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

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

Download Full-text

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

The European Journal of Health Economics ◽

10.1007/s10198-019-01114-6 ◽

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.

Download Full-text

Prevalence and estimated trend in chemotherapy use near death from population-based studies on cancer patients: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6590 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6590-6590

Author(s):

Pei-Chun Chou ◽

Chen Hsiu Chen ◽

Tsang-Wu Liu ◽

Siew Tzuh Tang

Keyword(s):

Cancer Patients ◽

Meta Analysis ◽

Population Based ◽

Poor Quality ◽

National Guidelines ◽

Payment Reform ◽

Effective Interventions ◽

The Us ◽

Before And After ◽

The Impact

6590 Background: Chemotherapy (CMT) use near death, based on US national guidelines, is an indicator of aggressive treatment and poor quality of end-of-life (EOL) care. US law also decreased Medicare payments for outpatient CMT since 2005-2006. To evaluate the impact of US payment reform and guidelines on CMT use at EOL, we estimated and compared the overall prevalence of CMT use at EOL in the US and other countries as well as before and after 2007 in the US. Methods: Six databases were systematically searched to January 2017 for population-based studies of CMT use at EOL for patients in all cancer groups. Two reviewers independently extracted data.Overall CMT use prevalence was pooled by a random-effects model. Differences in prevalence of CMT use were compared by meta-regression between subgroups (US vs non-US countries; before and after 2007 in the US). Results: We identified 9 and 7 articles from the US and non-US countries, respectively. CMT was provided to 28.9% [95% confidence interval (CI) 26.2%-31.8%], 23.2% [95% CI 21.7%- 24.8%], 10.0% [95% CI 8.5%-11.8%], and 4.5% [95% CI 3.9%- 5.2%] of cancer patients in their last 6, 3, and 1 months as well as 14 days of life, respectively. CMT use in the last 6 months was more common in the US than in non-US countries (32.4% vs. 26.2%, p = 0.015) but similar to that of other countries in the last month (9.3% vs.11.2%, p = 0.179) and last 14 days (4.6% vs.5.6%, p = 0.683) of life. Prevalence of CMT use in the last 14 days of life in the US did not differ significantly before and after 2007 (5.1% vs. 5.2%, p = 0.967). Conclusions: Many cancer patients worldwide receive CMT at EOL, and the prevalence of CMT use in US patients’ last 14 days of life was virtually unchanged over time. Effective interventions should be developed and provided to offset the trend of continuing CMT use at EOL.

Download Full-text

Methane emissions from boreal and tropical forest ecosystems derived from in-situ measurements

Atmospheric Chemistry and Physics Discussions ◽

10.5194/acpd-7-14011-2007 ◽

2007 ◽

Vol 7 (5) ◽

pp. 14011-14039 ◽

Cited By ~ 21

Author(s):

V. Sinha ◽

J. Williams ◽

P. J. Crutzen ◽

J. Lelieveld

Keyword(s):

Boreal Forest ◽

Tropical Forest ◽

Tropical Forests ◽

Forest Ecosystem ◽

Boreal Forests ◽

Forest Ecosystems ◽

Global Budget ◽

Night Time ◽

Mixing Ratios ◽

The Impact

Abstract. Methane is a climatologically important greenhouse gas, which plays a key role in regulating water vapour in the stratosphere and hydroxyl radicals in the troposphere. Recent findings that vegetation emits methane have stimulated efforts to ascertain the impact of this source on the global budget. In this work, we present the results of high frequency (ca. 1 min−1) methane measurements conducted in the boreal forests of Finland and the tropical forests of Suriname, in April–May, 2005 and October 2005 respectively. The measurements were performed using a gas chromatograph – flame ionization detector (GC-FID). The average of the median mixing ratios during a typical diel cycle were 1.83 μmol mol−1 and 1.74 μmol mol−1 for the boreal forest ecosystem and tropical forest ecosystem respectively, with remarkable similarity in the time series of both the boreal and tropical diel profiles. Night time methane emission flux of the boreal forest ecosystem, calculated from the increase of methane during the night and measured nocturnal boundary layer heights yields a flux of (3.62±0.87)×1011 molecules cm−2 s−1(or 45.5±11 Tg CH4 yr−1 for global boreal forest area). This is a source contribution of circa 8% of the global methane budget. These results highlight the importance of the boreal and tropical forest ecosystems for the global budget of methane. The results are also discussed in the context of recent work reporting high methane mixing ratios over tropical forests using space borne near infra-red spectroscopy measurements.

Download Full-text

The paradox of the COVID-19 pandemic: the impact on patient demand in Japanese hospitals

10.1101/2021.10.01.21264447 ◽

2021 ◽

Author(s):

Masako Ii ◽

Sachiko Watanabe

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Providers ◽

Care Providers ◽

Payment Reform ◽

Dramatic Decline ◽

Hygiene Measures ◽

Abundant Supply ◽

The Impact ◽

Care System

Analyzing data from a large, nationally distributed group of Japanese hospitals, we found a dramatic decline in both inpatient and outpatient volumes over the three waves of the COVID-19 pandemic in Japan from February-December 2020. We identified three key reasons for this fall in patient demand. First, COVID-19-related hygiene measures and behavioral changes significantly reduced non-COVID-19 infectious diseases. Second, consultations relating to chronic diseases fell sharply. Third, certain medical investigations and interventions were postponed or cancelled. Despite the drop in hospital attendances and admissions, COVID-19 is said to have brought the Japanese health care system to the brink of collapse. In this context, we explore longstanding systematic issues, finding that Japan's abundant supply of beds and current payment system may have introduced a perverse incentive to overprovide services, creating a mismatch between patient needs and the supply of health care resources. Poor coordination among health care providers and the highly decentralized governance of the health care system have also contributed to the crisis. In order to ensure the long-term sustainability of the Japanese health care system beyond COVID-19, it is essential to promote specialization and differentiation of medical functions among hospitals, to strengthen governance, and to introduce appropriate payment reform.

Download Full-text

Peritoneal Dialysis Patient Outcomes under the Medicare Expanded Dialysis Prospective Payment System

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01610219 ◽

2019 ◽

Vol 14 (10) ◽

pp. 1466-1474 ◽

Cited By ~ 6

Author(s):

Eric W. Young ◽

Alissa Kapke ◽

Zhechen Ding ◽

Regina Baker ◽

Jeffrey Pearson ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Outcomes ◽

Prospective Payment System ◽

Patient Characteristics ◽

The United States ◽

Payment System ◽

Prospective Payment ◽

Payment Reform ◽

Reform Period ◽

The Impact

Background and objectivesPeritoneal dialysis (PD) use increased in the United States with the introduction of a new Medicare prospective payment system in January 2011 that likely reduced financial disincentives for facility use of this home therapy. The expansion of PD to a broader population and facilities having less PD experience may have implications for patient outcomes. We assessed the impact of PD expansion on PD discontinuation and patient mortality.Design, setting, participants, & measurementsA prospective cohort study was conducted of patients treated with PD at 90 days of ESKD. Patients were grouped by study start date relative to the Medicare payment reform: prereform (July 1, 2008 to December 31, 2009; n=10,585), interim (January 1, 2010 to December 31, 2010; n=7832), and reform period (January 1, 2011 to December 31, 2012; n=18,742). Patient characteristics and facility PD experience were compared at baseline (day 91 of ESKD). Patients were followed for 3 years for the major outcomes of PD discontinuation and mortality using Cox proportional hazards models.ResultsPatient characteristics, including age, sex, race, ethnicity, rurality, cause of ESKD, and comorbidity, were similar or showed small changes across the three study periods. There was an increasing tendency for patients on PD to be treated in facilities with less PD experience (from 34% during the prereform period being treated in facilities averaging <14 patients on PD per year to 44% in the reform period). Patients treated in facilities with less PD experience had a higher rate of PD discontinuation than patients treated in facilities with the most experience (hazard ratio [HR], 1.16; 95% confidence interval [95% CI], 1.10 to 1.23 for the first versus fifth quintile of PD experience). Nevertheless, the risk of PD discontinuation fell during the late interim period (HR, 0.88; 95% CI, 0.82 to 0.95) and most of the reform period (from HR, 0.85; 95% CI, 0.79 to 0.91 to HR, 0.94; 95% CI, 0.87 to 1.01). Mortality risk was stable across the three study periods.ConclusionsIn the context of expanding PD use and declining facility PD experience, the risk of PD discontinuation fell, and there was no adverse effect on mortality.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_09_12_CJN01610219.mp3

Download Full-text