Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.
{"title":"Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service.","authors":"N. Siddiqui, D. Greenfield, Anthony Lawler","doi":"10.1002/hpm.2934","DOIUrl":"https://doi.org/10.1002/hpm.2934","url":null,"abstract":"Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132115881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A simple method is presented to evaluate bed numbers between countries using a logarithmic relationship between beds per 1000 deaths and deaths per 1000 population, both of which are readily available. The method relies on the importance of the nearness to death effect. This method was tested using data from Australian States. Beds per 1000 deaths varied considerably between States. This variation reduced after adjusting for the ratio of deaths per 1000 population which is a measure of population age structure. After this adjustment, most Australian States roughly approximate to the international average for developed countries while Tasmania was shown to have a chronic bed shortage, as has been recognized for many years. The Northern Territory and the Australian Capital Territory, both of which have the youngest populations, have more beds relative to the other States. The nearness to death effect must be incorporated into capacity planning models in order to give robust estimates of future bed demand and to evaluate differences between countries and health care systems.
{"title":"A pragmatic method to compare hospital bed provision between countries and regions: Beds in the States of Australia.","authors":"Rodney P. Jones","doi":"10.1002/hpm.2950","DOIUrl":"https://doi.org/10.1002/hpm.2950","url":null,"abstract":"A simple method is presented to evaluate bed numbers between countries using a logarithmic relationship between beds per 1000 deaths and deaths per 1000 population, both of which are readily available. The method relies on the importance of the nearness to death effect. This method was tested using data from Australian States. Beds per 1000 deaths varied considerably between States. This variation reduced after adjusting for the ratio of deaths per 1000 population which is a measure of population age structure. After this adjustment, most Australian States roughly approximate to the international average for developed countries while Tasmania was shown to have a chronic bed shortage, as has been recognized for many years. The Northern Territory and the Australian Capital Territory, both of which have the youngest populations, have more beds relative to the other States. The nearness to death effect must be incorporated into capacity planning models in order to give robust estimates of future bed demand and to evaluate differences between countries and health care systems.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125923469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xueyan Liu, Qilin Zhang, Yong Xu, Xiaoyun Wu, Xiaofeng Wang
Since China initiated new health-care reforms in early 2009, a variety of measures have been implemented to slow the growth of medical expenses. This study was conducted to investigate the effect of controlling medical expenses. Based on inpatients' medical expenses at the largest tertiary hospital in Shenzhen, China, from 2009 to 2017, this study analyzed the changes in medical expenses and expense structures according to payment sources (insured or self-financed), stratifying the medical expenses according to the ICD-10 classification chapters of the principal diagnoses of the inpatients in two years (2009 and 2017) in order to control for confounding diseases. The results showed that mean inpatient expenses continued to rise from 2009 to 2017, and the expenses of the self-financed group began to exceed those of the insured group after 2011. Drug and consumable expenses were still the main factors that affected inpatient expenses, and consumable expenses remarkably increased, becoming the highest proportion of expenses. New health-care reforms were effective in controlling growing medical expenses for insured patients but did not make a significant difference in the expenses of self-financed patients. The excessive use of consumables has become a new driver of growing medical expenses.
{"title":"Trend analysis of medical expenses in Shenzhen after China's new health-care reforms.","authors":"Xueyan Liu, Qilin Zhang, Yong Xu, Xiaoyun Wu, Xiaofeng Wang","doi":"10.1002/hpm.2951","DOIUrl":"https://doi.org/10.1002/hpm.2951","url":null,"abstract":"Since China initiated new health-care reforms in early 2009, a variety of measures have been implemented to slow the growth of medical expenses. This study was conducted to investigate the effect of controlling medical expenses. Based on inpatients' medical expenses at the largest tertiary hospital in Shenzhen, China, from 2009 to 2017, this study analyzed the changes in medical expenses and expense structures according to payment sources (insured or self-financed), stratifying the medical expenses according to the ICD-10 classification chapters of the principal diagnoses of the inpatients in two years (2009 and 2017) in order to control for confounding diseases. The results showed that mean inpatient expenses continued to rise from 2009 to 2017, and the expenses of the self-financed group began to exceed those of the insured group after 2011. Drug and consumable expenses were still the main factors that affected inpatient expenses, and consumable expenses remarkably increased, becoming the highest proportion of expenses. New health-care reforms were effective in controlling growing medical expenses for insured patients but did not make a significant difference in the expenses of self-financed patients. The excessive use of consumables has become a new driver of growing medical expenses.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129660403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soheil Hashtarkhani, Behzad Kiani, R. Bergquist, N. Bagheri, Reza Vafaeinejad, M. Tara
OBJECTIVE This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran. METHODS We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model. RESULTS Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method. CONCLUSION An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.
{"title":"An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas.","authors":"Soheil Hashtarkhani, Behzad Kiani, R. Bergquist, N. Bagheri, Reza Vafaeinejad, M. Tara","doi":"10.1002/hpm.2960","DOIUrl":"https://doi.org/10.1002/hpm.2960","url":null,"abstract":"OBJECTIVE\u0000This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran.\u0000\u0000\u0000METHODS\u0000We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model.\u0000\u0000\u0000RESULTS\u0000Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method.\u0000\u0000\u0000CONCLUSION\u0000An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115845741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Lungu, F. Pennucci, S. De Rosis, G. Romano, F. Melfi
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
{"title":"Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians.","authors":"D. Lungu, F. Pennucci, S. De Rosis, G. Romano, F. Melfi","doi":"10.1002/hpm.2959","DOIUrl":"https://doi.org/10.1002/hpm.2959","url":null,"abstract":"Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129891201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bayati, A. Rashidian, H. Zandian, Somayeh Alipoori
BACKGROUND Physician's dual practice is a common phenomenon in both developing and developed countries. This study aimed to investigate the rate and factors affecting the dual practice of general practitioners (GPs) as the most important primary care providers in Iran. METHODS This cross-sectional study was conducted on the data of 666 Iranian GPs, derived from a national survey. In this work, a researcher-made checklist was used to collect the required information. Multinomial logistic regression was used to examine the factors affecting concurrent employment in both public and private sectors and the factors affecting employment in more than one place (either public or private). RESULTS About 23.51% of the GPs were only working in the public sector, and 57.84% only in the private sectors. Also, 18.65% were working in both the private and public sectors. Results also indicated that 26.17% of the GPs were working in two or more places (whether public or private). Male GPs (p < .1) as well as the GPs with higher earnings expectations (p < .01) were more likely to have dual practice. Besides, the GPs working in small towns and villages (compared with Tehran, as capital of Iran; p < .05) were less likely to have dual practice. Gender (male) and earnings expectations had a significant effect on working in more than one place (p < .01). CONCLUSION The most important and significant factor affecting GPs' dual practice in Iran was their financial expectations. Thus, appropriate policies to modify physicians' income expectations and reforms such as improving tariffs setting should be adopted in the health systems.
{"title":"Dual practice and multiple job holding among Iranian general practitioners: rate and effective factors.","authors":"M. Bayati, A. Rashidian, H. Zandian, Somayeh Alipoori","doi":"10.1002/hpm.2961","DOIUrl":"https://doi.org/10.1002/hpm.2961","url":null,"abstract":"BACKGROUND\u0000Physician's dual practice is a common phenomenon in both developing and developed countries. This study aimed to investigate the rate and factors affecting the dual practice of general practitioners (GPs) as the most important primary care providers in Iran.\u0000\u0000\u0000METHODS\u0000This cross-sectional study was conducted on the data of 666 Iranian GPs, derived from a national survey. In this work, a researcher-made checklist was used to collect the required information. Multinomial logistic regression was used to examine the factors affecting concurrent employment in both public and private sectors and the factors affecting employment in more than one place (either public or private).\u0000\u0000\u0000RESULTS\u0000About 23.51% of the GPs were only working in the public sector, and 57.84% only in the private sectors. Also, 18.65% were working in both the private and public sectors. Results also indicated that 26.17% of the GPs were working in two or more places (whether public or private). Male GPs (p < .1) as well as the GPs with higher earnings expectations (p < .01) were more likely to have dual practice. Besides, the GPs working in small towns and villages (compared with Tehran, as capital of Iran; p < .05) were less likely to have dual practice. Gender (male) and earnings expectations had a significant effect on working in more than one place (p < .01).\u0000\u0000\u0000CONCLUSION\u0000The most important and significant factor affecting GPs' dual practice in Iran was their financial expectations. Thus, appropriate policies to modify physicians' income expectations and reforms such as improving tariffs setting should be adopted in the health systems.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"50 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126373029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The demand for voluntary private health insurance (VPHI) in universal coverage health systems in Europe raises some questions. The aim of this paper is to determine the factors that explain the decision to purchase VPHI, to analyse the role of individual risk attitudes and self-assessed health (SAH) in purchasing VPHI, to explore the factors that explain individual risk preferences, and to test how SAH relates to those preferences. To achieve this aim, two recursive simultaneous probits are estimated using data collected by SHARE, wave 6. The main results indicate that people who are more satisfied with the health system coverage are more likely to buy VPHI; SAH is negative correlated with VPHI, but being a risk taker contributes to that decision; however, being a risk taker is positively influenced by good health status. This paper contributes to the discussion on the role of SAH and risk preferences in the decision to buy VPHI. It brings new insights for the health insurance companies and for health policy makers.
{"title":"Voluntary private health insurance demand determinants and risk preferences: Evidence from SHARE.","authors":"A. Tavares","doi":"10.1002/hpm.2922","DOIUrl":"https://doi.org/10.1002/hpm.2922","url":null,"abstract":"The demand for voluntary private health insurance (VPHI) in universal coverage health systems in Europe raises some questions. The aim of this paper is to determine the factors that explain the decision to purchase VPHI, to analyse the role of individual risk attitudes and self-assessed health (SAH) in purchasing VPHI, to explore the factors that explain individual risk preferences, and to test how SAH relates to those preferences. To achieve this aim, two recursive simultaneous probits are estimated using data collected by SHARE, wave 6. The main results indicate that people who are more satisfied with the health system coverage are more likely to buy VPHI; SAH is negative correlated with VPHI, but being a risk taker contributes to that decision; however, being a risk taker is positively influenced by good health status. This paper contributes to the discussion on the role of SAH and risk preferences in the decision to buy VPHI. It brings new insights for the health insurance companies and for health policy makers.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114756996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sudden and unexplained increases in hospital medical admissions and population total deaths have been characterized in the United Kingdom. These sudden increases appear to endure for around 1 to 3 years before they abate. This study demonstrates that the sudden increases in deaths also occur in 125 countries and occur at subnational geographies. The magnitude of the sudden increase diminishes as a power law function up to around 10 000 deaths. Above 10 000 deaths, there is only a small decline with increasing size (deaths). At around 10 000 deaths, a 10% maximum sudden increase applies across many countries or subnational regions. The nearness to death effect, where around half of a person's lifetime hospital admissions occurs in the last 6 months of life, results in higher associated increases in medical admissions. This paper confirms that the use of calendar year data can be misleading. Periods of unexplained higher deaths appear to occur in bursts across multiple countries and appear to show spatial spread within the neighbourhoods which constitute the whole country.
{"title":"Unexplained periods of higher deaths contribute to marginal changes in health care demand and health insurance costs: International perspectives.","authors":"Rodney P. Jones","doi":"10.1002/hpm.2917","DOIUrl":"https://doi.org/10.1002/hpm.2917","url":null,"abstract":"Sudden and unexplained increases in hospital medical admissions and population total deaths have been characterized in the United Kingdom. These sudden increases appear to endure for around 1 to 3 years before they abate. This study demonstrates that the sudden increases in deaths also occur in 125 countries and occur at subnational geographies. The magnitude of the sudden increase diminishes as a power law function up to around 10 000 deaths. Above 10 000 deaths, there is only a small decline with increasing size (deaths). At around 10 000 deaths, a 10% maximum sudden increase applies across many countries or subnational regions. The nearness to death effect, where around half of a person's lifetime hospital admissions occurs in the last 6 months of life, results in higher associated increases in medical admissions. This paper confirms that the use of calendar year data can be misleading. Periods of unexplained higher deaths appear to occur in bursts across multiple countries and appear to show spatial spread within the neighbourhoods which constitute the whole country.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122115576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The impact of medical insurance on the health of the insured has long been an issue of major concern within academia. From the beginning of the 21st century, the Chinese government has invested a large amount of money in national medical insurance programmes. China's current national medical insurance system consists of three types of programmes: basic medical insurance for urban employees (BMIUE), basic medical insurance for urban and rural residents (BMIURR), and public medical insurance (PMI). These three types of medical insurance have significant differences in terms of premiums, policy deductibles, and levels of coinsurance, thus providing us with the opportunity to study the different impacts these programmes have on their covered members. Based on the 2016 China Family Panel Studies (CFPS) conducted by the China Social Science Research Centre in Peking University, this paper applies the ordered probit model to study the various impacts of these three programmes on the insured under each plan. The study found that compared with citizens who are not enrolled in any insurance programme, citizens who are covered by one of the three programmes report better health; compared with those covered by the BMIUE and BMIURR plans, members covered under the PMI programme report significantly better health; and after controlling for the adverse selection of participants in either the BMIUE or BMIURR plan, citizens who are enrolled in the BMIUE programme have a higher utilization rate of medical resources and report better health than those enrolled in the BMIURR plan.
{"title":"The impact of medical insurance programmes on the health of the insured: Evidence from China.","authors":"Yingying Meng, Xiaodong Zhang, Junqiang Han","doi":"10.1002/hpm.2931","DOIUrl":"https://doi.org/10.1002/hpm.2931","url":null,"abstract":"The impact of medical insurance on the health of the insured has long been an issue of major concern within academia. From the beginning of the 21st century, the Chinese government has invested a large amount of money in national medical insurance programmes. China's current national medical insurance system consists of three types of programmes: basic medical insurance for urban employees (BMIUE), basic medical insurance for urban and rural residents (BMIURR), and public medical insurance (PMI). These three types of medical insurance have significant differences in terms of premiums, policy deductibles, and levels of coinsurance, thus providing us with the opportunity to study the different impacts these programmes have on their covered members. Based on the 2016 China Family Panel Studies (CFPS) conducted by the China Social Science Research Centre in Peking University, this paper applies the ordered probit model to study the various impacts of these three programmes on the insured under each plan. The study found that compared with citizens who are not enrolled in any insurance programme, citizens who are covered by one of the three programmes report better health; compared with those covered by the BMIUE and BMIURR plans, members covered under the PMI programme report significantly better health; and after controlling for the adverse selection of participants in either the BMIUE or BMIURR plan, citizens who are enrolled in the BMIUE programme have a higher utilization rate of medical resources and report better health than those enrolled in the BMIURR plan.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114724980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the United Kingdom, one in seven babies require specialist neonatal care after birth, with a noticeable increase in demand. Coupled with budgeting constraints and lack of investment means that neonatal units are struggling. This will inevitably have an impact on baby's length of stay (LoS) and the performance of the service. Models have previously been developed to capture individual babies' pathways to investigate the longitudinal cycle of care. However, no models have been developed to examine the joint analysis of LoS and babies' pathways. LoS at each stage of care is a critical driver of both the clinical outcomes and economic performance of the neonatal system. Using the generalized linear mixed modelling approach, extended to accommodate multiple outcomes, the association between neonate's pathway to discharge and LoS is examined. Using the data about 1002 neonates, we noticed that there is a high positive association between baby's pathway and total LoS, suggesting that discharge policies needs to be looked at more carefully. A novel statistical approach that examined the association of key outcomes and how it evolved over time is developed. Its applicability can be extended to other types of long-term care or diseases, such as heart failure and stroke.
{"title":"Modelling the neonatal system: A joint analysis of length of stay and patient pathways.","authors":"Shola Adeyemi, E. Demir","doi":"10.1002/hpm.2928","DOIUrl":"https://doi.org/10.1002/hpm.2928","url":null,"abstract":"In the United Kingdom, one in seven babies require specialist neonatal care after birth, with a noticeable increase in demand. Coupled with budgeting constraints and lack of investment means that neonatal units are struggling. This will inevitably have an impact on baby's length of stay (LoS) and the performance of the service. Models have previously been developed to capture individual babies' pathways to investigate the longitudinal cycle of care. However, no models have been developed to examine the joint analysis of LoS and babies' pathways. LoS at each stage of care is a critical driver of both the clinical outcomes and economic performance of the neonatal system. Using the generalized linear mixed modelling approach, extended to accommodate multiple outcomes, the association between neonate's pathway to discharge and LoS is examined. Using the data about 1002 neonates, we noticed that there is a high positive association between baby's pathway and total LoS, suggesting that discharge policies needs to be looked at more carefully. A novel statistical approach that examined the association of key outcomes and how it evolved over time is developed. Its applicability can be extended to other types of long-term care or diseases, such as heart failure and stroke.","PeriodicalId":250539,"journal":{"name":"The International journal of health planning and management","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127621108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：