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Dissertations / Theses on the topic 'Health care reimbursement'
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1
Cabrera, Katherine Marie. "Florida's health care reimbursement for outpatient medical nutrition therapy." FIU Digital Commons, 2002. http://digitalcommons.fiu.edu/etd/1957.
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The purpose of this study was to describe and inform registered dietitians (RDs) in the State of Florida what insurance companies are providing in terms of medical nutrition therapy (MNT) coverage.
A questionnaire was developed to encompass major MNT reimbursement stipulations such as policies, specific diseases coverage, specific Current Procedural Terminology (CPT) codes and descriptors, use of the medical necessity letter and nutrition cost benefits analysis (CBA). The questionnaire, encompassing 27 plans (HMO, PPO, Indemnity, Medicare, Medicaid), also served as a MNT promotional tool for 11 top administrators from insurance companies (10 private, 1 government) around the State of Florida. The results showed that 78% of all plans reimbursed for MNT caseby- case even without specific MNT policies. Sixty-seven percent of the plans would approve for MNT reimbursement with a medical necessity letter. Half of these top administrators showed an optimistic interest in using nutrition CBAs, case studies and practice protocols for creating MNT policies. The top ranked CPT codes were found to be 99204 (1), 99202 (2), 99201 (2), 99203 (3). The most recognized corresponding descriptors with the CPT were MNT, disease management skills and training and nutritional counseling.
This questionnaire may be used to create additional MNT reimbursement audits or research. The results given in this study can aid RDs in proper documentation on insurance claim forms, usage of the medical necessity letter, nutrition CBAs, practice guidelines and case studies for successful MNT reimbursement.
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Teerawattananon, Yot. "Assessing the feasibility of using economic evaluation in reimbursement of health care services in Thailand." Thesis, University of East Anglia, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433921.
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Objective: the overall aim of this thesis is to assess the 'feasibility' of using economic evaluation for the development of health care benefit packages in Thailand, specifically for selective use on a small number of 'difficult' coverage decisions within the high-cost element of the Universal Healthcare Coverage Scheme (UC). The term 'feasibility' consists of (i) the availability of economic evaluation information for decision-making, (ii) knowledge and understanding among the users, (iii) users' perception of the benefits of economic evaluation, and (iv) the relevance of economic evaluation to the interests of different stakeholders.
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Gopinath, Puja Gopinath. "A Review of Pricing and Reimbursement for Abeona Theraputics’ Gene Therapy Products to Treat Sanfilippo Syndrome." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1497024647261096.
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Chambers, James D. "Current use and potential value of cost-effectiveness analysis in U.S. health care : the case of Medicare national coverage determinations." Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/6521.
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There is a growing recognition that we cannot afford the provision of all new health care technologies, even those that are proven to be beneficial. This is increasingly true in the US, where health care spending is on an unsustainable upward trajectory. US health care spending is greatly in excess of that of other countries; however, with respect to key health metrics, the US health care system performs relatively poorly. Despite this, unlike many other developed countries economic evaluation, and more specifically cost effectiveness evidence, is used sparingly in the US health care system. Notably, the Centers for Medicare and Medicaid Services (CMS), administrators of the Medicare programme, state that cost-effectiveness evidence is not relevant to coverage decisions for medical technology and interventions evaluated as part of National Coverage Determinations (NCDs). The empirical aspect of this thesis evaluates the current use and potential value of using cost-effectiveness evidence in CMS NCDs. A database was built using data obtained from NCD decision memoranda, the medical literature, a Medicare claims database, and Medicare reimbursement information. The findings of the empirical work show that, CMS’s stated position notwithstanding, cost-effectiveness evidence has been cited or discussed in a number of coverage decisions, and there is a statistically significant difference between positive and non-coverage decisions with respect to cost effectiveness. When controlling for factors likely to have an effect on coverage decisions, the availability of cost-effectiveness evidence is a statistically significant predictor of coverage. In addition, the quality of the supporting clinical evidence, the availability of alternative interventions, and the recency of the decision are statistically significant variables. Further, when hypothetically reallocating resources in accordance with cost-effectiveness substantial gains in aggregate health are estimated. It is shown that using cost-effectiveness to guide resource allocation has an effect on resource allocation across patient populations and types of technology.
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Lundkvist, Jonas. "The role of economic evaluations in health care decision making /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-423-6/.
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Forsberg, Ewa. "Do Financial Incentives Make a Difference? : A Comparative Study of the Effects of Performance-Based Reimbursement in Swedish Health Care." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5123-3/.
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Fowler, Erica N. Fowler. "Development of an Administrative Claims-Based Prospective Risk Tier Method for Percutaneous Coronary Intervention Episodes of Care." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1542467861407973.
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Vacková, Martina. "Finanční aspekty reformy zdravotnictví v ČR." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-85213.
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Healthcare in the Czech Republic is currently undergoing reform changes. The aim of the thesis is to evaluate the upcoming changes in the reimbursement of health care in hospitals. To achieve the goal is used as the literature, as well as proposed legislation and the case law. The practical part of the thesis focuses on the hospitals. Emphasis is placed on the analysis of mechanisms fixed costs reimbursement of health care and reimbursement of health care by the DRG method. The potential impact of reform measures is presented on the example of an extremely costly medical care (orphan drugs). Based on the information and analysis are in the final part of the thesis describes the effects of health reform on financing health care in hospitals. At the same time also outlined a possible solution to save the cost of medical equipment in the field of medicines.
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Davidson, Carrie Jane. "Profit Status and the Relationship between Medicaid Reimbursement and Nursing Home Quality in Ohio Nursing Homes." Connect to text online, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1138477611.
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Thesis (Ph. D.)--Case Western Reserve University, 2006.[School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.
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Krauchunas, Matthew. "EXAMINING CALIFORNIA’S ASSEMBLY BILL 1629 AND THE LONG-TERM CARE REIMBURSEMENT ACT: DID NURSING HOME NURSE STAFFING CHANGE?" VCU Scholars Compass, 2011. https://scholarscompass.vcu.edu/etd/2366.
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California’s elderly population over age 85 is estimated to grow 361% by the year 2050. Many of these elders are frail and highly dependent on caregivers making them more likely to need nursing home care. A 1998 United States Government Accountability Office report identified poor quality of care in California nursing homes. This report spurred multiple Assembly Bills in California designed to increase nursing home nurse staffing, change the state’s Medi-Cal reimbursement methodology, or both. The legislation culminated in Assembly Bill (AB) 1629, signed into law in September 2004, which included the Long-Term Care Reimbursement Act. This legislation changed the state’s Medi-Cal reimbursement from a prospective, flat rate to a prospective, cost-based methodology and was designed in part to increase nursing home nurse staffing. It is estimated that this methodology change moved California from the bottom 10% of Medicaid nursing home reimbursement rates nationwide to the top 25%. This study analyzed the effect of AB 1629 on a panel of 567 free-standing nursing homes that were in continuous operation between the years 2002 – 2007. Resource Dependence Theory was used to construct the conceptual framework. Ordinary least squares (OLS) and first differencing with instrumental variable estimation procedures were used to test five hypotheses concerning Medi-Cal resource dependence, bed size, competition (including assisted living facilities and home health agencies), resource munificence, and slack resources. Both a 15 and 25 mile fixed radius were used as alternative market definitions instead of counties. The OLS results supported that case-mix adjusted licensed vocational nurse (LVN) and total nurse staffing hours per resident day increased overall. Nursing homes with the highest Medi-Cal dependence increased only increased NA staffing more than nursing homes with the lowest Medi-Cal dependence post AB 1629. The fixed effects with instrumental variable estimation procedure provided marginal support that nursing homes with more home health agency competition, in a 15 mile market, had higher LVN staffing. This estimation procedure also supported that nursing homes with more slack resources (post AB 1629) increased nurse aide and total nurse staffing while nursing homes located in markets with a greater percentage of residents over the age of 85 had more nurse aide staffing.
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Hopes, Scott L. "Healthcare IT in Skilled Nursing and Post-Acute Care Facilities: Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations." Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
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Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Stråle, Johansson Nathalie, and Malin Tjernström. "The Perfect Contract - Does it Exist? : A case study of Health Choice Västerbotten and its reimbursement system, focusing on the effects on motivation and competition." Thesis, Umeå universitet, Företagsekonomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-79154.
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This study investigates the required implementation of the System of Choice in the Swedish County Council of Västerbotten. The System of Choice is a national law with the objective to improve efficiency within primary care in Sweden. This was done by opening the market for more competition and giving the citizens the right to choose where to seek care. The reform was a big change for the organisation of health provision, which had up until the reform been characterized by monopolistic behaviour by county councils as dominant firms. At the time of this study it had been three years since the beginning of Health Choice, which is the name for the reform in Västerbotten. The aim of this research was to find out if the way in which Västerbotten County Council has chosen to shape Health Choice has led to the fulfilment of the objective of increased competition and thus higher motivation to perform quality care. This has been done by examining the development of the Health Choice and its reimbursement system through the eyes of the primary care providers. The study has further looked at the reasons underlying the result and ways to improve it. This area is not new ground for research. The organisation of health care is a popular topic all over the world since the population is growing and becoming older, thus putting increased pressure on the provision of health care (WHO, 2010, p. VI). Research has however showed that the optimal organisation of a reimbursement system for the primary care largely depends upon local conditions (Anell, 2005, p. 61). Since there is little previous in-depth information about the outcome of the Health Choice, the approach of this study has been inductive. Due to this exploratory and explanatory nature of the study a qualitative approach was applied. The data-collection has been done through 14 semi-structured interviews of about an hour each. To be able to catch the effects of the reimbursement system 11 of the interviews were conducted with health centre directors, representing both private and public providers as well as the different regions within the county council. The three other interviews were held with representatives from the county council and the supporting department for the Primary Care Group. The interviews generated transcribed text of 250 pages. This material was sifted and processed using the template analysis approach. The result shows that the county council‟s attitude to the Health Choice has negatively affected how it has been implemented. Too little resources have been spent on the purchasing department that is responsible for the development of the Health Choice and its reimbursement system. These factors have led to an organisation of Health Choice that discourages private providers to enter the primary care market in Västerbotten and there has thus only been a small increase in competition. A complex system with low continuity, lack of information and focus on the wrong things have led to the value of the reimbursement system as a motivational tool for increasing cost effectiveness and quality of care to be low.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Siazon, Maria Reina Ventura. "Evaluating the Discharge Process Improvement Initiative in Reducing the Length of Stay." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6949.
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Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.
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Beneda, Tomáš. "Analýza systému zdravotnictví ve Spolkové republice Německo." Master's thesis, Vysoká škola ekonomická v Praze, 2008. http://www.nusl.cz/ntk/nusl-9621.
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The diploma paper analyses the health care system in Germany with a view to principles of organization and financial relations in the system. After short description of historical system development follows brief analysis of incomes. Then there is made the analysis of the health care system focused on the expenditures. In this chapter there are presented the segments of health care, way of their organization, forms of payment and analysis of expenditures between the years 1995 and 2007. An unavoidable part of this paper is also the selection of positive constructional elements of health care system and their recommendation for application in the system of Czech Republic.
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Kerns, Elizabeth E. "A Study on the Efficacy of the Medicare Bundled Payments for Care Improvement Initiative at a Large Community Hospital in the Southeast United States." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/7044.
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In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues.
Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program.
The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.
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Narasimhan, Anirudhan. "Commercialization of HFAC Electronic Nerve Block Technology to Treat Chronic Post Surgical Pain." Case Western Reserve University School of Graduate Studies / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=case1290641992.
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Rodriguez, Jason. "Reimbursement comes from the heart the organizational structure of emotions and care-work in nursing homes /." Amherst, Mass. : University of Massachusetts Amherst, 2009. http://scholarworks.umass.edu/dissertations/AAI3380010/.
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Chen, Pei-Chen, and 陳珮甄. "The Impacts of the National Health Insurance Reimbursement Price on the Utilization of Oral Hypoglycemic Agents for Ambulatory Care." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/66938859762383893330.
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碩士國立成功大學
臨床藥學研究所
94
Background Changes in drug expenditure can be divided into 3 components: the prices of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. Recent empirical studies suggested that the health-care organizations consider “whether National Health Insurance reimburses or not”, “the profit margin from pharmaceutical reimbursement”, and “price comparison” as the priority in pharmaceutical purchasing. No matter what accreditation level would be, health-care organizations tended to select the medicine with higher price. The prevalence and incidence of diabetes mellitus are all increasing which thus pose significant burden on the health care system. The proportion of medical expenditure for diabetes mellitus to total medical expenditure was high, especially among the ambulatory care. And the mean medical expenditure for one diabetes mellitus patient was higher than that for non-diabetes mellitus. To control diabetes mellitus, most patients were treated with oral hypoglycemic agents (OHAs). Therefore, the prescribing patterns of OHAs were selected as the study subject. Objective To estimate the relationship between reimbursement price and prescribing patterns of brand and generic OHAs under the pharmaceutical reimbursement scheme of National Health Insurance. Methods The health care claim data from the National Health Insurance (NHI) program during the period 1997-2004 was included for analysis. Microsoft Excel and SAS package software were used for data analysis. And, the relationship among the independent variable, controlled variables and the dependent variable was examined by descriptive analysis and inferential statistics. Results The patient number and frequency for medical consultations of diabetes mellitus were increasing during the study period. Nearly, all the diabetic patients were treated with hypoglycemic agents: 13% of those patients took insulin, and 96% patients took OHAs. In medical centers, metropolitan hospitals, and local community hospitals, the proportion of brand pharmaceuticals prescription frequency to total OHAs and the proportion of brand pharmaceuticals consumption to total OHAs were higher than those of generic pharmaceuticals. Drug utilization in primary clinics was mainly generic pharmaceuticals. The results of multivariance regression analysis showed that health-care organizations tended to use generic pharmaceuticals when NHI reimbursement price had been decreased. The lower the reimbursement price, the more quantity the health-care organizations had consumed. Public hospitals, medical centers, and metropolitan hospitals tended to use more brand pharmaceuticals, while primary clinics did not. After implementing the Global Budget, health-care organizations did not tend to prescribe brand-name pharmaceuticals, and the quantity per day per patient all increased in medical centers, metropolitan hospitals, and local community hospitals, but it decreased in primary clinics. Conclusion First, there was difference in the OHAs utilization between brand- and generic pharmaceuticals. In medical centers, metropolitan hospitals, and local community hospitals, the proportion of brand pharmaceuticals prescription frequency and consumption to total OHAs were higher than generic pharmaceuticals. Drug utilization in primary clinics was mainly generic pharmaceuticals. No matter what accreditation level of health-care organizations would be, quantity per day per patient of brand pharmaceuticals was higher than generic pharmaceuticals. Secondly, NHI reimbursement price indeed affected drug utilization of oral hypoglycemic agents. When NHI reimbursement price had been decreased, health-care organizations tended to use more generic pharmaceuticals. The lower the reimbursement price, the more quantity the health-care organizations had consumed.
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Shyu, Horng-Jeng, and 徐弘正. "The Impacts of Physicians' Behavior Affected by the Optimal Health Care Resources Allocation Under the Global Budget Reimbursement System." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/87630851467654774476.
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博士亞洲大學
健康產業管理學系健康管理組
102
After the launch of Taiwan's National Health Insurance (NHI), the fee-for-service (FFS) payment system allowed hospitals to provide accessible health care. However, continually rising healthcare costs resulted in an unsustainable burden on the system. The global budget payment system (GBPS) has been implemented, which not only controlled health care costs but also motivated the hospital to enhance management efficacy. Determining how to appropriately allocate limited hospital claims resources among its physicians became an important management issue. Without proper allocation of physicians' claims resources, It could induce the unethical behaviors, such as unnecessary drug prescriptions leading to drug costs increasing and medical resources abuse. Thus, appropriate allocation of claims resources is essential to hospital revenue management. It also allows physicians to service a greater number of patients, while limiting the unnecessary waste of resources. This study analyzed the issue of claims resources allocation under the consideration of patient needs and medical services supply of physicians. This study employed the genetic algorithms (GA)and Monte Carol simulation to tackle the uncertainty of patient volumes in the optimization process. The objects of this study was to find out the impacts of physicians' behavior affected by the optimal healthcare resources allocation under the global budget reimbursement system. The study results of outpatient data revealed that physicians of over-budget group had character of well-trained background from center clinic. Their patient's profile had more severity nature with higher CMI. The physicians of below-budget group failed to meet budget in the spring season but better to meet budget in the winter season. The study results of inpatient data revealed over-budget physicians had higher CMI patients and higher service price of their prescription. The physicians' budget compliance of post allocation strategy revealed significant difference in seasons and physician's training background and patient's CMI nature by GEE statistic method. These conclusions could be suggested as a foundation of pre-implement planning of resources allocation strategy of hospital management. Hospitals could use historical data on claims' data as a basis for optimization, and utilize the existing health information system (HIS) as an self-regulation platform for managing budget by physicians.
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Brown-Podgorski, Brittany L. "Examining the Impact of State-Mandated Insurance Benefits and Reimbursement Provisions on Access to Diabetes Self-Management Education and Training (DSME/T)." Diss., 2019. http://hdl.handle.net/1805/21085.
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Indiana University-Purdue University Indianapolis (IUPUI)With an estimated 30.2 million diagnosed and undiagnosed cases among adults (and another 84 million at risk), diabetes mellitus is one of the most prevalent chronic conditions and a leading cause of mortality in the US. Diabetes self-management education and training (DSME/T) is a recognized standard of care and provides patients with the requisite knowledge and skills to properly manage the condition, improve long-term health outcomes, and reduce health care expenditures. Yet, DSME/T is greatly underutilized. Health insurance coverage that does not include benefits for DSME/T effectively imposes barriers to access for patients in need of the service. Many states have adopted laws and regulations requiring public and/or private insurers in their market to provide benefits for DSME/T; however, these requirements vary by state. It is unclear if these policies effectively improve access to DSME/T services. This dissertation seeks to rigorously assess the impact of state-mandated benefits and reimbursement provisions on access to DSME/T among adult patients with diabetes. The first analysis utilizes a unique combination of legal and programmatic data to quantify changes in the supply of DSME/T resources after the adoption of state-mandated benefits (potential access). The second analysis merges legal data with the Medical Expenditure Panel Survey (MEPS) from 2008 to 2016 to examine the impact of state mandates and reimbursement provisions on patient utilization of DSME/T (realized access). Lastly, the final analysis utilizes electronic health record data (2010-2016) from a safety net population to determine if patients’ evaluated need for DSME/T predicts the likelihood of receiving a DSME/T referral during a provider encounter (equitable access). Using novel data sources and a sophisticated policy analysis technique, this study provides a rigorous assessment of the impact of decades of state policies designed to improve access to care.
2020-04-02
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Chih-Lin and 陳志麟. "The Influence of NHI Drug Reimbursement Adjustment for Drug Utilization and Expenditure on Different Levels of Health Care Organizations from 2000 to 2002." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/26523577152011762096.
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碩士中山醫學大學
醫學研究所
93
Background: National Health Insurance (NHI) Program has been launching for more than a decade, in which the drug expenditure has always been a large financial burden to Bureau of National Health Insurance (BNHI), from 62.1 billion in 1996 up to 80.4 billion in 1999. The growth rates at 1998 and 1999 even reached to 12.9% and 11.3% respectively. In view of the drastic increase in drug expenditure and its growth rate, BNHI in 1999 announced a drug reimbursement adjustment policy for drug utilization and expenditure aiming at controlling the drug expenditure to a reasonable level. Eventually, the expenditure on drug utilization has been decreasing from around 7% in 2000 to 3.1% in 2001, and then to 2.2% in 2002. Although the drug expenditure has been dropped to below 3%, the underlying factors controlling the growth are still unknown. The influence of the reimbursement adjustment policy on different levels of health care organizations has yet been studied. Therefore, the primary objective of this thesis is to analyze in-depth the utilization and expenditure of drug in between January 2000 to December 2002, three years of time when the new policy has been launched. Then, recommendations are inferred from the findings to improve the monitoring of the drug expenditure and medical care. Materials and methods: Data being analyzed is obtained from the BNHI, starting from January 2000 to December 2002. The data is basically the detail break-down expenditures the health organization units submitted to BNHI for reimbursement. In which, the data not only provides the information about the total amount of drug expenditure within the organization, but also provide detail information regarding the expenditures in different period of time, different levels and different departments, such as in-patient departments (IPD) and out-patient departments (OPD). Not all kinds of drug are studied in the thesis. Only the top 1000 drugs out of about 4000 drugs ranked by their total expenditures within the period of study will be selected, which have already constituted over 70% of the total amount on drug expenditure. Their trends are thus analyzed by using one-way ANOVA in different dimensions including by different levels, by AHFS and by in/out-patient departments. Results: Within the period of study, it is found that (1) the expenditures of all 19 categories of drugs in accordance with AHFS categorization are increasing. The expenditure in curing heart blood vessel is the largest. (2) By analysis the expenditure in different levels, it is also found that the drug expenditure in curing blood vessel is the largest in all 4 levels. (3) By different levels of health care organizations, the drug expenditure in curing heart blood vessel is the top in medical centers & regional hospitals while the drug expenditure in curing intestine is the top in district hospitals & clinics. Conclusions: (1) The drop of the expenditure in Vitamin should be due to the imposing of the reimbursement adjustment policy. (2) Observe a large amount of expenditure in anti-infection medicine in medical center, regional & district hospitals, it seems that infection has been an inevitable problem in hospital. A better monitoring system for infection control seems to be a topic to be concerned. (3) It is an alarm to our citizen that the expenditure of drugs for curing blood vessel is increasing. It seems necessary to have a campaign to promote the health care on heart diseases. (4) The proportional of the unclassified drugs is persistently in high level. Re-categorization should be done in the future.
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Anita, Pei-Yi Huang, and 黃珮怡. "The Impact of National Health Insurance Reimbursement Policies on Business Strategy and Market Shaping Plan of Health Care IndustryCase Study for “A” product of “A” Medical Technology Company." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/9bwvu8.
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碩士國立臺灣大學
企業管理碩士專班
107
Abstract In Taiwan, everyone has health insurance and the coverage rate of national health insurance has already exceeded 99%; the health care benefits are also broadly covered and reimbursed, almost all-encompassing. As a result of the high insurance rate and high disease coverage rate, the National Health Insurance Administration (NHIA), Ministry of Health and Welfare has become the largest payer for the health care industry in Taiwan. Therefore, the reform of the national health insurance policy has significant impact on the operation and development of the entire health care industry. The financial status of national health insurance has always been a key focus of the public. Since being founded in 1995, with the ultimate goal of achieving a balance of payments, National Health Insurance Administration (NHIA) carried out a number of policy changes, such as global budget payment system, comprehensive drug price surveys, hospital self-management, Fee-for-service, and second-generation national health insurance, which was implemented in 2013. These changes in reimbursement policies are mainly to reduce or control expenditures, in order to achieve the goal of sustainable health care for all. The national health insurance policy, which control expenditures, hinders market growth, operation and development of the health care industry and even patient safety. The case study uses literature and company confidential data analysis to explore the impact of changes under national health insurance policy on Taiwan''s health care industry. It also uses “Case Study Method” to explore the impact of the case company under a critical environment and how it faces challenges and comes out with an effective strategy. The case study concluded that changes with national health insurance policy caused the case company product to vanish from the health care market and affected company operational performance. The case company leveraged health care professionals to re-enter the market successfully and resulting of the product being fully reimbursed by NHI instead of being a self-pay product before 2012. The transformation of this business model has allowed the case company product to continue growing, getting rid of the competition and shaping the market.
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HUANG, YEU-JIUN, and 黃宇君. "Evaluation of the benefit of the Health care reimbursement for the new generation of NSAIDs（COX-2 selective NSAIDs） via retrospective analysis using data warehouse of BNHI Taiwan." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/24730536060056057305.
Full textAbstract:
碩士長庚大學
醫務管理學研究所
95
A new-generation non-steroid anti-inflammatory agent, known as COX-2, was introduced in 1998. This agent, according to clinical studies, produces a lower level of gastrointestinal toxicity than most conventional therapies and has soon become a popular treatment in medical practices. While the uses of COX-2 continue to grow, the rising expenses also draw the attention of health-care organizations concerning the effectiveness of such agent. In this study, an analysis on the effectiveness of COX-2 was performed based on medical claims submitted to the Bureau of National Health Insurance during 2004 and 2005 using the Logistic regression model. Comparisons were made on age, gender, medical facilities chosen, and ratio of inpatient anti-inflammatory treatment resulting from both conventional and COX-2 therapies. During the analysis, it was found that the average age of COX-2 users was higher than that of the others due to the age restriction in the insurance policy. Therefore, in order to avoid the estimation problem caused by this patient selection bias, a separate analysis was conducted on qualified patients alone. The results of this analysis indicate that for general patients, COX-2 users has a higher inpatient ratio (1.5%) than the recipients of traditional therapy (0.4%). For patients qualified for reimbursement, however, the inpatient ratio of COX-2 users (1.7%) is slightly lower than the other (1.9%), and the difference between these two becomes even less significant in the Logistic regression model.
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Dobiáš, Michal. "Právní postavení nestátních zdravotnických zařízení v českém zdravotnictví." Master's thesis, 2011. http://www.nusl.cz/ntk/nusl-313068.
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The purpose of my Master's thesis in law is to analyse the legal position which the private healthcare providers (i.e. operators of private healthcare facilities) occupy in the Czech healthcare system, particularly in the system of public health insurance. Since the private providers emerged in the Czech Republic only after the Velvet Revolution in 1989, the development of their position within the system is relatively short and unsettled. The legal regulation of the field is quite complicated, yet is the subject of strong political controversies, partly due to the generous but vaguely formulated constitutional right to free healthcare. Currently, the Parliament is in the middle of adoption of the healthcare reform of larger scale which would make changes that deserve to be examined. The thesis is composed of Introduction, three chapters and Conclusion. Each of the chapters aims on different aspect of the topic; however, they are interlinked by common legal institutes which play role in the whole thesis. First two subchapters of Chapter I are most general and introduce the possible ways of financing healthcare (public and private insurers, direct payment) and its specifics. The options of foreign citizens are also clarified. After the conclusion that the most important system in the Czech context...
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Bobula, Peter. "Vliv zájmových skupin na úhradovou vyhlášku zdravotnictví České republiky." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-406133.
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Reference (bibliographic reference of this thesis) BOBULA, P. (2019) Influence of the interest groups on healthcare reimbursement decree in Czech Republic. Prague, 2019. Master's thesis (Mgr.). Charles University, Faculty of Social Sciences, Institute of Political Studies. Department of Political Science. Supervisor Mgr. Michal Paulus Abstract Reimbursement decree is an important part of the healthcare policy in Czech Republic. It determines how the resources will be allocated in the healthcare system the next year. According to the Czech legislature, Ministry of Health invites the representatives of insurance companies and healthcare providers to discuss and create a balanced form of reimbursement. When they are not able to agree, it's up to Ministry of Health to determine the reimbursement in corresponding segment. We assume that this kind of organization enables the involved representatives to push their interests in order to get more favorable financing for their profession. Different groups have different positions in the bargaining process so we can expect the existence of winners and losers according to the financial arrangements they were able to enforce. Using the content analysis of final protocols from reimbursement decree conciliations, spending of insurance companies in healthcare segments and...
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Rodriquez, Jason. "Reimbursement comes from the heart: The organizational structure of emotions and care-work in nursing homes." 2009. https://scholarworks.umass.edu/dissertations/AAI3380010.
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This dissertation is a comparative, ethnographic study of emotion-work in two nursing homes – one part of a large, for-profit chain, the other part of a small, non-profit chain – and examines how nursing care-workers grapple with tensions between meeting organizational demands in an increasingly market driven field and providing compassionate care in times of personal crisis. Based on eighteen-months of fieldwork, sixty-five in-depth interviews and analysis of company documents, my research connects the financial and regulatory structure of long-term care to the emotional lives of staff in both nursing homes. While scholars have analyzed the consequences of medical reimbursement regimes on health care systems, my research uncovers the processes by which those consequences are created, and shows how their effects on residents are mediated through staff. Chapters 2-4 examine how proprietary status shaped the experience of work. Many scholars argue that for-profit facilities and non-profit facilities have become isomorphic since the imposition of market forces on long-term care. Although there were similarities between the two nursing homes, they were also strikingly different in their approach to reimbursement. While the for-profit won corporate awards for deftly maneuvering through the market, the non-profit’s community-oriented mission left them with a half-million dollar budget deficit. This section shows the processes by which market forces discipline community-oriented health services organizations such as nursing homes. Given this context, chapters 5-8 turn to how the staff used emotional attachments with residents to give their work dignity and meaning. Contrary to the established view that emotion work alienates employees, I argue that nursing care-workers used emotions – their own, their residents, and their colleagues – as resources in novel ways, even as their emotions were shaped and constrained by the financial and regulatory structure of long-term care. Emotions were shaped by organizations but they were not simply imposed on workers. Nursing care-workers themselves produced emotions, sometimes in ways consistent with organizational goals, and sometimes not, but they consistently found in their emotions a set of resources to manage the strains of their work lives.