Payment Systems for Telemedicine: Comparative Study (Preprint)

2021 ◽  
Author(s):  
Sarah Raes ◽  
Jeroen Trybou ◽  
Lieven Annemans
Keyword(s):  
Decision Making ◽  
The Netherlands ◽  
Payment System ◽  
Future Research ◽  
Reimbursement Policy ◽  
Fee For Service ◽  
Physician Payment ◽  
Convenience Sample ◽  
Cardiac Devices ◽  
Payment Models

BACKGROUND Many researchers have addressed the lack of reimbursement for telemedicine as one of the most important barriers to telemedicine adoption. However, little is known on how telemedicine should be implemented in reimbursement policy, how it must be financed, and what the right incentives are for an effective and efficient telemedicine use. OBJECTIVE To help future researchers to provide reimbursement policy recommendations, and to facilitate reimbursement decision-making, this paper analyzed and compared the telemedicine payment models of ten countries. METHODS A convenience sample was created of Western countries inside and outside Europe that already reimburse to some extent telemedicine. Ten countries met this criterion: Australia, Belgium, Denmark, France, Germany, Luxembourg, the Netherlands, Canada (Ontario province), Switzerland, and the United Kingdom. The study was based on the countries’ official physician fee schedules, listing all reimbursed medical services performed by physicians, including telemedicine. Based on the fee schedules, a comparative analysis of the payment models of telemedicine was conducted. RESULTS Televisits are reimbursed in all countries, which is not the case for telemonitoring and tele-expertise services. Telemonitoring is often restricted for patients with implanted cardiac devices. Telemedicine services are mainly paid fee-for-service, except for the telemonitoring of patients with implanted cardiac devices, which is paid through an episodic payment system in Australia. Payment parity exists across televisits and visits in person in France, Luxembourg, the Netherlands, and Switzerland, meaning that an equal fee is given for both services. CONCLUSIONS Our findings show that fees for telemedicine are lacking, especially for telemonitoring and tele-expertise. As telemedicine might enlarge disparities in healthcare access, policymakers should consider payment parity across televisits and face-to-face visits, and across telephone and video visits. Furthermore, an episodic physician payment system complemented with bonuses for quality outcomes, should be considered by policymakers for telemonitoring as it might capture the specificities of telemonitoring better than a fee-for-service system. Future research is needed on payment models, including research linking cost-effectiveness analyses with analyses on payment models, to allow profound reimbursement recommendations and a faster decision-making process for the reimbursement of telemedicine.

“Tell Me More and Help Me to Decide, Doctor” – Information Seeking Attitudes and Use of Information Resources in Patients with Depression

2017 ◽  
Vol 41 (S1) ◽  
pp. S146-S146
Author(s):  
H. Almeida ◽  
A.M. Pisco Almeida ◽  
M. Figueiredo-Braga
Keyword(s):  
Decision Making ◽  
Information Seeking ◽  
Psychiatric Treatment ◽  
A Priori ◽  
Information Resources ◽  
Self Report ◽  
Mental Condition ◽  
Future Research ◽  
Limited Information ◽  
Convenience Sample

IntroductionShared decision-making (SDM) has shown to improve adherence, decrease hospitalization, and enhance knowledge of the illness and satisfaction with mental health services. Eliciting each patient's preferences for information allows tailoring the physician behavior according perspectives and expectations. Patients with depression (PWD) have frequently limited information regarding the availability and efficacy of psychiatric treatments.Aims/objectivesUnveil information seeking attitudes of patients with depression and their a priori use of digital sources of information.MethodsA convenience sample of PWD was submitted to a battery of self-report questionnaires. Standardized instruments were used to measure information seeking attitudes and the accessibility and usage of digital information resources.ResultsThirty-six patients were inquired, with a mean age of 39.8 (13.4) years. Information-seeking preferences were high, with an API-I score of 90.1 (13.8). Preferences for information-seeking behaviors were higher in severely depressed (P = 0.010) and less educated (P = 0.026) patients. Preferences were negatively correlated with length of psychiatric treatment (r = −0.514; P = 0.002). Sixty-one percent had a priori information regarding their psychiatric problem, and 68.8% considered it was influential in the decision-making behavior. Access and use of digital resources were correlated with education level (0.644; P = 0.000 and 0.554; P = 0.003), age (−0.357; P = 0.001 and −0.559; P = 0.007) and illness severity (−0.431; P = 0.04).ConclusionPatients with depression want to be informed about their mental condition and treatment options. Few resources are used and decision mostly relies on health professional's opinion and guidance. Accessible resources seem scarce and future research shall address the acceptance and impact of decisional-aid instruments on this population.

Perspectives of decision-making in requests for euthanasia: A qualitative research among patients, relatives and treating physicians in the Netherlands

2012 ◽  
Vol 27 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Marianne K Dees ◽  
Myrra J Vernooij-Dassen ◽  
Wim J Dekkers ◽  
Glyn Elwyn ◽  
Kris C Vissers ◽  
...  
Keyword(s):  
Decision Making ◽  
The Netherlands ◽  
Relationship Building ◽  
Future Research ◽  
Decision Making Process ◽  
Building Relationships ◽  
Proactive Approach ◽  
Qualitative Thematic Analysis ◽  
Complex Process ◽  
Complex Decision Making

Background: Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient’s autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. Aim: To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. Design: A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Participants/setting: Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients’ and relatives’ homes and physicians’ offices. Results: Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. Conclusions: A patient’s request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants’ preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

scholarly journals THE NEED TO REFORM THE HOSPITAL PAYMENT SYSTEM IN INDONESIA

2019 ◽  
Vol 19 (2) ◽  
pp. 132-140
Author(s):  
Nur Hidayah ◽  
Arlina Dewi ◽  
OU Jen-ho ◽  
Qurratul Aini
Keyword(s):  
National Health ◽  
Employee Satisfaction ◽  
Hospital Performance ◽  
Payment System ◽  
Public Hospitals ◽  
Full Time ◽  
Fee For Service ◽  
Health Coverage ◽  
Payment Method ◽  
Physician Payment

One of the crucial health policies in hospitals is about physician payment methods. Indonesia had implemented the National Health Assurance since 2014 to achieve Universal Health Coverage by 2019. Most of hospital revenue is packaging from the National Health Insurance Agent (called BPJS). However, Fee-for-service (FFS) payment method is still dominant in many hospitals. How can hospitals make policy to rearrange the payment method to attain hospital performance? The purpose of this research is to analyze the payment system that can improve employee satisfaction and performances. Mix method was used to collect data and make an interpretation. Data collected from 185 respondents and four key informants. The result showed that the policy in private and public hospitals in Indonesia of the physician payment is diverse. Most of the hospitals use the pure FFS for self-employee physicians (part timer employee). For full time employee, they applied FFS mixed with salary, or remuneration. To improve employee satisfaction and performance, the hospitals should make a policy to link the FFS to pay for performances. The hospital should make the tailoring program by involving the physician in a designing method of the hospital remuneration.

Prophetic Leadership Model: Conceptualizing a Prophet’s Leadership Behaviour, Leader-Follower Mutuality and Altruism to Decision Making Quality

2015 ◽  
Vol 3 (1) ◽  
pp. 93
Author(s):  
Nik Maheran Nik Muhammad
Keyword(s):  
Decision Making ◽  
Social Network ◽  
A Priori ◽  
Complex Function ◽  
Spiritual Leadership ◽  
Leadership Theory ◽  
Future Research ◽  
Leadership Model ◽  
Leadership Behaviour ◽  
Current Leadership

This article advocates that research is lacking on the connection between leadership theory and social network theory. To date, little empirical research has been conducted on leadership and social networks. Thus, the proposition of this article goes beyond traditional leadership models to advocate for a fuller and more integrative focus that is multilevel, multi-component and interdisciplinary, while recognizing that leadership is a complex function of both the organisational leaders and the followers who perform tasks, all of which subsequently leads to decision making qualities. Indeed, the current leadership model focuses on leadership behaviour and the ability to gain followers mutuality, to achieve decision making quality involving the integration of leadership and social network theories. Given the apparent mutable palette of contemporary leadership theory, this emergent construct of the leadership paradigm can expand the poles of the leadership continuum and contribute to a richer and deeper understanding of the relationships and responsibilities of leaders and followers as they relate to decision making qualities. This new construct, which is termed prophetic leadership, explores the literature of the life experiences of the prophet in the ‘Abrahamic Faith’ religion. Drawing on a priori links between the personality trait and spiritual leadership that has recently garnered the interest of scholars, the present study asserts a normative leadership theory that links the personal quality of a leader, posture and principal (based on the Prophet’s leadership behaviour) to synergy and decision making quality. Altruism is proposed to enhance relationships between leadership behaviour and decision making quality. For future research, much work needs to be done specifically aiming to (a) achieve greater clarity of construct definitions, (b) address measurement issues, and (c) avoid construct redundancy.

Prophetic Leadership Model: Conceptualizing a Prophet’s Leadership Behaviour, Leader-Follower Mutuality and Altruism to Decision Making Quality

2015 ◽  
Vol 1 (3) ◽  
pp. 93
Author(s):  
Nik Maheran Nik Muhammad
Keyword(s):  
Decision Making ◽  
Social Network ◽  
A Priori ◽  
Complex Function ◽  
Spiritual Leadership ◽  
Leadership Theory ◽  
Future Research ◽  
Leadership Model ◽  
Leadership Behaviour ◽  
Current Leadership

This article advocates that research is lacking on the connection between leadership theory and social network theory. To date, little empirical research has been conducted on leadership and social networks. Thus, the proposition of this article goes beyond traditional leadership models to advocate for a fuller and more integrative focus that is multilevel, multi-component and interdisciplinary, while recognizing that leadership is a complex function of both the organisational leaders and the followers who perform tasks, all of which subsequently leads to decision making qualities. Indeed, the current leadership model focuses on leadership behaviour and the ability to gain followers mutuality, to achieve decision making quality involving the integration of leadership and social network theories. Given the apparent mutable palette of contemporary leadership theory, this emergent construct of the leadership paradigm can expand the poles of the leadership continuum and contribute to a richer and deeper understanding of the relationships and responsibilities of leaders and followers as they relate to decision making qualities. This new construct, which is termed prophetic leadership, explores the literature of the life experiences of the prophet in the ‘Abrahamic Faith’ religion. Drawing on a priori links between the personality trait and spiritual leadership that has recently garnered the interest of scholars, the present study asserts a normative leadership theory that links the personal quality of a leader, posture and principal (based on the Prophet’s leadership behaviour) to synergy and decision making quality. Altruism is proposed to enhance relationships between leadership behaviour and decision making quality. For future research, much work needs to be done specifically aiming to (a) achieve greater clarity of construct definitions, (b) address measurement issues, and (c) avoid construct redundancy.

Factors Affecting Customer Switching Behavior towards Hybrid Electrical Vehicles (HEV’s) from a Customer Perspective in Jordan

2018 ◽  
Vol 1 (3) ◽  
pp. 53
Author(s):  
Bushra Mahadin
Keyword(s):  
Decision Making ◽  
Consumer Behaviour ◽  
New Technologies ◽  
International Marketing ◽  
Current Trend ◽  
Switching Behavior ◽  
Future Research ◽  
Decision Making Process ◽  
Customer Switching ◽  
Electrical Vehicles

Purpose-This paper aims to investigate factors that affect customer switching from Internal Combustion Engine Vehicles (ICEV’s) to Hybrid Electrical Vehicles (HEV’s), in Jordan for the period of (2010-2014).Design/methodology/approach-A self-administered survey was hand-delivered to the targeted sample of car users in Jordan. The authors delivered 400 questionnaires to customers, from which 333 were deemed valid for the analysis, corresponding to the percentage of (83.25%) which indicates the validity of the study. Findings- There was no difference in switching behavior between (ICEV’s) and (HEV’s) based on gender in the Jordanian market. Fuel consumption efficiency was the number one variable that supports the switching behavior towards (HEV's), followed by Eco friendliness, lower taxes and technological features. Price and the current trend in the market were the least supporting factors. In addition to that the perception of the battery life of (HEV's), limited choices in the market, lack of information and fear of the relatively new technology were the major hindering factors of choosing an (HEV).Research limitations-Future research needs to investigate other factors that may affect customers’ behavior such as perceived image, trust, and subjective norms. Future research should investigate into the importance of environmental awareness and new technologies, and gender differences in behavior. From an international marketing standpoint, comparative studies between Jordanian and non-Jordanian customers are potential areas of future research for international marketing strategies and cross-cultural consumer behaviour analysis. Practical implications-The paper identifies the determinants of switching behavior. marketers should focus addressing customers concerns in terms of providing enough information and building awareness towards the technology and it's benefits towards the society and the environment.Originality/value-Our study is one of the few in Jordan that investigates the switching behavior towards vehicles technology. Our study is thought to have made a modest contribution to consumer behaviour literature and, specifically, for decision making process. It offers marketers insights into the determinants of switching behavior towards the hybrid vechicle technology and how this contribute to consumers’ decision making process and attitudes to achieve the intended behavioural outcomes

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

Differences in Reward and Persistency characterise Behavior in Chronic Pain for the Iowa Gambling Task in a Web-based Lab-in-the-field study (Preprint)

2020 ◽  
Author(s):  
Lili Zhang ◽  
Himanshu Vashisht ◽  
Alekhya Nethra ◽  
Brian Slattery ◽  
Tomas Ward
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Chronic Pain ◽  
Iowa Gambling Task ◽  
Learning Curves ◽  
Self Report ◽  
Healthy Controls ◽  
Gambling Task ◽  
Convenience Sample ◽  
Pain Experiences

BACKGROUND Chronic pain is a significant world-wide health problem. It has been reported that people with chronic pain experience decision-making impairments, but these findings have been based on conventional lab experiments to date. In such experiments researchers have extensive control of conditions and can more precisely eliminate potential confounds. In contrast, there is much less known regarding how chronic pain impacts decision-making captured via lab-in-the-field experiments. Although such settings can introduce more experimental uncertainty, it is believed that collecting data in more ecologically valid contexts can better characterize the real-world impact of chronic pain. OBJECTIVE We aim to quantify decision-making differences between chronic pain individuals and healthy controls in a lab-in-the-field environment through taking advantage of internet technologies and social media. METHODS A cross-sectional design with independent groups was employed. A convenience sample of 45 participants were recruited through social media - 20 participants who self-reported living with chronic pain, and 25 people with no pain or who were living with pain for less than 6 months acting as controls. All participants completed a self-report questionnaire assessing their pain experiences and a neuropsychological task measuring their decision-making, i.e. the Iowa Gambling Task (IGT) in their web browser at a time and location of their choice without supervision. RESULTS Standard behavioral analysis revealed no differences in learning strategies between the two groups although qualitative differences could be observed in learning curves. However, computational modelling revealed that individuals with chronic pain were quicker to update their behavior relative to healthy controls, which reflected their increased learning rate (95% HDI from 0.66 to 0.99) when fitted with the VPP model. This result was further validated and extended on the ORL model because higher differences (95% HDI from 0.16 to 0.47) between the reward and punishment learning rates were observed when fitted on this model, indicating that chronic pain individuals were more sensitive to rewards. It was also found that they were less persistent in their choices during the IGT compared to controls, a fact reflected by their decreased outcome perseverance (95% HDI from -4.38 to -0.21) when fitted using the ORL model. Moreover, correlation analysis revealed that the estimated parameters had predictive value for the self-reported pain experiences, suggesting that the altered cognitive parameters could be potential candidates for inclusion in chronic pain assessments. CONCLUSIONS We found that individuals with chronic pain were more driven by rewards and less consistent when making decisions in our lab-in-the-field experiment. In this case study, it was demonstrated that compared to standard statistical summaries of behavioral performance, computational approaches offered superior ability to resolve, understand and explain the differences in decision- making behavior in the context of chronic pain outside the lab.

Sign in / Sign up

Export Citation Format

Share Document