the largely regional structures of health care supply. This insurance company has specialized in contracts for Integrated Health Care in cardiology in order to achieve sustainable solutions for all providers of invasive and interventional cardiology that are economically reasonable. But first of all, only evidence-based medical procedures and interventions based on clinical pathways are eligible for the contracts of this company. In outlining this, it becomes evident that by far not all German public health insurance companies have yet used their opportunity.

The impact of a comprehensive medical benefit cost management program for the city of Birmingham: results at five years.

Double digit annual increases in the cost of medical benefits represent one of the major financial challenges for many private and public sector employers. Gaining greater control is a top priority. Since the procurement, administration, and delivery of employee/dependent medical care is a highly complex venture, it is unlikely that any one activity will contain costs effectively. This report examines a comprehensive cost management effort for the municipal government of the city of Birmingham, Alabama, which included health promotion, medical plan redesigning, managed care, and "how to use the medical system" education programs. The $3 million project was funded by the National Institutes of Health and the employer and conducted from 1985 to 1990. In 1985, medical benefits expenses for the 3,586 employees were $2,047 per employee which was about $400 above the state of Alabama per employee average. In 1990, for 4,000 employees, it was $2,075 which was $922 below the state average. While the project design does not permit a precise evaluation of the exact impact of each of the cost containment activities, attempts are made to estimate their impact. Several health promotion activities, which may be unique to this project, including the all-employee medical screen, are presented and evaluated.

Catastrophic medical protection: a plan for sharing excessive costs.

Cost sharing provisions in both private and public health insurance plans have greatly increased consumer out-of-pocket expenses for medical services in recent years. The effects of these provisions, coupled with the effects of massive unemployment, have been that many individuals are unable to afford adequate health insurance protection. To protect the nation's health, new proposals to expand health coverage have given rise to catastrophic health insurance. This new health policy priority may assist many low-wage and unemployed workers to meet their cost-sharing obligations in the face of rising medical costs.