[POLISH CITIZENS' OPINIONS CONCERNING CO-PAYMENT FOR HOSPITALIZATION AND SUBSIDIES FOR NON-STANDARD BENEFITS]. / OPINIE POLAKÓW O WSPÓLPLACENIU ZA LECZENIE SZPITALNE ORAZ O DOPLATACH DO SWIADCZEN PONADSTANDARDOWYCH.

INTRODUCTION: Co-payment in the health sector operates in most healthcare systems in European countries. The aim of this study was knowledge of Polish citizens' opinions concerning healthcare services co-payment with respect to selected socio-demographic factors. MATERIAL AND METHODS: The study was conducted using a diagnostic survey of 636 respondents, representing residents of the West Pomeranian region, Poland. RESULTS: The majority of respondents did not accept co-payment for health services. CONCLUSIONS: Material situation and educational background impact on decisions concerning co-payment for hospital treatment.

Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India.

BACKGROUND: India's health expenditure is met mostly by households through out-of-pocket (OOP) payments at the time of illness. To protect poor families, the Indian government launched a national health insurance scheme (RSBY). Those below the national poverty line (BPL) are eligible to join the RSBY. The premium is heavily subsidised by the government. The enrolled members receive a card and can avail of free hospitalisation care up to a maximum of US$ 600 per family per year. The hospitals are reimbursed by the insurance companies. The objective of our study was to analyse the extent to which RSBY contributes to universal health coverage by protecting families from making OOP payments. METHODS: A two-stage stratified sampling technique was used to identify eligible BPL families in Patan district of Gujarat, India. Initially, all 517 villages were listed and 78 were selected randomly. From each of these villages, 40 BPL households were randomly selected and a structured questionnaire was administered. Interviews and discussions were also conducted among key stakeholders. RESULTS: Our sample contained 2,920 households who had enrolled in the RSBY; most were from the poorer sections of society. The average hospital admission rate for the period 2010-2011 was 40/1,000 enrolled. Women, elderly and those belonging to the lowest caste had a higher hospitalisation rate. Forty four per cent of patients who had enrolled in RSBY and had used the RSBY card still faced OOP payments at the time of hospitalisation. The median OOP payment for the above patients was US$ 80 (interquartile range, $16-$200) and was similar in both government and private hospitals. Patients incurred OOP payments mainly because they were asked to purchase medicines and diagnostics, though the same were included in the benefit package. CONCLUSIONS: While the RSBY has managed to include the poor under its umbrella, it has provided only partial financial coverage. Nearly 60% of insured and admitted patients made OOP payments. We plea for better monitoring of the scheme and speculate that it is possible to enhance effective financial coverage of the RSBY if the nodal agency at state level would strengthen its stewardship and oversight functions.

Validity of laboratory-based surveillance for detection of respiratory syncytial virus seasons.

In this study, we validated the Centers for Disease Control and Prevention's use of a 10% threshold of median proportion of positive laboratory tests (median proportion positive (MPP)) to identify respiratory syncytial virus (RSV) seasons against a standard based on hospitalization claims. Medicaid fee-for-service recipients under 2 years of age from California, Florida, Illinois, and Texas (1999-2004), continuously eligible since birth, were categorized for each week as high-risk or low-risk with regard to RSV-related hospitalization based on medical and pharmacy claims data and birth certificates. Weeks were categorized as on-season if the RSV hospitalization incidence rate in high-risk children exceeded the seasonal peak of the incidence rate in low-risk children. Receiver operating characteristic (ROC) curves were used to measure the ability of MPP to discriminate between on-season and off-season weeks as determined from hospitalization data. Areas under the ROC curve ranged from 0.88 (95% confidence interval: 0.83, 0.92) in Illinois to 0.96 (95% confidence interval: 0.94, 0.98) in California. Requiring at least 5 positive tests in addition to the 10% MPP threshold optimized accuracy, as indicated by minimized root mean square errors. The 10% MPP with the added requirement of at least 5 positive tests is a valid method for identifying clinically significant RSV seasons across geographically diverse states.

Who pays for agricultural injury care?

Analysis of 295 agricultural injury hospitalizations in a single state's hospital discharge database found that workers' compensation covered only 5% of the inpatient stays. Other sources were commercial health insurance (47%), Medicare (31%), and Medicaid (7%); 9% were uninsured. Estimated mean hospital and physician payments (not costs or charges) were $12,056 per hospitalization. Nearly one sixth (16%) of hospitalizations were either unreimbursed or covered by Medicaid, indicating a substantial cost-shift to public funding sources. Problems in characterizing agricultural injuries and states' exceptions to workers' compensation coverage mandates point to the need for comprehensive health coverage.

[The G-DRG system 2008. Relevant changes for rheumatology]. / Das G-DRG-System 2008. Relevante Neuerungen für die Rheumatologie.

The G-DRG system 2008 once again brings many changes to rheumatological departments in Germany. The following article presents the main general and specific changes in the G-DRG system, as well as in the classification systems for diagnoses and procedures and in invoicing for 2008. Since the G-DRG system is only a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative effects from the system's application. The strain placed on hospitals by the inadequate funding of increased costs needs to be assessed separately from the effects of redistribution by the G-DRG system.

Does the patient's payer matter in hospital patient safety?: a study of urban hospitals.

BACKGROUND: Previous studies have documented that hospitals decrease costs in response to reimbursement cutbacks. However, research concerning how this may affect quality of care has produced mixed results. Until recently, the ability to study changes in patient safety and payment has been limited. OBJECTIVE: The objective of the study was to determine whether changes in 4 hospital patient safety indicator (PSI) rates are related to changes in the generosity of payers over time. DATA AND METHODS: Study data are drawn from 1995-2000 hospital discharges in 11 states in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Database. Following the same organizations over time, we estimate hospital fixed-effects regression models of the association of payer-specific time and post Balanced Budget Act (BBA) payment changes with risk-adjusted hospital PSI rates controlling for patient, organizational, and market characteristics. Four PSIs relevant to a large number of patients and hospitals that reflect general care processes are studied. RESULTS: The time trend during 1995-2000 is consistently significantly positive for private and Medicare hospital PSI rates. Thus, after controlling for patient characteristics and organizational and market factors, performance worsened. The trend is less consistent for Medicaid and does not exist for self-pay hospital PSI rates. After adjusting for multiple comparisons, we also find that the Medicare trend is fairly consistently higher than that of the other payers. In contrast, there is a less consistent BBA effect, especially for Medicare.

Shining a light on hospital charges.

With growing insistence, consumers, legislators and payers want to know how much a hospital stay really costs--and health care leaders need to have answers.

The big squeeze. Insurers point to slower growth in premiums in past few years to show progress, but providers say they're paying the price.

While insurers last week were trumpeting the third straight year of slower growth in premiums, providers weren't exactly celebrating. That's because of huge mergers, which give insurers far more leverage and have led to reimbursements being cut back even more. "What's worrying us is that there's a growing segment (of insurers) that aren't going to budge an inch, no matter what," says Russ Weaver, left.

Linking operating margin to payer contracting.

Hospital performance is driven by the revenue generated through paver contracts--and hospitals must demand the contracts they need in order to meet their margin.

Private care and public waiting.

Waiting time for public hospital care is a regular matter for political debate One political response has been to suggest that expanding private sector activity will reduce public waiting times. This paper tests the hypothesis that increased private activity in the health system is associated with reduced waiting times using secondary analysis of hospital activity data for 2001-02. Median waiting time is shown to be inversely related to the proportion of public patients. Policymakers should therefore be cautious about assuming that additional support for the private sector will take pressure off the public sector and reduce waiting times for public patients.