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Fan W, Jiang Y, Pei J, Yan P, Qiu L. The impact of medical insurance payment systems on patient choice, provider behavior, and out‐of‐pocket rate: Fee‐for‐service versus diagnosis‐related groups. DECISION SCIENCES 2023. [DOI: 10.1111/deci.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Wenjuan Fan
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Yuanyuan Jiang
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Jun Pei
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Ping Yan
- School of Management Hefei University of Technology Hefei China
- Key Laboratory of Process Optimization and Intelligent Decision‐making of Ministry of Education Hefei China
| | - Liangfei Qiu
- Department of Information Systems and Operations Management, Warrington College of Business University of Florida Gainesville FloridaUnited States
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Kim SH, Joo HJ, Kim JY, Kim HJ, Park EC. Healthcare Policy Agenda for a Sustainable Healthcare System in Korea: Building Consensus Using the Delphi Method. J Korean Med Sci 2022; 37:e284. [PMID: 36217570 PMCID: PMC9550634 DOI: 10.3346/jkms.2022.37.e284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of this study is to suggest priority tasks necessary for building a sustainable healthcare system in Korea based on the Delphi consensus among healthcare professionals. METHODS Twenty-five items covering the three categories that make up healthcare policy (healthcare demand, supply, and environment) were selected based on a literature evaluation. Email surveys were also analyzed using a two-round modified Delphi method. Of 59 experts, 21 completed the first and second rounds. Each item asked about the degree of importance and urgency, and the answers were rated on a 9-point Likert scale. A coefficient of variation less than 50% for each item in the Delphi survey meant that consensus was reached. Only items that meet a predetermined threshold are prioritized (agreement ≥ 90%, average importance score and urgency score ≥ 6.5). RESULTS Eight items that satisfy all three criteria were set as priorities for a sustainable healthcare system. These tasks are "Securing the financial soundness of the National Health Insurance (NHI)," "Solving the problem of low fertility," "Strengthening response to public health crises such as infectious or environmental diseases," "Bio-health technology innovation using D.N.A (Data, Network, AI)," "Intensive management of dementia patients," "Mental healthcare and suicide prevention," "Reform of the operation structure of the NHI Service," and "Reform the healthcare delivery system and payment system." CONCLUSION The eight items for which consensus was reached in this study should be prioritized for Korea's sustainable healthcare system. Health policy makers will need to put considerable effort into researching and establishing these priorities.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Hye Jin Joo
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Joo Youn Kim
- Division of Healthcare Research & Research Planning, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Hyo Jeong Kim
- Division of Healthcare Research & Research Planning, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea.
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Healthcare Providers’ Knowledge of Value-Based Care in Germany: An Adapted, Mixed-Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148466. [PMID: 35886327 PMCID: PMC9322307 DOI: 10.3390/ijerph19148466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
Background: Value-Based Care (VBC) is being discussed to provide better outcomes to patients, with an aim to reimburse healthcare providers (HCPs) based on the quality of care they deliver. Little is known about German HCPs’ knowledge of VBC. This study aims to investigate the knowledge of HCPs of VBC and to identify potential needs for further education toward implementation of VBC in Germany. Methods: For evidence generation, we performed a literature search and conducted an online survey among HCPs at 89 hospitals across Germany. The questionnaire was based on published evidence and co-developed with an expert panel using a mixed methods approach. Results: We found HCPs to believe that VBC is more applicable in surgery than internal medicine and that well-defined cycles of care are essential for its application. HCPs believe that VBC can reduce health care costs significantly. However, they also assume that implementing VBC will be challenging. Conclusions: The concept in general is well perceived, however, HCPs do not want to participate in any financial risk sharing. Installing an authority/independent agency that measures achieved value, digital transformation, and that improves the transition between the inpatient and the outpatient sectors are top interests of HCPs.
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Constantinou P, Tuppin P, Gastaldi-Ménager C, Pelletier-Fleury N. Defining a risk-adjustment formula for the introduction of population-based payments for primary care in France. Health Policy 2022; 126:915-924. [DOI: 10.1016/j.healthpol.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
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Lee HY, Oh J, Kawachi I. Changes In Catastrophic Health Expenditures For Major Diseases After A 2013 Health Insurance Expansion In South Korea. Health Aff (Millwood) 2022; 41:722-731. [PMID: 35500181 DOI: 10.1377/hlthaff.2021.01320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The South Korean National Health Insurance scheme has lacked sufficient coverage scope (services covered) and depth (costs covered) since it achieved national coverage in 1989. The government implemented two separate welfare plans (2004-08 and 2009-12) to improve the financial protection of National Health Insurance by mainly focusing on costs covered. The third plan (initiated in 2013) was the most comprehensive, addressing both scope and depth. We evaluated the impact of this benefit expansion policy for four categories of major disease (cancer, cardiac disease, cerebrovascular disease, and rare diseases) on catastrophic health expenditures, impoverishment, and unmet need. Using 2012-17 Korean Health Panel Survey data, we performed difference-in-differences analyses and triple-difference analyses to examine the differential impact of policy across income groups. The policy reduced catastrophic health expenditures among beneficiary households across almost all postpolicy years. However, there was no average effect on reducing household impoverishment or unmet need. The policy had mixed effects by income but did not generally favor low-income households. To provide stronger financial protection, the policy must address issues beyond expanding coverage, such as provider payment structure. In addition, special policy measures for low-income households need to be adopted.
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Affiliation(s)
- Hwa-Young Lee
- Hwa-Young Lee, Harvard University, Boston, Massachusetts
| | - Juhwan Oh
- Juhwan Oh , Seoul National University, Seoul, South Korea
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Golla V, Williams SB. Cost-effectiveness of Robotic-Assisted Prostatectomy in the UK-Are We Doing Enough? JAMA Netw Open 2022; 5:e225747. [PMID: 35377430 DOI: 10.1001/jamanetworkopen.2022.5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vishnukamal Golla
- National Clinician Scholars Program, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina
| | - Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston
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O’Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens’ Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Northwell Health Cancer Institute, New Hyde Park, NY, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Conquest JH, Gill N, Sivanujan P, Skinner J, Kruger E, Tennant M. Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective. Healthcare (Basel) 2021; 9:1129. [PMID: 34574902 PMCID: PMC8469501 DOI: 10.3390/healthcare9091129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this review was to assess relevant global literature on capped-fee (CF) and fee-for-service (FFS) payment models as used by public dental services. Research data were assessed through the PRISMA check list and sourced from MEDLINE, PubMed, ProQuest, Cochrane Library, and other methods. The inclusion criteria were peer reviewed articles published between 2004 and 2020 and (i) other countries' health systems that were evaluated in contrast to Australia; (ii) care provided to individuals; (iii) payment models for private services that were the same as Australian government policy (CF and FFS); and (iv) care provided by dentists. We used a mixed methodology for data collection. A total of 262 references were reviewed with 10 references meeting the inclusion criteria with the quality rating being: three-strong, six-moderate, and one-weak. The literature included studies from Sweden (three references), Ireland (three references), United Kingdom (six references), United States of America (two references), and Norway (one reference). Four references included studies within multiple countries. The sample size varied between 20 and 106,874 participants. The two payment systems can impact on individual outcomes, such as by overtreatment in an FFS system and undertreatment in a CF system.
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Affiliation(s)
- Jennifer H. Conquest
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (J.H.C.); (E.K.); (M.T.)
| | - Nirjgot Gill
- Dentistry, James Cook University, Cairns 4870, Australia; (N.G.); (P.S.)
| | - Praveena Sivanujan
- Dentistry, James Cook University, Cairns 4870, Australia; (N.G.); (P.S.)
| | - John Skinner
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Estie Kruger
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (J.H.C.); (E.K.); (M.T.)
| | - Marc Tennant
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (J.H.C.); (E.K.); (M.T.)
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Laugesen MJ, Gusmano MK. Commentary: Global Comparisons of Physician Associations. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2021; 46:747-754. [PMID: 33493324 DOI: 10.1215/03616878-8970924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The authors reflect on their own work in relation to the articles in this special section on physician organizations, and they make four observations. First, association-government power relations shift after countries introduce universal health insurance, but they are by no means diminished. In France, Germany, and Japan, physicians' economic interests are explicitly considered against broader health system goals, such as providing affordable universal insurance. In low- and middle-income countries (LMICs), physician organizations do not share power in the same way. Second, in higher-income countries, fragmentation may occur along specialty or generalist lines, and some physicians are unionized. Generally speaking, physician influence over reimbursement policy is reduced because of organizational fragmentation. Third, associations develop as legitimate voices for physicians, but their relationship to other professions differs in higher-income countries. Associations in LMICs form coalitions with other health professionals. Finally, although German state physician associations have a key implementation role, in most countries, state and federal policy roles seem relatively defined. Global comparison of the LMICs and other countries suggests power, unity, legitimacy, and federal roles are tied closely to the stage of health system development.
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