scholarly journals Global budget versus cost ceiling: a natural experiment in hospital payment reform in the Netherlands

2019 ◽  
Vol 21 (1) ◽  
pp. 105-114
Author(s):  
Katalin Gaspar ◽  
France Portrait ◽  
Eric van der Hijden ◽  
Xander Koolman
Keyword(s):  
Code Region ◽  
Postal Code ◽  
Care Utilization ◽  
Global Budget ◽  
Payment Reform ◽  
Dutch Hospital ◽  
Lower Growth ◽  
Hospital Funding ◽  
Hospital Visits ◽  
Efficient Care

Abstract Global budget (GB) arrangements have become a popular method worldwide to control the rise in healthcare expenditures. By guaranteeing hospital funding, payers hope to eliminate the drive for increased production, and incentivize providers to deliver more efficient care and lower utilization. We evaluated the introduction of GB contracts by certain large insurers in Dutch hospital care in 2012 and compared health care utilization to those insurers who continued with more traditional production-based contracts, i.e., cost ceiling (CC) contracts. We used the share of GB hospital funding per postal code region to study the effect of contract types. Our findings show that having higher share of GB financing was associated with lower growth in treatment intensity, but it was also associated with higher growth in the probability of having at least one hospital visit. While the former finding is in line with our expectation, the latter is not and suggests that hospital visits may take longer to respond to contract incentives. Our study covers the years of 2010–2013 (2 years before and 2 years following the introduction of the new contracts). Therefore, our results capture only short-term effects.

scholarly journals A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-199
Author(s):  
M Patterson ◽  
M Gozdzik ◽  
J Peña-Sánchez ◽  
S Fowler
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
Postal Code ◽  
Care Utilization ◽  
Specialist Care ◽  
Disease Characteristics ◽  
Significant Difference ◽  
Inflammatory Bowel

Abstract Background Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones. Aims The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods A retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care. Funding Agencies None

scholarly journals Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Albert Wong ◽  
Rianne Elderkamp-de Groot ◽  
Johan Polder ◽  
Job van Exel
Keyword(s):  
Long Term Care ◽  
Care Utilization ◽  
Dutch Hospital ◽  
Term Care ◽  
Hospital Patients

scholarly journals Predictors of High Health Care Utilization in Patients With Inflammatory Bowel Disease Within 1 Year of Establishing Specialist Care

2020 ◽  
Author(s):  
Kenechukwu Chudy-Onwugaje ◽  
Alexander P Mamunes ◽  
David A Schwartz ◽  
Sara Horst ◽  
Raymond K Cross
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
The United States ◽  
Care Utilization ◽  
Medical Assistance ◽  
High Utilizers ◽  
Inflammatory Bowel ◽  
Hospital Visits

Abstract Background A small proportion of patients with inflammatory bowel disease (IBD) consume a disproportionate amount of health care resources, with most of these spent on unplanned care in emergency room (ER) and hospital visits. Interventions in those at high risk in the outpatient setting could reduce the need for future inpatient care. We sought to describe the characteristics predictive of high health care utilization within 1 year after an initial IBD clinic encounter. Methods This was a retrospective study of new IBD patients seen at the outpatient clinics of 2 tertiary IBD centers in the United States. Baseline sociodemographic and clinical characteristics were collected, and the number of IBD-related ER and hospital visits were recorded over the 1-year period after the initial clinic encounter. Patients with ≥2 visits (high utilizers) were compared with those with no visits. Results Of the 735 patients included in the final analysis, 106 (14.4%) were high utilizers, and they had a mean of 2.9 visits (maximum = 10) in the 1 year after their initial encounter. In multivariate analysis, insurance coverage through medical assistance (odds ratio [OR] 3.57; 95% confidence interval [CI], 1.38–9.20), steroid use (OR 1.83; 95% CI, 1.11–3.04), short inflammatory bowel disease questionnaire score <50 (OR 2.29; 95% CI, 1.23–4.27), and current ostomy (OR 4.82; 95% CI, 1.51–15.37) were independently associated with high utilization. Conclusions Multidisciplinary care and resources should be preferentially channeled towards new clinic patients with severe disease and on medical assistance, as this could reduce future inpatient visits and result in cost savings.

scholarly journals Influence of insurance type on rate and type of initial concussion-related medical visits among youth

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chris Radlicz ◽  
Kenneth Jackson ◽  
Amanda Hautmann ◽  
Junxin Shi ◽  
Jingzhen Yang
Keyword(s):  
Sports Medicine ◽  
Private Insurance ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Seeking ◽  
Medical Visits ◽  
Insurance Type ◽  
Publicly Insured ◽  
Efficient Care ◽  
Privately Insured

Abstract Background A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses. Results Of 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011). Conclusions Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.

scholarly journals Impacts of Hospital Payment based on Diagnosis Related Groups (DRGs) with Global Budget on Resource Use and Quality of Care: A Case Study in China

2019 ◽  
Author(s):  
Suwei YUAN ◽  
Wenwei LIU ◽  
Fengqing WEI ◽  
Haichen ZHANG ◽  
Suping WANG ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Resource Use ◽  
Care Quality ◽  
Global Budget ◽  
Payment Reform ◽  
Readmission Rates ◽  
Cost Shifting ◽  
Hospital Expenditures ◽  
Hospital Payment ◽  
The Impact

Background: China has implemented numerous pilots to shift its hospital payment mechanism from the traditional retrospective cost-based system to prospective diagnosis-related-group (DRG) -based system. This study investigated the impact of the DRG payment reform with global budget in Zhongshan, China. Methods: A total of 2895 patients diagnosed with acute myocardial infarction (AMI) were selected from local two largest tertiary hospitals, among which 727 were discharged prior to the payment reform and 2168 afterwards. Difference-in-difference (DID) regression models were used to evaluate the policy effects on patients’ percutaneous coronary intervention (PCI) use, hospital expenditures, in-hospital mortality, and readmission rates within 30 days after discharge. Results: Patients’ PCI use and hospital expenditures increased quickly after the payment reform. With patients with no local insurance scheme as reference, PCI use for local insured patients decreased significantly by 4.55 percent (95 percent confidence interval [CI]: 0.23, 0.72), meanwhile the total hospital expenses decreased significantly by US$986.10 (b=-0.15, P=0.0037) after reform. No changes were observed with patients’ hospital mortality and readmission rates in our study. Conclusion: The innovative DRG-based payment reform in Zhongshan suggested a positive effect on AMI patient’s cost containment but negative effect on encouraging resource use. It had no impacts on patients’ care quality. Cost shifting consequence from the insured to the uninsured was observed. More evidence of the impacts of the DRG-based payment in China’s health scenario is needed before it is generalized nationwide

scholarly journals Longitudinal analysis of historical payments and utilization in patients with hip and knee osteoarthritis

2019 ◽  
Author(s):  
Jackson Allen ◽  
Meredith Grogan Moore ◽  
Luke M Marushack ◽  
Jonathan O'Donnell ◽  
William Jiranek ◽  
...  
Keyword(s):  
Longitudinal Analysis ◽  
Target Population ◽  
Service Level ◽  
Care Utilization ◽  
First Year ◽  
Payment Reform ◽  
Patient Centered ◽  
Knee Oa ◽  
Diagnosis Codes ◽  
New Diagnosis

Abstract Background Osteoarthritis (OA) is a highly prevalent condition associated with substantial clinical and economic burden. Value-based payment reform requires detailed understanding of care utilization. However, previous analyses of OA care have limitations, such as constraining analysis to a single year or to surgical patients. We aimed to more comprehensively characterize health services utilization and payment for hip and knee OA through a 3-year longitudinal analysis, including both operative and non-operative services, using Medicare claims data. Methods We utilized Medicare Standard Analytic Files available from PearlDiver, Inc. The target population for analysis was patients with osteoarthritis in the hip, knee, or both, identified by ICD-9 diagnosis codes. Patients were limited to those whose 1) first instance of hip or knee OA diagnosis in the payer dataset occurred between 2008 and 2011 and 2) who were continuously active in the payer dataset for one year prior to and three years following diagnosis. Results Payments for relevant hip and knee OA services were highest during the first year after diagnosis, representing 55.6%, 65.3%, and 51.2% of total payments for patients with knee, hip, or knee and hip OA, respectively. Payments and utilization of services in the second and third treatment years were lower, and similar to the year prior to OA diagnosis. Service-level analysis revealed that total payments were driven by utilization of high-intensity services like surgery, which accounted for 57.7%, 60.6%, and 63.6% of payments in the first year for knee, hip, and knee and hip OA patients, respectively. High utilization of Medical Services like physician-administered medications, arthrocentesis, and physical therapy drove high payments as well, especially later in treatment. Conclusion Hip and knee OA treatment intensity is highest in the year immediately following a new diagnosis and decreases considerably in the second- and third-years following diagnosis across all relevant service categories. This analysis supports the identification of specific, time-sensitive opportunities to transform hip and knee OA care and payment models to optimize patient-centered outcomes while controlling costs across the episode of care.

Alberta's Acute Care Funding Project

1992 ◽  
Vol 5 (3) ◽  
pp. 4-11 ◽  
Author(s):  
Philip Jacobs ◽  
Edward M. Hall ◽  
Judith R. Lave ◽  
Murray Glendining
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Performance Index ◽  
Inpatient Care ◽  
Hospital Performance ◽  
Performance Measure ◽  
Case Mix ◽  
Global Budget ◽  
Hospital Funding ◽  
Related Group

Alberta initiated the Acute Care Funding Project (ACFP) in 1988, a new hospital funding system that institutes case mix budgeting adjustments to the global budget so that hospitals can be treated more equitably. The initiative is a significant departure in principle from the former method of funding. The ACFP is summarized and critiqued, and focuses on the inpatient side of the picture. The various elements of the project are discussed, such as the hospital performance index, the hospital performance measure, the Refined Diagnostic Related Group, case weights, typical and outlier cases, and the costing mechanisms. Since its implementation, the ACFP has undergone substantial changes; these are discussed, as well as some of the problems that still need to be addressed. Overall, the system offers incentives to reduce length of stay and to increase the efficiency with which inpatient care is provided.

scholarly journals The impact of global budget payment reform on systemic overuse in Maryland

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 100475
Author(s):  
Allison H. Oakes ◽  
Aditi P. Sen ◽  
Jodi B. Segal
Keyword(s):  
Global Budget ◽  
Payment Reform ◽  
The Impact
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