The Impact of a Billing System on Healthcare Utilization: Evidence from the Thai Civil Servant Medical Benefit Scheme

2020 ◽  
Author(s):  
Nada Wasi ◽  
Jirawat Panpiemras ◽  
Wanwiphang Manachotphong
Keyword(s):  
Healthcare Utilization ◽  
Civil Servant ◽  
Medical Benefit ◽  
Billing System ◽  
The Impact

scholarly journals Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

2021 ◽  
Vol 6 (2) ◽  
pp. e004117
Author(s):  
Aniqa Islam Marshall ◽  
Kanang Kantamaturapoj ◽  
Kamonwan Kiewnin ◽  
Somtanuek Chotchoungchatchai ◽  
Walaiporn Patcharanarumol ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Civil Servant ◽  
Social Health ◽  
Health Coverage ◽  
Medical Benefit ◽  
The Social ◽  
Universal Health ◽  
Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

scholarly journals Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Qian-Li Xue ◽  
Kristine Ensrud ◽  
Shari Lin
Keyword(s):  
Cohort Studies ◽  
Healthcare Utilization ◽  
Risk Adjustment ◽  
Healthcare Services ◽  
Self Report ◽  
Added Value ◽  
Care Organization ◽  
Frailty Phenotype ◽  
Frailty Assessment ◽  
The Impact

Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

The impact of cigarette smoking on healthcare utilization among rural residents in China

2018 ◽  
Vol 23 (6) ◽  
pp. 626-633 ◽  
Author(s):  
Changle Li ◽  
Yancun Fan ◽  
Siripen Supakankunti
Keyword(s):  
Cigarette Smoking ◽  
Healthcare Utilization ◽  
Rural Residents ◽  
The Impact

scholarly journals The Giving Of Disciplinary Penalty of Civil Servants Based On Government Regulation Number 53 of 2010 in Governments of Demak Regency

2020 ◽  
Vol 2 (4) ◽  
pp. 443
Author(s):  
Muhammad Adib ◽  
Sri Kusriyah Kusriyah ◽  
Siti Rodhiyah Dwi Istinah
Keyword(s):  
Government Regulation ◽  
Positive Impact ◽  
Secondary Data ◽  
Civil Servant ◽  
Civil Servants ◽  
Disciplinary Action ◽  
Primary Data ◽  
Immediate Supervisor ◽  
The Government ◽  
The Impact

Government Regulation No. 53 of 2010 regarding the discipline of the Civil Servant loading obligations, prohibitions, and disciplinary action which could be taken to the Civil Servant who has been convicted of the offense, is intended to foster a Civil Servant who has committed an offense, the form of disciplinary punishment is mild, moderate, and weight. Disciplinary punishment for the Civil Servant under Government Regulation No. 53 of 2010 Concerning the Discipline of Civil Servants. The formulation of this journal issue contains about how the process of disciplinary punishment, and constraints and efforts to overcome the impact of the Civil Servant disciplinary punishment in Government of Demak regency. The approach used in this study is a sociological juridical approach or juridical empirical, that is an approach that examines secondary data first and then proceed to conduct research in the field of primary data normative. The process of giving disciplinary sanctions for State Civil Apparatus in Government of Demak regency begins with the examination conducted by the immediate supervisor referred to in the legislation governing the authority of appointment, transfer and dismissal of civil servants. The results showed that in general the process of sanctioning / disciplinary punishment of civil servants in the Government of Demak be said to be good and there have been compliance with the existing regulations / applied in Government Regulation No. 53 of 2010, although it encountered the competent authorities judge still apply tolerance against the employee, but also a positive impact among their deterrent good not to repeat the same offense or one level higher than before either the Civil Servant concerned or the other. Obstacles in carrying out disciplinary punishment in Government of Demak regency environment is still low awareness of employees to do and be disciplined in performing the tasks for instance delays incoming work, lack of regulatory discipline, lack of supervision system and any violations of employee discipline. There must be constraints to overcome need for cooperation with other stakeholders comprising Inspectorate, BKPP, and the immediate superior civil servants in this way can be mutually reinforcing mutual communication, consultation, coordination so that if later there is a problem in the future could be accounted for.Keywords: Delivery of Disciplinary Sanctions; Civil Servant; Government Regulation No. 53 of 2010.

scholarly journals Saving Lives One Bite at a Time: The King Hussein Cancer Foundation´s Restaurant Care Program

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 185s-185s
Author(s):  
M. Nababteh ◽  
N. Al Abed Al Mahdi
Keyword(s):  
Care Program ◽  
Cost Effective ◽  
Program Cost ◽  
Funding Model ◽  
Billing System ◽  
Opt Out ◽  
Public Behavior ◽  
Fixed Line ◽  
The Impact ◽  
Financial Process

Amount raised: Since 2007, the program has raised USD 5.25 million. Background and context: In 2007, the King Hussein Cancer Foundation (KHCF) established the Restaurant Care Program (RCP); an innovative sustainable fundraising program targeting the general public. The RCP invites restaurants to incorporate a fixed contribution to KHCF as a line item on their diner bills, enabling restaurant guests to join the fight against cancer. At the time when cancer was still considered a taboo, the idea of bringing cancer onto restaurant tables and associating it with food was a huge undertaking which was frowned upon by most. It took one champion to join the program to for the rest to follow suit; gradually overcoming the taboo and changing public behavior. Within 10 years, the program was able to partner with over 70 restaurants with an annual growth of 8.4%. Aim: Establishing an innovative, sustainable fundraising program that creates behavior change and serves as an accessible, effortless donation channel while they dine Strategy/Tactics: Generating funds in a systematic and sustainable method by including the contribution as a line item on diners' bills within partner restaurants' financial/billing systems. Customizing the contributions according to restaurant's tier; JD 1 (USD 1.4), JD 0.50 (USD 0.70) and JD 0.25 (USD 0.35). Implementation of a donation opt-out method rather than making it opt-in. This means that the contribution is automatically added by the restaurant to the bill, yet allows the diner to optionally remove the donation if they request to do so. Shifting from the opt-in to opt-out method significantly more than doubled the donations received allowing the program to raise USD 512,711 in 2017 alone. Training and educating restaurant employees and raising their awareness about cancer, the program and the impact of raising funds to support patients- deeming them on-the ground KHCF advocates. Program process: Official agreements are signed with partner restaurants indicating the fixed donation amount and the financial process. Restaurants add the contribution as a fixed line item within their financial/billing system-KHCF provides restaurant partners with jointly branded marketing materials which are placed on dining tables and which explain the program and its process. Training of restaurant financial staff and waiters on program process in addition to educating them on cancer, KHCF mission and impact of the donations. Monthly financial reconciliation with each partner restaurant based on provided and audited receipts/bills. Costs and returns: The expenditure of the program is 2-4% of the programs' returns making the program cost-effective and sustainable. What was learned: Despite KHCF being in a resource-poor developing country, the program´s success is proof that it´s possible to conquer taboos and create an innovative funding model that is both cost-effective and sustainable and can be replicated across sectors and countries.

Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Rob F Walker ◽  
Richard F Maclehose ◽  
J'Neka Claxton ◽  
Terrence Adam ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Oral Anticoagulation ◽  
Primary Treatment ◽  
Emergency Department Visits ◽  
Office Visits ◽  
International Classification Of Disease ◽  
Hospitalization Rates ◽  
The Impact

Introduction: Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE. Hypothesis: Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin. Methods: MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses. Results: The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization. Conclusions: VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.

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