995 resultados para Economics, Hospital
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA School of Business and Economics
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In this paper, we analyze the prospective method of paying hospitals when the within-DRG variance is high. To avoid patients dumping, an outlier payment system is implemented. In the APDRG Swiss System, it consists in a mixture of fully prospective payments for low costs patients and partially cost-based system for high cost patients. We show how the optimal policy depends on the degree to which hospitals take patients' interest into account. A fixed-price policy is optimal when the hospital is sufficiently benevolent. When the hospital is weakly benevolent, a mixed policy solving a trade-off between rent extraction, efficiency and dumping deterrence must be preferred. Following Mougeot and Naegelen (2008), we show how the optimal combination of fixed price and partially costbased payment depends on the degree of benevolence of the hospital, the social cost of public funds and the distribution of patients severity. [Authors]
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"April 1995."
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AbstractBackground:Heart surgery has developed with increasing patient complexity.Objective:To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).Method:All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.Results:Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 R$ 13.928,00 versus R$ 34.854,00 R$ 27.814,00 versus R$ 43.234,00 R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 R$ 4.571,00 versus R$ 16.217,00 R$ 7.298,00 versus R$ 19.548,00 R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.Conclusion:Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
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Sponsored by the Health Administrations of nine cantons, this study was conducted by the University Institute of Social and Preventive Medicine in Lausanne in order to assess how DRGs could be used within the Swiss context. A data base mainly provided by the Swiss VESKA statistics was used. The first step provided the transformation of Swiss diagnostic and intervention codes into US codes, allowing direct use of the Yale Grouper for DRG. The second step showed that the overall performance of DRG in terms of variability reduction of the length of stay was similar to the one observed in US; there are, however, problems when the homogeneity of medicotechnical procedures for DRG is considered. The third steps showed how DRG could be used as an account unit in hospital, and how costs per DRG could be estimated. Other examples of applications of DRG were examined, for example comparison of Casemix or length of stay between hospitals.
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Travaux effectus dans le cadre de l'tude "Case Mix" mene par l'Institut universitaire de mdecine sociale et prventive de Lausanne et le Service de la sant publique et de la planification sanitaire du canton de Vaud, en collaboration avec les cantons de Berne, Fribourg, Genve, Jura, Neuchtel, Soleure, Tessin et Valais
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Pour mettre en vidence le rle respectif de la concurrence et de la rgulation, cet article traitera essentiellement de la question du financement des hpitaux. Aprs une section 1 consacre aux justifications de la rgulation, les modalits de celles-ci seront analyses dans la section 2 avant d'tudier la place de la concurrence dans la section 3. [Auteur, p. 62] [Table des matires] 1. Les fondements de la rgulation du systme de sant. 1A. Pourquoi rguler (assurance-maladie ; la production de soins). 1B. Comment rguler. - 2. La rgulation des tarifs hospitaliers. 2A. Principes gnraux de paiement. 2B. La tarification l'activit. 3. Concurrence et rgulation. 3A. Concurrence fictive, spcialisations, et concurrence priv-public. 3B. La concurrence par la qualit. 3C. La concurrence en prix.
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Laparoscopy is one of the cornerstones in the surgical revolution and transformed outcome and recovery for various surgical procedures. Even if these changes were widely accepted for basic interventions, like appendectomies and cholecystectomies, laparoscopy still remains challenged for more advanced operations in many aspects. Despite these discussion, there is an overwhelming acceptance in the surgical community that laparoscopy did transform the recovery for several abdominal procedures. The importance of improved peri-operative patient management and its influence on outcome started to become a focus of attention 20 years ago and is now increasingly spreading, as shown by the incoming volume of data on this topic. The enhanced recovery after surgery (ERAS) concept incorporates simple measures of general management, and requires multidisciplinary collaboration from hospital staff as well as the patient and the relatives. Several studies have demonstrated a significant decrease in postoperative complication rate, length of hospital stay and reduced overall cost. The key elements of success are fluid restriction, a functioning epidural and preoperative carbohydrate intake. With the expansion of laparoscopic techniques, ERAS increasingly incorporates laparoscopic patients, especially in colorectal surgery. However, the precise impact of laparoscopy on ERAS is still not clearly defined. Increasing evidence suggests that laparoscopy itself is an additional ERAS item that should be considered as routine where feasible in order to obtain the best surgical outcomes.
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Le financement des tablissements de soins a connu dans le courant de l'anne 2007 d'importants changements lgislatifs. De l'introduction de la tarification l'activit sur la base des diagnostic-related groups (DRG) la mise en concurrence directe des hpitaux, qu'ils appartiennent au secteur public ou au secteur priv, de l'ingrence de la Confdration dans la planification hospitalire (jusque l domaine rserv des Cantons) la mise au premier plan des critres de qualit dans l'valuation des tablissements hospitaliers, les exemples ne manquent pas pour illustrer le changement conceptuel auquel nous assistons. L'auteur de ces lignes, privilgiant l'approche historique l'approche normative, s'est demand quels taient les prmices de ce changement lgislatif et s'est confront aux diffrents textes qui ont maill les dbats de ces vingt dernires annes, qu'ils manent du pouvoir excutif (messages aux chambres fdrales, ordonnances d'application) ou du pouvoir lgislatif (textes de loi) afin d'en dgager la cohrence politique. Ce mmoire suit donc une ligne strictement chronologique. Il s'inspire des diffrents travaux parlementaires. A la lecture de ces textes, il apparat que, pour les parlementaires, la question du financement des hpitaux n'est qu'une partie, parfois essentielle, parfois accessoire, selon les poques et l'amplitude du champ d'application du document lgislatif, du financement des soins par l'assurance-maladie. Les grands principes qui rgissent l'assurance-maladie s'appliquent donc ncessairement au financement des hpitaux. Pour cette raison, il est apparu judicieux l'auteur de ces lignes de ne pas sparer les deux problmes et de se plonger dans un premier temps dans les dbats qui ont eu cours lors de l'adoption de la nouvelle loi sur l'assurance-maladie (LAMaI) en 1994. [Auteur, p. 5]
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L'objectif de ce mmoire est d'valuer les consquences du nouveau financement hospitalier de la LAMaI sur les hpitaux publics et plus particulirement sur l'Hpital du Valais. Les nouvelles dispositions votes le 21 dcembre 2007 par le Parlement ont pour but d'accrotre la concurrence entre les hpitaux et de mettre sur un pied d'galit les tablissements privs et publics. Ce document traite des principales modifications lgislatives et de leur entre en vigueur, des nouveauts concernant le calcul des cots et des tarifs la charge de l'assurance obligatoire des soins avec l'inclusion des investissements et la nouvelle dfmition des frais de formation, de l'introduction des forfaits par pathologie SwissDRG, des problmatiques de l'ouverture des frontires cantonales et de la concurrence. Selon les hypothses retenues, des effets peu importants sont prvoir en Valais pour l'ouverture des frontires, la liste hospitalire et la rpartition du tarif entre assureurs et cantons. Par contre on estime que la prise en compte des investissements augmentera les cots de l'Hpital du Valais de 5 13% alors les activits d'intrt gnral se chiffrent entre 4 et 22 Mio. Les consquences de l'introduction de la concurrence voulue par le lgislateur sont plus difficiles valuer, car elles dpendent de paramtres encore inconnus tels que le gain espr et le comportement des parties. Une concurrence par les prix prtritera les hpitaux publics si leurs spcificits, telles que les urgences, les soins intensifs et l'obligation d'admission, ne sont pas prises en compte dans la structure tarifaire, le prix ou la planification. Le changement de comportement du patient, des assureurs, des mdecins traitants voire des cantons ou des mdias constitue galement une inconnue qui pourrait avoir de fortes consquences et contraindre les hpitaux publics dvelopper leurs concepts de marketing et de communication. [Auteur, p. 2]
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"HRP-0906516."
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A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral -126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was f52.85 for those in urban areas and f59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.
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Mestrado em Interveno Scio-Organizacional na Sade - rea de especializao: Polticas de Administrao e Gesto de Servios de Sade
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA School of Business and Economics
