1
|
Hong M, Devlin RA, Zaric GS, Thind A, Sarma S. Primary care services and emergency department visits in blended fee-for-service and blended capitation models: evidence from Ontario, Canada. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:363-377. [PMID: 37154832 DOI: 10.1007/s10198-023-01591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION It is well-known that the way physicians are remunerated can affect delivery of health care services to the population. Fee-for-service (FFS) generally leads to oversupply of services, while capitation leads to undersupply of services. However, little evidence exists on the link between remuneration and emergency department (ED) visits. We fill this gap using two popular blended models introduced in Ontario, Canada: the Family Health Group (FHG), an enhanced/blended FFS model, and Family Health Organization (FHO), a blended capitation model. We compare primary care services and rates of emergency department ED visits between these two models. We also evaluate whether these outcomes vary by regular- and after-hours, and patient morbidity status. METHODS Physicians practicing in an FHG or FHO between April 2012 and March 2017 and their enrolled adult patients were included for analyses. The covariate-balancing propensity score weighting method was used to remove the influence of observable confounding and negative-binomial and linear regression models were used to evaluate the rates of primary care services, ED visits, and the dollar value of primary care services delivered between FHGs and FHOs. Visits were stratified as regular- and after-hours. Patients were stratified into three morbidity groups: non-morbid, single-morbid, and multimorbid (two or more chronic conditions). RESULTS 6184 physicians and their patients were available for analysis. Compared to FHG physicians, FHO physicians delivered 14% (95% CI 13%, 15%) fewer primary care services per patient per year, with 27% fewer services during after-hours (95% CI 25%, 29%). Patients enrolled to FHO physicians made 27% more less-urgent (95% CI 23%, 31%) and 10% more urgent (95% CI 7%, 13%) ED visits per patient per year, with no difference in very-urgent ED visits. Differences in the pattern of ED visits were similar during regular- and after-hours. Although FHO physicians provided fewer services, multimorbid patients in FHOs made fewer very-urgent and urgent ED visits, with no difference in less-urgent ED visits. CONCLUSION Primary care physicians practicing in Ontario's blended capitation model provide fewer primary care services compared to those practicing in a blended FFS model. Although the overall rate of ED visits was higher among patients enrolled to FHO physicians, multimorbid patients of FHO physicians make fewer urgent and very-urgent ED visits.
Collapse
Affiliation(s)
- Michael Hong
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, Western University, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
| |
Collapse
|
2
|
McLeod CD, Kornegay EC, Tiwari T, Mason MR, Mathews RB, Apostolon DN, Heaton LJ, Wright JT, Quinonez RB. Pre-doctoral dental faculty perceptions toward value-based care: An exploratory study. J Dent Educ 2023; 87:189-197. [PMID: 36131371 DOI: 10.1002/jdd.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore pre-doctoral faculty perceptions toward implementation of value-based care (VBC) in didactic and clinical teaching. METHODS This project was a collaborative effort between CareQuest and the University of North Carolina at Chapel Hill, Adams School of Dentistry introducing VBC to pre-doctoral dental faculty as part of a new curriculum. Following a faculty development session on VBC in June 2021, faculty and subject matter experts were invited to participate in qualitative interviews. Subject matter experts were interviewed to establish a baseline for VBC knowledge and understanding. Interviews were recorded and transcribed verbatim. Analysis was conducted by two analysts using ATLAS.ti and a thematic analysis approach. RESULTS Six faculty and two subject matter experts participated in interviews. Although dental faculty demonstrated some understanding of VBC, they recognized that more training is required to build in-depth knowledge and implementation strategies for teaching dental students. Faculty discussed value-based concepts such as prevention-focused teaching, person-centered care, and disease management over invasive restoration of teeth, and how VBC is bringing about a paradigm shift in dentistry that needs to be reflected in dental education. They acknowledged a disconnect between VBC in didactic teaching versus clinical instruction. Those interviewed believed it would take time to shift faculty mindset and readiness to teach VBC, and continued efforts are needed at the leadership and faculty level for acceptance and implementation. CONCLUSIONS Although dental faculty recognize that VBC can bring a shift in dental practice, more training and guidance to implement it in didactic and clinical teaching is needed.
Collapse
Affiliation(s)
| | - Elizabeth C Kornegay
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Tamanna Tiwari
- Department of Community Dentistry & Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Matthew R Mason
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | | | | | - Lisa J Heaton
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA
| | - John T Wright
- Division of Pediatrics and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Rocio B Quinonez
- Division of Pediatrics and Public Health, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Physician influence on medication adherence, evidence from a population-based cohort. PLoS One 2022; 17:e0278470. [PMID: 36454907 PMCID: PMC9714848 DOI: 10.1371/journal.pone.0278470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication adherence. METHODS We conducted a retrospective cohort study using health administrative databases from Saskatchewan, Canada. Participants included physician prescribers and their patients beginning a new statin medication between January 1, 2012 and December 31, 2017. We grouped prescribers based on the prevalence of optimal adherence (i.e., proportion of days covered ≥ 80%) within their patient group. Also, we constructed multivariable logistic regression analyses on optimal statin adherence using two-level non-linear mixed-effects models containing patient and prescriber-level characteristics. An intraclass correlation coefficient was used to estimate the physician effect. RESULTS We identified 1,562 GPs prescribing to 51,874 new statin users. The median percentage of optimal statin adherence across GPs was 52.4% (inter-quartile range: 35.7% to 65.5%). GP prescribers with the highest patient adherence (versus the lowest) had patients who were older (median age 61.0 vs 55.0, p<0.0001) and sicker (prior hospitalization 39.4% vs 16.4%, p<0.001). After accounting for patient-level factors, only 6.4% of the observed variance in optimal adherence between patients could be attributed to GP prescribers (p<0.001). The majority of GP prescriber influence (5.2% out of 6.4%) was attributed to the variance unexplained by patient and prescriber variables. INTERPRETATION The overall impact of GP prescribers on statin adherence appears to be very limited. Even "high-performing" physicians face significant levels of sub-optimal adherence among their patients.
Collapse
|
4
|
Nyawira L, Tsofa B, Musiega A, Munywoki J, Njuguna RG, Hanson K, Mulwa A, Molyneux S, Maina I, Normand C, Jemutai J, Barasa E. Management of human resources for health: implications for health systems efficiency in Kenya. BMC Health Serv Res 2022; 22:1046. [PMID: 35974324 PMCID: PMC9382760 DOI: 10.1186/s12913-022-08432-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. Methods We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. Results Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. Conclusions Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.
Collapse
Affiliation(s)
- Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joshua Munywoki
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebecca G Njuguna
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Mulwa
- Directorate of Medical Services, preventive and promotive health, Ministry of Health, Nairobi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Isabel Maina
- Health Financing Department, Ministry of Health, Nairobi, Kenya
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Julie Jemutai
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Institute of Healthcare Management, Strathmore Business School, Strathmore University, Nairobi, Kenya.
| |
Collapse
|
5
|
Redeker S, Massey EK, van Merweland RG, Weimar W, Ismail S, Busschbach J. Induced Demand in Kidney Replacement Therapy. Health Policy 2022; 126:1062-1068. [DOI: 10.1016/j.healthpol.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
|
6
|
Overview of Cardiothoracic Surgeon Compensation: Practice Setting, Productivity, and Payment Structures. Ann Thorac Surg 2022; 114:2383-2390. [PMID: 35337788 DOI: 10.1016/j.athoracsur.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/29/2021] [Accepted: 02/01/2022] [Indexed: 11/20/2022]
Abstract
The Centers for Medicare and Medicaid Services recently proposed a substantial cut to reimbursement for surgical services, punctuating a steady decline in reimbursement for clinical services provided by cardiothoracic surgeons during the last several decades. Meanwhile, the costs of practicing cardiothoracic surgery continue to increase. In an effort to defect against diminishing control over patient care and further negative changes affecting reimbursement, cardiothoracic surgeons must be able to convincingly demonstrate their value to patients and the health care system. However, the overall contribution of a cardiothoracic surgeon can be difficult to measure objectively and varies widely according to a host of factors, including practice setting, experience, subspecialization, and the local market. To address these challenges, The Society of Thoracic Surgeons Workforce on Practice Management has commissioned a Writing Task Force to raise awareness, to concentrate knowledge, and to organize information related to compensation as a comprehensive resource for cardiothoracic surgeons. The purpose of this initial report is to provide an overview of the major factors having an impact on compensation for cardiothoracic surgeons.
Collapse
|
7
|
Sanchez-Ramirez DC, Singer AG, Kosowan L, Katz A, Polimeni C. Increasing likelihood of prescribing recommended lipid management: Primary care providers' participation in cardiology continuing medical education. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:39-46. [PMID: 35063983 PMCID: PMC9810061 DOI: 10.46747/cfp.680139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore whether participation in a series of cardiology continuing medical education (CME) activities affects primary care providers' (PCPs') lipid management for their patients. DESIGN This retrospective cohort study used a database of participation in cardiology CME activities (2011 to 2017) linked to electronic medical records. Statistical analyses were completed using logistic regression with generalized estimating equations. SETTING Manitoba. PARTICIPANTS Patients receiving care from 225 PCPs participating in the Manitoba Primary Care Research Network. MAIN OUTCOME MEASURES Recommended lipid management was defined as prescription of statins (yes or no) among patients diagnosed with cardiovascular disease (CVD), patients diagnosed with diabetes mellitus (DM; 40 years or older), and patients diagnosed with chronic kidney disease (CKD; 50 years and older) in 2017. Treatment was identified using the ATC (Anatomical Therapeutic Chemical) system (ATC code C10AA or C10B). RESULTS After adjusting for relevant confounders, the odds of prescribing statins to patients with CVD, DM, or CKD among PCPs who did not participate in the cardiology CME activities were 50%, 55%, and 67% lower, respectively, than among PCPs who participated in 2 or more activities. The odds of prescribing statins to patients with CVD and DM among PCPs who participated in only 1 cardiology CME activity were also 67% and 63% lower, respectively, than among PCPs who participated in 2 or more activities. CONCLUSION Results suggested that PCPs who participated in 2 or more cardiology CME activities were more likely to prescribe recommended lipid management (statins) for adults with CVD, DM, or CKD.
Collapse
Affiliation(s)
- Diana C. Sanchez-Ramirez
- Assistant Professor in the College of Rehabilitation Sciences in the Rady Faculty of Health Sciences at the University of Manitoba in Winnipeg.,Correspondence Dr Diana C. Sanchez-Ramirez; e-mail
| | | | | | | | | |
Collapse
|
8
|
AlRuthia Y, Abdulaziz Bin Aydan N, Sulaiman Alorf N, Asiri Y. How can Saudi Arabia reform its public hospital payment models? A narrative review. Saudi Pharm J 2020; 28:1520-1525. [PMID: 33041625 PMCID: PMC7537664 DOI: 10.1016/j.jsps.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The cost of Saudi healthcare continues to rise at an alarming rate, putting the sustainability of the public healthcare system into question. Data have shown that hospital and healthcare providers' services represent the bulk of this rising cost, which makes the calls to reform the Saudi healthcare system more focused on payment models than at any time before. OBJECTIVE The aim of this paper is to review various identified payment models that can be used to contain costs and improve the quality of the care provided. METHOD A literature review of articles addressing the issues of cost containment and improving the quality of healthcare by reforming the current Saudi healthcare payment policy were identified through the Ovid®, Medline, and Google® Scholar search engines. RESULTS AND CONCLUSIONS Many research articles and literature reviews have identified and discussed different models of healthcare payments. Some articles have focused on one payment model, while others have discussed different payment models that have been identified. There is an urgent need to reform the current system of healthcare payments to improve the quality of healthcare and maintain funding for universal healthcare coverage in the future. Future healthcare payment reforms should consider restructuring the current healthcare system, which is largely fragmented by providing incentives to different governmental healthcare sectors, in order to transform it into a more organized and coordinated system. Thus far, there is not a single payment model that can, by itself, reduce healthcare costs and improve healthcare quality. Future healthcare reforms should use a mixture of different payment models to pay hospitals and physicians.
Collapse
Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Nora Sulaiman Alorf
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Andoh-Adjei FX, Boudewijns B, Nsiah-Boateng E, Asante FA, van der Velden K, Spaan E. Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana. HEALTH ECONOMICS REVIEW 2018; 8:17. [PMID: 30151701 PMCID: PMC6111020 DOI: 10.1186/s13561-018-0203-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after introduction of capitation payment policy to understand whether the intended objective was achieved. METHODS The study was cross-sectional, using a non-equivalent pre-test and post-test control group design. We did trend analysis, comparing utilization and claims expenditure data from three administrative regions of Ghana, one being an intervention region and two being control regions, over a 5-year period, 2010-2014. We performed multivariate analysis to determine differences in utilization and claims expenditure between the intervention and control regions, and a difference-in-differences analysis to determine the effect of capitation payment on utilization and claims expenditure in the intervention region. RESULTS Findings indicate that growth in outpatient utilization and claims expenditure increased in the pre capitation period in all three regions but slowed in post capitation period in the intervention region. The linear regression analysis showed that there were significant differences in outpatient utilization (p = 0.0029) and claims expenditure (p = 0.0003) between the intervention and the control regions before implementation of the capitation payment. However, only claims expenditure showed significant difference (p = 0.0361) between the intervention and control regions after the introduction of capitation payment. A difference-in-differences analysis, however, showed that capitation payment had a significant negative effect on utilization only, in the Ashanti region (p < 0.007). Factors including availability of district hospitals and clinics were significant predictors of outpatient health care utilization. CONCLUSION We conclude that outpatient utilization and related claims expenditure increased in both pre and post capitation periods, but the increase in post capitation period was at slower rate, suggesting that implementation of capitation payment yielded some positive results. Health policy makers in Ghana may, therefore, want to consider capitation a key provider payment method for primary outpatient care in order to control cost in health care delivery.
Collapse
Affiliation(s)
| | - Bronke Boudewijns
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre-Netherlands, Nijmegen, Netherlands
| | - Eric Nsiah-Boateng
- National Health Insurance Authority, PMB Ministries Post Office, 36-6th Avenue, Ridge, Accra, Ghana
| | - Felix Ankomah Asante
- Institute of Statistical, Social and Economic Research (ISSER) University of Ghana, Legon, Accra Ghana
| | - Koos van der Velden
- Radboud Institute for Health Science, Department for Primary and Community Health, Radboud University Medical Centre-Netherlands, Nijmegen, Netherlands
| | - Ernst Spaan
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre-Netherlands, Nijmegen, Netherlands
| |
Collapse
|
10
|
Andoh-Adjei FX, Spaan E, Asante FA, Mensah SA, van der Velden K. A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries. Ghana Med J 2018; 50:207-219. [PMID: 28579626 DOI: 10.4314/gmj.v50i4.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. METHODS We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. RESULTS Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. CONCLUSION The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care. FUNDING Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352.
Collapse
Affiliation(s)
- Francis-Xavier Andoh-Adjei
- National Health Insurance Authority - Research, Policy, Monitoring & Evaluation, Accra, Greater Accra, Ghana
| | - Ernst Spaan
- Radboud University Medical Centre, Radboud Institute for Health Sciences - Department for Health Evidence, Nijmegen, Netherlands
| | - Felix A Asante
- University of Ghana, Institute of Statistical, Social and Economic Research, Accra, Ghana
| | - Sylvester A Mensah
- University of Professional Studies, Centre for Universal Health Coverage, Accra, Ghana
| | - Koos van der Velden
- Radboud University Medical Centre, Radboud Institute for Health Sciences - Department for Primary Care, Nijmegen, Netherlands
| |
Collapse
|
11
|
Hasan Y, Parviz SS, Bahram N. Health System Reform Plan and Performance of Hospitals: an Iranian Case Study. Mater Sociomed 2017; 29:201-206. [PMID: 29109667 PMCID: PMC5644193 DOI: 10.5455/msm.2017.29.201-206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Health system reform is essential to make desired Changes. In Iran, first phase of Health Reform Plan (HRP) was implemented in hospitals affiliated with Ministry of Health and Medical Education (MHME) in 2014. Aim: The present study was carried out to evaluate the performance of hospitals affiliated with Urmia University of Medical Sciences at the time of the implementation of HRP. Methods: This cross-sectional study carried out in two stages, before (2012- 2013) and during (2014- 2015) implementation of the HRP in district and teaching hospitals. Data collection and evaluation of performance of hospitals was performed using indices issued by MHME using graphical and statistical analysis. Results: Average bed occupancy rate and bed turnover rate increased and the average length of stay decreased in the majority of hospitals during the study period. The highest and lowest bed occupancy rate was observed in district hospitals. All hospitals were shifted toward the third zone in Pabon Lasso (PL) diagram. Conclusion: This study confirmed that the implementation of the defined package of HRP in hospitals affiliated with UUMS resulted in increased admissions and hospitalization and improved performance.
Collapse
Affiliation(s)
- Yusefzadeh Hasan
- Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Salem Safi Parviz
- Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Nabilou Bahram
- Social determinants of health Research Center, School of Public Health, Urmia University of Medical Science, Urmia, Iran
| |
Collapse
|
12
|
Rudmik L, Xu Y, Kukec E, Liu M, Dean S, Quan H. A validated case definition for chronic rhinosinusitis in administrative data: a Canadian perspective. Int Forum Allergy Rhinol 2016; 6:1167-1172. [DOI: 10.1002/alr.21801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/18/2016] [Accepted: 04/12/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| | - Yuan Xu
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| | - Edward Kukec
- Data Integration, Measurement and Reporting (DIMR); Alberta Health Services; Calgary Alberta Canada
| | - Mingfu Liu
- Data Integration, Measurement and Reporting (DIMR); Alberta Health Services; Calgary Alberta Canada
| | - Stafford Dean
- Data Integration, Measurement and Reporting (DIMR); Alberta Health Services; Calgary Alberta Canada
| | - Hude Quan
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| |
Collapse
|