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Geographic variation in Part B reimbursement and physician offsetting behavior: a physician matching approach. B部分报销和医生补偿行为的地域差异:医生匹配方法。
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-06-01 Epub Date: 2021-03-18 DOI: 10.1007/s10754-021-09297-3
Christopher S Brunt, Joshua R Hendrickson

Historically, Medicare has operated under the assumption that providers respond to reductions in reimbursement through increased provision of services in an effort to offset declining practice revenue; however, some recent empirical work examining fee reductions has found evidence of either small offsetting effects or reductions in the quantity supplied. Using a distance matching approach that matches practices to nearby practices that are subject to different reimbursement rates, we find overall evidence in support of Medicare's offsetting assumption collectively for all services and for evaluation and management services. We also find evidence consistent with a traditional volume response for imaging and testing services.

从历史上看,医疗保险一直是在这样的假设下运作的:提供者通过增加服务来应对报销减少,以努力抵消实践收入的下降;然而,最近一些考察费用削减的实证工作发现,有证据表明,要么产生了很小的抵消效应,要么减少了供给量。使用距离匹配方法,将实践与受不同偿还率约束的附近实践相匹配,我们找到了支持医疗保险对所有服务以及评估和管理服务的抵消假设的总体证据。我们还发现了与成像和测试服务的传统体积响应一致的证据。
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引用次数: 4
The association of insurance plan characteristics with physician patient-sharing network structure. 保险计划特征与医患共享网络结构的关系。
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-06-01 Epub Date: 2021-02-26 DOI: 10.1007/s10754-021-09296-4
Kimberley H Geissler, Benjamin Lubin, Keith M Marzilli Ericson

Professional and social connections among physicians impact patient outcomes, but little is known about how characteristics of insurance plans are associated with physician patient-sharing network structure. We use information from commercially insured enrollees in the 2011 Massachusetts All Payer Claims Database to construct and examine the structure of the physician patient-sharing network using standard and novel social network measures. Using regression analysis, we examine the association of physician patient-sharing network measures with an indicator of whether a patient is enrolled in a health maintenance organization (HMO) or preferred provider organization (PPO), controlling for patient and insurer characteristics and observed health status. We find patients enrolled in HMOs see physicians who are more central and densely embedded in the patient-sharing network. We find HMO patients see PCPs who refer to specialists who are less globally central, even as these specialists are more locally central. Our analysis shows there are small but significant differences in physician patient-sharing network as experienced by patients with HMO versus PPO insurance. Understanding connections between physicians is essential and, similar to previous findings, our results suggest policy choices in the insurance and delivery system that change physician connectivity may have important implications for healthcare delivery, utilization and costs.

医生之间的专业和社会关系会影响患者的治疗结果,但人们对保险计划的特征如何与医生-患者共享网络结构相关联知之甚少。我们使用2011年马萨诸塞州所有付款人索赔数据库中的商业保险参保人的信息,使用标准和新颖的社会网络度量来构建和检查医生-患者共享网络的结构。使用回归分析,我们检验了医生-患者共享网络措施与患者是否加入健康维护组织(HMO)或首选提供者组织(PPO)的指标之间的关联,控制了患者和保险公司的特征以及观察到的健康状况。我们发现,在hmo注册的患者看的医生在患者共享网络中处于更中心、更密集的位置。我们发现,HMO患者看到的pcp会推荐那些不那么以全球为中心的专家,即使这些专家更以当地为中心。我们的分析表明,HMO和PPO保险的患者在医患共享网络上有微小但显著的差异。了解医生之间的联系是必不可少的,与之前的研究结果相似,我们的研究结果表明,改变医生联系的保险和提供系统中的政策选择可能对医疗服务的提供、利用和成本有重要影响。
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引用次数: 1
Socioeconomic inequality in tobacco use in Kenya: a concentration analysis. 肯尼亚烟草使用中的社会经济不平等:集中分析。
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-06-01 Epub Date: 2021-01-04 DOI: 10.1007/s10754-020-09292-0
Hermann Pythagore Pierre Donfouet, Shukri F Mohamed, Eric Malin

This paper aims at assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, and concentration index, we investigate the determinants of tobacco use, and whether it disproportionately affects the poor. All data used in this study emanated from the 2014 Global Adult Tobacco Survey implemented in Kenya on a nationally representative sample of men and women aged 15 years and older. Our results suggest a link between tobacco use and socioeconomic inequality. Overall, poorer households are more affected by tobacco use than richer households. This socioeconomic inequality is more evident among men and households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 69.11% of household wealth. To reduce the prevalence rate of smoking in Kenya, policymakers could design and implement tobacco control programs through the equity lens. Community health workers could be used to promote non-smoking behaviors among the poor.

本文旨在评估和探索肯尼亚烟草使用中的社会经济不平等。利用根本原因理论和浓度指数,我们调查了烟草使用的决定因素,以及它是否不成比例地影响穷人。本研究中使用的所有数据均来自2014年在肯尼亚实施的全球成人烟草调查,调查对象是15岁及以上的全国代表性男性和女性样本。我们的研究结果表明,烟草使用与社会经济不平等之间存在联系。总体而言,较贫穷的家庭比较富裕的家庭受烟草使用的影响更大。这种社会经济不平等在生活在城市地区的男性和家庭中更为明显。对集中指数的分解表明,当前吸烟者的整体社会经济不平等可以用69.11%的家庭财富来解释。为了降低肯尼亚的吸烟率,政策制定者可以从公平的角度设计和实施烟草控制项目。可以利用社区卫生工作者来促进穷人的不吸烟行为。
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引用次数: 4
Dimensions and Indicators of Quality of Health Care Used for Healthcare Systems’ Performance Assessment 用于医疗保健系统绩效评估的医疗保健质量的维度和指标
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I1.7672
V. Nikolova
Delivering high-quality health care is a central goal of all healthcare systems. Quality of health care is one of the basic components used for health system performance assessment (HSPA). Quality of health care is measured by six dimensions – effectiveness, safety, patient-centeredness, access, appropriateness, and continuity of care. This study aims to identify and systematize the most frequently used dimensions and indicators for measuring the quality of health care used for health system performance assessment. To achieve this aim the review is implemented on the base of HSPA reports from various countries and organizations as well as scientific publications related to quality of health care. Founded on the review of conceptual HSPA frameworks are identified 304 different indicators for measuring quality of health care. Most of them are focused on measuring process and outcome of health care. Effectiveness, safety and patient centeredness are the elements consist of the most used dimensions for measuring quality of health care. Certain differences in understanding of the essence of quality of health care dimensions and indicators were identified in the reports. They could be explained by the diversity of concepts of quality of health care, of health insurance models and of health care system goals in different countries. Measuring quality of health care is a key significance in health care system performance assessment. It provides important information about areas and components of the health care system which need of improvement as a basis for consequential policy and political decisions.
提供高质量卫生保健是所有卫生保健系统的中心目标。卫生保健质量是卫生系统绩效评估(HSPA)的基本组成部分之一。卫生保健的质量由六个方面衡量——有效性、安全性、以病人为中心、可及性、适当性和护理的连续性。本研究旨在找出并系统化用于卫生系统绩效评估的最常用的衡量卫生保健质量的维度和指标。为了实现这一目标,审查工作是在各国和各组织的卫生保健服务调查报告以及与卫生保健质量有关的科学出版物的基础上进行的。在审查卫生保健服务体系概念性框架的基础上,确定了衡量卫生保健质量的304个不同指标。它们大多侧重于衡量卫生保健的过程和结果。有效性、安全性和以病人为中心是衡量卫生保健质量最常用的三个方面。报告指出,在对保健质量的本质的理解方面存在某些差异。这可以用不同国家对卫生保健质量、健康保险模式和卫生保健系统目标的不同概念来解释。卫生服务质量的测量是卫生服务系统绩效评估的重要内容。它提供了关于卫生保健系统中需要改进的领域和组成部分的重要信息,作为后续政策和政治决策的基础。
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引用次数: 0
Managerial competence of health care managers in hospital obstetric structures 医院产科机构卫生保健管理人员的管理能力
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I2.7675
S. Radeva
Health care management in hospital obstetric and gynecological structures is carried out by managers who have organizational and communication qualities specific to the health sector, trained to perform managerial and administrative functions. Managers with their knowledge and skills of planning, organizing, directing and controlling financial, human and material resources largely determine the quality of medical care in a medical institution. Solving problems related to defining the duties, activities, rights and responsibilities of primary and senior midwives is an important condition for improving and developing the quality of medical care. It is important for practice to manage time, activity, motivation, and development by changing not only the work model, but also the approaches, activities, and thinking style of health managers at different hierarchical levels. This means a new development of flexible management competence. Management is inextricably linked to efficiency. It requires constant monitoring of the ratio of „benefits“ of results“ of each activity in different structures and hospitals, as a macronutrient. An effective manager is not just a good employee who is preferred by his subordinates. This is a person who is able to increase the usefulness of medical services with relatively limited resources. the new approach, new style and new way of thinking require managers at different levels of management in hospitals not only to understand hospital management, but also to have the qualities for successful leadership. The purpose of this work is to study the possibility of applying a methodological model of obstetric health care management and its importance for improving their quality and effectiveness. The object of the study is the management of obstetric and gynecological health care in 16 hospitals. The study is based on the use of a direct individual survey and covers 68 primary and senior midwives. Signs related to the organization of work in the ward, the role and place of the midwife in the treatment process were studied. the analysis of the survey data was aimed at characterizing obstetric care in a hospital setting and the applicability of a single health management model with the corresponding information product to the hospital information system.
医院产科和妇科机构的保健管理由具有卫生部门特有的组织和沟通素质的管理人员进行,这些管理人员接受过管理和行政职能方面的培训。管理人员在计划、组织、指导和控制财务、人力和物质资源方面的知识和技能在很大程度上决定了医疗机构的医疗质量。解决与确定初级和高级助产士的职责、活动、权利和责任有关的问题,是改善和发展医疗保健质量的重要条件。通过改变工作模式,以及不同层次卫生管理人员的方法、活动和思维方式来管理时间、活动、动机和发展,对于实践来说是很重要的。这意味着柔性管理能力的新发展。管理与效率密不可分。它要求作为一种宏量营养素,不断监测不同结构和医院中每项活动的"效益"与"结果"的比率。一个有效的管理者不仅仅是一个受下属青睐的好员工。这是一个能够以相对有限的资源增加医疗服务效用的人。新思路、新作风、新思维要求医院各级管理人员不仅要懂得医院管理,而且要具备成功领导的素质。这项工作的目的是研究应用产科保健管理方法模型的可能性及其对提高其质量和效力的重要性。研究的对象是16家医院的产科和妇科保健管理。这项研究基于直接的个人调查,涵盖了68名初级和高级助产士。研究了与病房工作组织有关的标志,助产士在治疗过程中的作用和地位。对调查数据的分析旨在描述医院产科护理的特点,以及单一健康管理模式和相应信息产品对医院信息系统的适用性。
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引用次数: 0
Attitudes of Bulgarian students toward the introduction of health education as a new discipline in the high school curriculum 保加利亚学生对将健康教育作为一门新学科纳入高中课程的态度
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I2.7676
Ivelina I Borisova, N. Mihaylov
Introduction: Health Education as a school subject presents to high-school students knowledge about health and develops attitudes for responsible health behaviors. The school system is the second-best place, after the family, where children are be socialized and educated. Health promotion is an effective method to improve or change our health-related lifestyles. The aim of this study was to research the attitudes and opinions among school students in Bulgaria toward having Health Education as an additional subject in their school curriculum. Materials and Methods: Existing health education frameworks and programs for students were researched. Existing data on the state of children’s well-being and health attitudes among students in Bulgaria were studied using official policy and normative documents. New data were collected via a survey among school students in Bulgaria from diverse locales. In total, 720 students participated in the survey, aged 9 to 19, from the 5th to the 12th grades. The students were asked to fill in a questionnaire developed by the first author. The collected data were analyzed with statistical tools and conclusions were drawn based on the results. Results: Results from the survey show that a healthy lifestyle is quite popular among young people. Overall, they trust the information given by healthcare specialists and health institutions. Health issues are discussed formally in school several times during the school year. The students think that a new Health Education subject would be very useful and they would take part in the classes, especially if healthcare specialists present the subject. The study shows Health Education is most desired and needed by the students in the 7th grade (14 years of age). Conclusion: Existing studies show that health education in Bulgaria is still far away from what should be expected. Only the students from the largest cities are well-informed about health and healthy behaviors. Furthermore, Bulgarian youth consistently report poor health behaviors and low health status. On the other hand, in this study children underscored the importance of health education and reported high motivation to broaden their health-related knowledge.
健康教育作为一门学校学科,向高中生介绍健康知识,培养负责任的健康行为态度。学校系统是仅次于家庭的第二好地方,在那里孩子们被社会化和接受教育。健康促进是改善或改变与健康有关的生活方式的有效方法。本研究的目的是研究保加利亚中学生对在学校课程中增设健康教育科目的态度和意见。材料与方法:对现有的学生健康教育框架和方案进行研究。利用官方政策和规范性文件研究了关于保加利亚学生儿童福利状况和健康态度的现有数据。通过对保加利亚不同地区的学生进行调查,收集了新的数据。共有720名学生参加了调查,年龄在9岁到19岁之间,从5年级到12年级。学生们被要求填写一份由第一作者制作的问卷。对收集到的数据进行统计分析,并根据结果得出结论。结果:调查结果显示健康的生活方式在年轻人中很受欢迎。总的来说,他们相信医疗专家和医疗机构提供的信息。每学年,健康问题在学校被正式讨论过几次。学生们认为开设一门新的健康教育课程会非常有用,他们会参加课程,特别是如果有医疗保健专家讲授这门课程。研究表明,七年级(14岁)学生对健康教育的期望和需求最大。结论:现有的研究表明,保加利亚的健康教育仍远未达到应有的水平。只有大城市的学生对健康和健康行为有充分的了解。此外,保加利亚青年一贯报告健康行为不良和健康状况不佳。另一方面,在本研究中,儿童强调健康教育的重要性,并报告了扩大健康相关知识的高度动机。
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引用次数: 0
Под надслов „Науката преобразява животи“ премина Европейска нощ на учените 2020 в Медицински университет – Варна
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I2.7678
Илияна Георгиева, Александър Дончев, Силвана Добрева, Ваня Маринова, Анета Докова, Т. Костадинова
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引用次数: 0
University Partnerships Management in Times of Pandemics – Mission (Im)Possible 大流行时期的大学伙伴关系管理-可能的任务
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I2.7674
Aneta Dokova, T. Kostadinova, S. Panayotova
Background. The main challenges, faced by the international departments of the European universities during the COVID-19 pandemic, result from the need for fast adaptation, entirely online interaction with national and international partners, the huge amount of work, the absence of established guidelines and information about the procedures for acting under the unknown circumstances. During the coronavirus crisis the university international departments adopted a key role of communication centres with the world outside and turned into hubs for information exchange. Aim. This article aims to present and analyse the communication at the beginning of the COVID – 19 pandemic between the academic partners of the Medical University of Varna at international level with a focus on the partners under „Erasmus+“ programme in the period March – September 2020. There are four main accents of the study: 1) information about the current conditions in the countries, from which the international partners come, about the stage and the course of the disease, the changes in the training process and the state of the mobility; 2) contact with the universities with which activities are planned in the framework of bilateral agreements for academic cooperation; 3) participation in online international events; and 4) training and exchange of good practices for university partnerships and mobility management in times of COVID-19. Material and methods. Based on written documantation, electronic and virtual communication as well as the reports and observations of the officers working at the Department of International Relations and the team of the „Erasmus+“ programme, an analysis was performed of the communication during the pandemic and the impact of the social distancing on the international partnerships of the Medical University of Varna, the changes in the channels used for communication and the overall process of communication and operational activities. Results. Due to the COVID-19 crisis, the summer internships and practices which became traditional for the last seven years with partner medical universities in Moscow and St. Petersburg (Russia) and Kharkiv (Ukraine) had to be cancelled. Two new agreements for academic cooperation were signed and one was resumed. Two international events were organized by Varna Medical University, in which the teams of the Department of International Relations and „Erasmus+“ programme took an active part. For the studied period of six months in the field of international cooperation, the Medical University participated in twenty online trainings, virtual meetings and conferences, organized by partner organisations, whose member Varna Medical University is. Some of them include the European University Association, the Black Sea Universities Network, the European Health Management Association and the World Health Organisation. Conclusions. The communication with the European partners proved crucial under pandemic conditions, characteri
背景。在2019冠状病毒病大流行期间,欧洲大学国际部面临的主要挑战是,需要快速适应,与国家和国际合作伙伴进行完全在线互动,工作量巨大,缺乏关于在未知情况下采取行动的既定指导方针和程序的信息。在冠状病毒危机期间,大学国际系发挥了与外界沟通中心的关键作用,成为信息交流的枢纽。的目标。本文旨在介绍和分析COVID - 19大流行开始时瓦尔纳医科大学国际学术合作伙伴之间的沟通,重点关注2020年3月至9月期间“伊拉斯谟+”计划下的合作伙伴。该研究有四个主要重点:1)国际合作伙伴来自的国家的现状信息,关于疾病的阶段和过程,培训过程中的变化和活动状态;2)与计划在双边学术合作协议框架内开展活动的大学保持联系;3)在线参与国际赛事;4)培训和交流应对2019冠状病毒病的大学伙伴关系和流动管理的良好做法。材料和方法。根据书面文件、电子和虚拟通信以及国际关系部工作人员和"伊拉斯谟+ "方案小组的报告和意见,分析了大流行病期间的通信情况以及社会距离对瓦尔纳医科大学国际伙伴关系的影响。用于沟通的渠道的变化以及沟通和业务活动的整体过程。结果。由于新冠肺炎危机,过去7年在莫斯科和圣彼得堡(俄罗斯)以及哈尔科夫(乌克兰)的合作医科大学传统的暑期实习和实践不得不取消。签署了两项新的学术合作协议,并恢复了一项协议。瓦尔纳医科大学组织了两次国际活动,国际关系系和"伊拉斯谟+ "方案小组积极参加了活动。在为期6个月的国际合作研究期间,瓦尔纳医科大学参加了由伙伴组织组织的20次在线培训、虚拟会议和会议,瓦尔纳医科大学是这些组织的成员。其中包括欧洲大学协会、黑海大学网络、欧洲健康管理协会和世界卫生组织。结论。事实证明,在不可预测和不确定的大流行病条件下,与欧洲伙伴的沟通至关重要。国际交流和在包括瓦尔纳医科大学在内的国际关系部门工作的小组巩固并扩大了它们作为大学中心与国际伙伴交流和信息交流的作用。这最突出地反映在交流的范围和类型完全改变,特别是在“伊拉斯谟+”流动方面,其中学生和学术人员的健康保护和安全成为关键问题。人们观察到一个明显的趋势是向在线交流转移,在这种情况下,伴侣们可以远距离实时交流。传统的实体论坛让位于虚拟活动,网络研讨会和虚拟会议成为国际交流的标准。国际关系部门必须应对的许多前所未有的情况和案例,可以在大流行的过程中通过快速反应和创造性思维成功解决。这一意想不到的、全面的非常局势是对国际伙伴关系的巨大挑战,也是对未来的准备。它表明了沟通的可持续性,建设性的关系和良好的结果。
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引用次数: 0
Characteristics of remote teamwork among clinical research company employees 临床研究公司员工远程团队合作特征
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-14 DOI: 10.14748/HEM.V20I2.7677
K. Dimitrova
Introduction: Remote work is increasingly common in our times due to globalization and the revolutionary development of digital technologies. Utilizing skills such for communicating, collaborating and efficient work in the virtual environment is important for the proper functioning of teams and for the whole organization. Therefore, it is necessary to implement strategies that supports virtual teamwork and the individual performance of employees. Material and methods: Research literature on the research problem was studied and analyzed. Sociological methods were utilized to collect and analyze empirical data. An individual anonymous online questionnaire was deployed containing 29 questions: 22 closed and 7 open-ended. The respondents are employees of a clinical research company, working remotely and on site at the office located in the city of Sofia. The total number of surveyed employees is 109. A quantitative descriptive analysis of the survey data was performed. Results and discussion: The number of employees working remotely in the surveyed organization has increased by 75% from the start of the quarantine measures. Most of them have had no difficulties in adapting, and the quality of teamwork has even improved. No significant difficulties that would negatively affect teamwork and individual performance were reported. Most employees have managed to achieve a balance between personal and professional life, and even prefer remote work to working only on site at the office. Conclusion: Although some employees experience difficulties working remotely, the positive effects of the change are significantly greater. Based on the given recommendations, strategies can be developed in the organization to support the effectiveness of remote teamwork.
由于全球化和数字技术的革命性发展,远程工作在我们这个时代越来越普遍。在虚拟环境中利用沟通、协作和高效工作等技能对于团队和整个组织的正常运作非常重要。因此,有必要实施支持虚拟团队合作和员工个人绩效的战略。材料和方法:对研究问题的研究文献进行研究和分析。运用社会学方法收集和分析实证数据。一份个人匿名在线调查问卷包含29个问题:22个封闭式问题和7个开放式问题。受访者是一家临床研究公司的员工,他们在索非亚市的办公室远程和现场工作。被调查的员工总数为109人。对调查数据进行定量描述性分析。结果和讨论:自隔离措施开始以来,被调查组织中远程工作的员工数量增加了75%。他们中的大多数人在适应方面没有困难,团队合作的质量甚至有所提高。没有重大困难会对团队合作和个人表现产生负面影响。大多数员工都设法在个人生活和职业生活之间取得平衡,甚至更喜欢远程工作,而不是只在办公室工作。结论:尽管一些员工在远程工作中遇到了困难,但这种变化的积极影响明显更大。根据给出的建议,可以在组织中制定策略,以支持远程团队合作的有效性。
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引用次数: 0
Costing of healthcare services in Bulgaria – guidelines for implementing some good practices 保加利亚保健服务的成本计算——实施一些良好做法的准则
IF 2.4 4区 经济学 Q3 BUSINESS, FINANCE Pub Date : 2021-03-13 DOI: 10.14748/HEM.V20I1.7669
Mincho Minev, Lyubomira Koeva-Dimitrova
Costing of healthcare services is one of the most severe challenges facing hospitals’ accounting and management teams. The article presents the characteristics, advantages, and limitations of three different approaches to costing medical services – Time-Driven Activity-Based Costing, Target Costing, and Micro-Costing. We provide a summary of the international experience in their application, and guidelines for their implementation in the Bulgarian context. Aligning the costing systems with current developments in the management accounting field has the potential to improve hospitals’ cost management and their financial condition. At a health system level, accumulating reliable information on the actual cost of medical services would facilitate the process of setting fair reimbursement prices and thus result in more effective ways to spend the scarce resources.
医疗保健服务成本计算是医院会计和管理团队面临的最严峻挑战之一。本文介绍了三种不同的医疗服务成本计算方法的特点、优点和局限性——时间驱动的作业成本法、目标成本法和微观成本法。我们提供了适用这些原则的国际经验的摘要,以及在保加利亚情况下实施这些原则的指导方针。将成本核算系统与管理会计领域的最新发展相结合,有可能改善医院的成本管理和财务状况。在卫生系统一级,积累有关医疗服务实际成本的可靠信息将有助于制定公平的报销价格,从而产生更有效的方式来使用稀缺资源。
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引用次数: 0
期刊
International Journal of Health Economics and Management
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