scholarly journals Buying efficiency: optimal hospital payment in the presence of double upcoding

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Simon B. Spika ◽  
Peter Zweifel
Keyword(s):  
Decision Making ◽  
Severity Of Illness ◽  
Hospital Management ◽  
Payment System ◽  
Principal Agent ◽  
Decision Making Process ◽  
Bargaining Solution ◽  
Chief Physician ◽  
Hospital Payment

Abstract Background With DRG payments, hospitals can game the system by ’upcoding’ true patient’s severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent of the distortion depending on hospital’s internal decision-making process. The internal decision making can be of the principal-agent type with the management as the principal and the chief physician as the agent, but the chief physicians may be able to engage in negotiations with management resulting in a bargaining solution. Results In case of the principal-agent mechanism, the distortion due to upcoding is shown to accumulate, whereas in the bargaining case it is avoided at the level of the chief physician. Conclusion In the presence of upcoding it may be appropriate for the sponsor to design a payment system that fosters bargaining to avoid additional distortions even if this requires extra funding.

scholarly journals Decision-making in intensive care medicine – A review

2017 ◽  
Vol 19 (3) ◽  
pp. 247-258 ◽  
Author(s):  
Fiona R James ◽  
Nicola Power ◽  
Shondipon Laha
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Intensive Care Units ◽  
Severity Of Illness ◽  
Patient Choice ◽  
Decision Making Process ◽  
Do Not Resuscitate ◽  
Admission Decisions

Decision-making by intensivists around accepting patients to intensive care units is a complex area, with often high-stakes, difficult, emotive decisions being made with limited patient information, high uncertainty about outcomes and extreme pressure to make these decisions quickly. This is exacerbated by a lack of clear guidelines to help guide this difficult decision-making process, with the onus largely relying on clinical experience and judgement. In addition to uncertainty compounding decision-making at the individual clinical level, it is further complicated at the multi-speciality level for the senior doctors and surgeons referring to intensive care units. This is a systematic review of the existing literature about this decision-making process and the factors that help guide these decisions on both sides of the intensive care unit admission dilemma. We found many studies exist assessing the patient factors correlated with intensive care unit admission decisions. Analysing these together suggests that factors consistently found to be correlated with a decision to admit or refuse a patient from intensive care unit are bed availability, severity of illness, initial ward or team referred from, patient choice, do not resuscitate status, age and functional baseline. Less research has been done on the decision-making process itself and the factors that are important to the accepting intensivists; however, similar themes are seen. Even less research exists on referral decision and demonstrates that in addition to the factors correlated with intensive care unit admission decisions, other wider variables are considered by the referring non-intensivists. No studies are available that investigate the decision-making process in referring non-intensivists or the mismatch of processes and pressure between the two sides of the intensive care unit referral dilemma.

AAC Decision-Making and Mobile Technology: Points to Ponder

2014 ◽  
Vol 23 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Mary Ann Abbott ◽  
Debby McBride
Keyword(s):  
Decision Making ◽  
Mobile Technology ◽  
Communication System ◽  
Augmentative And Alternative Communication ◽  
Evaluation Process ◽  
Decision Making Process ◽  
Alternative Communication ◽  
Ipod Touch ◽  
Feature Match

The purpose of this article is to outline a decision-making process and highlight which portions of the augmentative and alternative communication (AAC) evaluation process deserve special attention when deciding which features are required for a communication system in order to provide optimal benefit for the user. The clinician then will be able to use a feature-match approach as part of the decision-making process to determine whether mobile technology or a dedicated device is the best choice for communication. The term mobile technology will be used to describe off-the-shelf, commercially available, tablet-style devices like an iPhone®, iPod Touch®, iPad®, and Android® or Windows® tablet.

Women in Power and Decision making Positions : Conditions and Restraints

1970 ◽  
pp. 53-57
Author(s):  
Azza Charara Baydoun
Keyword(s):  
Decision Making ◽  
Political Participation ◽  
Political Life ◽  
The Political ◽  
Decision Making Process ◽  
Power Structures ◽  
Policies And Procedures ◽  
The Social ◽  
The Status ◽  
Slow Progress

Women today are considered to be outside the political and administrative power structures and their participation in the decision-making process is non-existent. As far as their participation in the political life is concerned they are still on the margins. The existence of patriarchal society in Lebanon as well as the absence of governmental policies and procedures that aim at helping women and enhancing their political participation has made it very difficult for women to be accepted as leaders and to be granted votes in elections (UNIFEM, 2002).This above quote is taken from a report that was prepared to assess the progress made regarding the status of Lebanese women both on the social and governmental levels in light of the Beijing Platform for Action – the name given to the provisions of the Fourth Conference on Women held in Beijing in 1995. The above quote describes the slow progress achieved by Lebanese women in view of the ambitious goal that requires that the proportion of women occupying administrative or political positions in Lebanon should reach 30 percent of thetotal by the year 2005!

Implementation System of Business Intelligence System In The Company

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Abdul Hamid Arribathi ◽  
Maimunah Maimunah ◽  
Devi Nurfitriani
Keyword(s):  
Decision Making ◽  
Business Intelligence ◽  
Research Library ◽  
Decision Making Process ◽  
Intelligence System ◽  
Business Intelligence Systems

This study aims to determine the stages that must be implemented in building a Business Intelligence System structured and appropriate in building Business Intelligence Systems in an organization, and understand the important aspects that must be considered for investment development Business Intelligence System is increasing. Business must be based on the conditions and needs of the organization in achieving the desired goals. If these conditions occur, then the decision-making process will be better and more accurate. The purpose of this study is to determine the important aspects that must be understood and prepared in using the Business Intelligence System in an organization. The method used is the explanation as well as the research library of several books, articles and other literature.

The Decision Making Process in SMeS

2012 ◽  
Vol 3 (4) ◽  
pp. 1-4
Author(s):  
George Ungureanu ◽  
◽  
Gabriela Ignat
Keyword(s):  
Decision Making ◽  
Decision Making Process
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