A Study on the Job Satisfactions of the Workers in the Fields of Medical Insurance Computerization of Medical Institutions

1999 ◽  
Vol 2 ◽  
pp. 251
Author(s):  
Seung-Hee Kim ◽  
Seung-Ho Kim
Keyword(s):  
Medical Insurance ◽  
Medical Institutions ◽  
Job Satisfactions

scholarly journals Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors

2021 ◽  
Vol 18 (6) ◽  
pp. 2969
Author(s):  
Yanbing Zeng ◽  
Yuanyuan Wan ◽  
Zhipeng Yuan ◽  
Ya Fang
Keyword(s):  
Older Adults ◽  
Predictive Factors ◽  
Medical Insurance ◽  
Utilization Rate ◽  
Heckman Selection Model ◽  
Healthcare Seeking ◽  
Inpatient Services ◽  
Medical Institutions ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior

This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.

Reforming Payment Methods for Basic Medical Insurance to Accommodate Traditional Chinese Medicine (TCM) in China : A Case Study of Shaanxi Province

2020 ◽  
Author(s):  
FANG ZHOU ◽  
XIAOHAO ZHANG ◽  
ZHIGUO MA
Keyword(s):  
Medical Insurance ◽  
Diagnosis And Treatment ◽  
Shaanxi Province ◽  
Insurance Fund ◽  
Payment Methods ◽  
Treatment Services ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Insurance Funds ◽  
Basic Medical

Abstract Background: Traditional Chinese medicine (TCM) attaches importance to the philosophy of holism and disease prevention. Meanwhile, costs arising from TCM diagnosis and treatment services are relatively low. Such features cater to the needs of less developed countries and regions to increase the equity and accessibility of medical services and to save basic medical insurance funds. However, China’s current payment system for basic medical insurance fails to fully regard these features, thus unable to incent the demand for and supply of TCM services. Methods: Based on the analysis of the features or rather the advantages of TCM, the article, taking Shaanxi Province located in central China as an example, studies the status quo of economic development, coverage of TCM diagnosis and treatment services by basic medical insurance, implementation of payment methods for basic medical insurance in TCM medical institutions, and aims to explore the reformation of payment methods for basic medical insurance. Results: Statistics have shown that the economic power of Shaanxi Province is below average in China, as a result of which, Shaanxi Province is confronted with a general lack of basic medical insurance fund. On the other hand, the present payment methods for basic medical insurance fail to accommodate the features of TCM. Besides, only a very limited number of TCM medical institutions, service items and medicines are covered by basic medical insurance. Consequently, the advantages of TCM are not exploited to the full in a country that has always treasured TCM. Therefore, reformation in payment methods is pressing. Conclusion: In view of the economic and social development of Shaanxi Province, this article proposes to reform the payment methods for basic medical insurance by introducing a new medicinal-effect-based payment method to accommodate TCM. This payment method has the following four features. Firstly, it advocates strengthening process supervision of diagnosis and treatment activities in medical institutions, establishing a rating system for therapeutic or prophylactic effects, and implementing a reward and punishment mechanism accordingly. Secondly, special audit standards for TCM services shall be determined by the health care department of the people’s government together with the relevant TCM administrative department, more TCM institutions, service items and medicines shall be covered by basic medical insurance, and the negotiation mechanism with medical insurance institutions shall be adjusted. Thirdly, in pricing the fees and standards for TCM services, the price control administrations of the people’s government shall consult TCM experts, and dynamic price adjustments based on costs and professional technical values shall be made. Last but not least, outpatient diagnosis and treatment services shall be covered by basic medical insurance fund, a practice which will not only give full play to the advantages TCM services, but also help reduce the financial burden on patients and save medical insurance funds.

scholarly journals Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China

2020 ◽  
Vol 57 ◽  
pp. 004695802091928
Author(s):  
Xinpeng Xu ◽  
Hai Gu ◽  
Hua You ◽  
Lan Bai ◽  
Decheng Li ◽  
...  
Keyword(s):  
Low Income ◽  
Health Expenditure ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
New Cooperative Medical Scheme ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Significant Difference ◽  
Cooperative Medical Scheme ◽  
Basic Medical

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure ( P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service ( P < .001, P = .020) and choose low-level medical institutions for treatment ( P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure ( P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

scholarly journals Suggestions on Linkage Mechanism between Medical Insurance and Hierarchical Medical System in a Southern City of Anhui Province in China: Analysis on Disease Structure of New Rural Cooperative Medical System (NCMS) Inpatients

2019 ◽  
Author(s):  
Luo Meng ◽  
Ru Zhi Tang ◽  
li Li Wang ◽  
hua Shao Li
Keyword(s):  
Respiratory System ◽  
Medical Insurance ◽  
Medical System ◽  
Malignant Neoplasms ◽  
Linkage Mechanism ◽  
Genitourinary System ◽  
Medical Institutions ◽  
Non Local ◽  
Southern City ◽  
Hierarchical Medical System

Abstract Objective: The chief aim of this paper is to explore the characteristics of medical treatment for NCMS inpatients in the central district of the southern city, and identify the main problems, so as to give some suggestions on the promotion of linkage mechanism between medical insurance and hierarchical medical system in the southern city. Methods: Hospitalization person-times and expenses were analyzed using the medical insurance inpatients who have settled in the NCMS information management system in the central district of the sourthen city from 2013 to 2015. Results: Among pieces of data, there were identical 5 system diseases hospitalized both in local and non-local medical institutions from 2013 to 2015: respiratory system diseases, malignant neoplasms, digestive system diseases, genitourinary system diseases, and circulatory system diseases, which also ranked top 5. In the hospitalization ratio of the top 5 systemic diseases in 2015, the respiratory system accounted for the largest proportion of 95.65%, and malignant neoplasms inpatients occupied the largest proportion who hospitalized in non-local medical institutions(36.27%). The proportion of inpatients with genitourinary system diseases hospitalized in non-local medical institutions was higher(10.32%), and the cost was lower(21.44%), compared with that of inpatients with digestive system diseases and circulatory system diseases. We chose the 3 repesentive system diseases to analyze diseases structure: there were 4 diseases of respiratory system diseases, 7 diseases of malignant neoplasms, 3 diseases of genitourinary system diseases both hospitalized in local and non-local medical institutions.Conclusions: All the preliminary results threw light on some defects in the process of medical treatment, which was rationality of choice and direction of diagnosis and treatment. The problem may be caused by included inpatients' incorrect medical concepts, unstandardized diagnosis and treatment behaviours, imperfect medical insurance reimbursement policy, and no adequate capacity to treat difficult and miscellaneous diseases. Under the background of deepening medical reform, the city municipal government needs to further increase the publicity of medical reform and make decisions to adapt to the changes in policy environment, for the medical insurance linkage mechanism with hierarchical medical system.

scholarly journals Reflection on There Form of China's Emergency Medical Insurance System Based on the Prevention and Control of COVID-19

2020 ◽  
Author(s):  
Hui Cheng ◽  
Meng Luo ◽  
Shaohua Li
Keyword(s):  
Public Health ◽  
Prevention And Control ◽  
Medical Insurance ◽  
Health Events ◽  
Insurance System ◽  
National Medical ◽  
Emergency Medical ◽  
Medical Security ◽  
Medical Institutions ◽  
And Control

Abstract Objective: Based on the Prevention and Control of COVID-19, this paper points out the shortcomings of China's current medical insurance system, and puts forward the concept of establishing emergency medical insurance system.Methods: This paper analyzes the characteristics of the modern epidemic and its special requirements for medical insurance. Putting forward the idea of mechanism construction.Results:The operation of China's national medical insurance system is mainly operated by the insured, the government, medical institutions and medical institutions. However, the rapid spread of the epidemic has caused great disasters to the society. In the face of major public health events, medical insurance should have four characteristics: the "normalization" of the emergency medical insurance system, the fairness of guarantees, the public quality of treatment and positive externalities. China should establish an emergency system in line with these four characteristics from the four parties. Therefore, this paper analyzes the characteristics of modern epidemic risk, its development process and the requirements for the insurance industry in combination with the situation of China's response to dealing with COVID-19, and puts forward that China should further improve the universal medical insurance system and establish an emergency medical security system to better deal with all kinds of sudden public health events, which will still happen in the future.Conclusions:China's national medical insurance system should not be limited to meet people's conventional medical needs. When public health emergencies occur, it is also necessary to establish a sound medical insurance system to operate.The establishment of emergency medical security system is one of the important development directions of our country in the future.

scholarly journals The agenda of management accounting in healthcare

2021 ◽  
Vol 22 (6) ◽  
pp. 697-710
Author(s):  
Andrei V. CHURIKOV
Keyword(s):  
Management Accounting ◽  
Medical Insurance ◽  
Voronezh Oblast ◽  
Comparison Analysis ◽  
Current Management ◽  
Accounting Practice ◽  
Accounting Management ◽  
Medical Institutions ◽  
Insurance Funds ◽  
The Russian Federation

Subject. This article discusses changes in the economic and legislative environment of State-financed healthcare institutions, regulatory framework of the Russian Federation, which influences management accounting indicators. Objectives. I outline a system of relations in the design of management accounting indicators of State-financed healthcare institutions. Methods. The study is based on the methods of grouping, comparison, analysis, and generalization. I analyzed the current management accounting practice in State-financed medical institutions of the Voronezh Oblast. Results. Analyzing regulatory documents and industrial distinctions and difficulties in healthcare, I outlined a system of relations in the design of management accounting indicators in State-financed healthcare institutions. I traced factors that influence the creation of management accounting in State-financed healthcare institutions. I suggest implementing the practice of accounting for costs incurred per patient into the accounting and information system of management accounting. Aspects of statistical accounting should be integrated into the accounting process for this purpose. Conclusions and Relevance. The specifics of financing sources now influence a set of indicators and internal reporting in management accounting. Management accounting of income becomes a priority in management accounting as part of compulsory medical insurance funding. Management accounting of income and process designing approaches are getting more and more specific as the methods for paying the medical assistance with compulsory medical insurance funds get changed.

scholarly journals Reflection on the Reform of China's Emergency Medical Insurance System based on the Prevention and Control of COVID-19

2020 ◽  
Author(s):  
Luo Meng ◽  
Hui Cheng ◽  
Shaohua Li
Keyword(s):  
Public Health ◽  
Prevention And Control ◽  
Medical Insurance ◽  
Health Events ◽  
Insurance System ◽  
National Medical ◽  
Emergency Medical ◽  
Medical Security ◽  
Medical Institutions ◽  
And Control

Abstract Objective: Based on the Prevention and Control of COVID-19, this paper points out the shortcomings of China's current medical insurance system, and puts forward the concept of establishing emergency medical insurance system.Methods: This paper analyzes the characteristics of the modern epidemic and its special requirements for medical insurance. Putting forward the idea of mechanism construction.Results:The operation of China's national medical insurance system is mainly operated by the insured, the government, medical institutions and medical institutions. However, the rapid spread of the epidemic has caused great disasters to the society. In the face of major public health events, medical insurance should have four characteristics: the "normalization" of the emergency medical insurance system, the fairness of guarantees, the public quality of treatment and positive externalities. China should establish an emergency system in line with these four characteristics from the four parties. Therefore, this paper analyzes the characteristics of modern epidemic risk, its development process and the requirements for the insurance industry in combination with the situation of China's response to dealing with COVID-19, and puts forward that China should further improve the universal medical insurance system and establish an emergency medical security system to better deal with all kinds of sudden public health events, which will still happen in the future.Conclusions:China's national medical insurance system should not be limited to meet people's conventional medical needs. When public health emergencies occur, it is also necessary to establish a sound medical insurance system to operate.The establishment of emergency medical security system is one of the important development directions of our country in the future.

ANALYSIS OF THE QUALITY OF MEDICAL CARE PROVIDED BASED ON INSURANCE SUPERVISORY

2020 ◽  
pp. 160-170
Author(s):  
Ольга Игоревна Муратова ◽  
Наталия Андреевна Матвеева
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Insurance Companies ◽  
Medical Services ◽  
Medical Organization ◽  
Medical Institutions ◽  
Quality Of Medical Care ◽  
The Russian Federation

Статья посвящена анализу качества медицинской помощи, оказываемой населению в рамках системы обязательного медицинского страхования (ОМС), на основе мероприятий страхового надзора над медицинскими организациями. Полис ОМС гарантирует пациентам доступность, качество и своевременность предоставления медицинских услуг. Проверка качества медицинской помощи производится путем осуществления экспертиз и контроля уполномоченными органами РФ по направлениям: законности работы медицинской организации, системности оказания медицинской помощи, результативности и своевременности проводимых мероприятий в рамках оказания медицинской помощи. Таким образом, страховой надзор за медицинскими организациями осуществляется путем соблюдения объема, сроков и условий оказания медицинской помощи, контроля качества медицинской помощи фондами обязательного медицинского страхования и страховыми медицинскими организациями в соответствии с законодательством Российской Федерации. Страховой надзор над медучреждениями осуществляется в рамках ОМС и включает следующие виды страхового надзора: медико-экономический контроль, медико-экономическая экспертиза и экспертиза качества медицинской помощи. Отличительной особенностью современного состояния системы страхового надзора за качеством оказываемой медицинской помощи в системе ОМС является его совершенствование на основе анализа удовлетворенности потребителей медицинских услуг, что позволяет выявить нарушения, которые допущены при оказании медицинской помощи. Причем эти мероприятия способствуют как повышению качества обслуживания застрахованных лиц, так и улучшению репутации медицинских организаций, что серьезно влияет на решения участников программы обязательного медицинского страхования. Повышение ответственности страховых компаний становится важным элементом модернизации системы ОМС. В этой связи актуальным является обеспечение эффективной работы страховых медицинских компаний и медицинских учреждений на принципах конкурентоспособности и повышения качества медицинской помощи, реализуемое с помощью механизмов ориентации на требования потребителей медицинских услуг The article is devoted to the analysis of the quality of medical care provided to the population within the framework of the system Compulsory health insurance (CHI), based on the measures of insurance supervisory over medical organizations. The CHI guarantees patients the availability, quality and timeliness of medical services. Quality control of medical care is performed by carrying out examinations and control by the authorized bodies of the Russian Federation in the following areas: the legality of the work of a medical organization, the consistency of medical care, the effectiveness and timeliness of measures taken within the framework of medical care. Thus, insurance supervisory of medical organizations is carried out by observing the scope, terms and conditions of medical care, and monitoring the quality of medical care by mandatory medical insurance funds and insurance medical organizations in accordance with the legislation of the Russian Federation. Insurance supervisory of medical institutions is carried out within the framework of the CHI and includes the following types of insurance supervisory: medical and economic control, medical and economic expertise and examination of the quality of medical care. A distinctive feature of the current state of the system of insurance supervisory over the quality of medical care in the CHI system is its improvement based on the analysis of satisfaction of consumers of medical services, which allows you to identify violations that have been committed in the provision of medical care. Moreover, these measures contribute both to improving the quality of care for insured persons and to improving the reputation of medical organizations, which seriously affects the decisions of participants in the compulsory medical insurance program. Increasing the liability of insurance companies is becoming an important element of the modernization of the CHI system. In this regard, it is important to ensure the effective operation of medical insurance companies and medical institutions based on the principles of competitiveness and improving the quality of medical care, implemented through mechanisms of orientation to the requirements of consumers of medical services

scholarly journals Options for Care of Elderly Inpatients With Chronic Diseases: Analysis of Distribution and Factors Influencing Use of Care in Shanghai, China

2021 ◽  
Vol 9 ◽  
Author(s):  
Jianwei Shi ◽  
Ning Chen ◽  
Nana Liu ◽  
Yan Yang ◽  
Dehua Yu ◽  
...  
Keyword(s):  
Community Health ◽  
Chronic Diseases ◽  
Community Health Centers ◽  
Medical Insurance ◽  
Health Centers ◽  
Factors Influencing ◽  
Medical Institutions ◽  
Tertiary Hospitals ◽  
Elderly Inpatients ◽  
Different Levels

Background: China's ability to provide sufficient healthcare for an elderly population with chronic diseases has become a challenge because of poor utilization of different levels of medical institutions. We aimed to explore the characteristics and factors influencing patient choices and the resulting utilization of different levels of public medical institutions among elderly inpatients with chronic diseases.Methods: Data were collected from the Information Center of the Health and Family Planning Commission of Pudong New Area in Shanghai from 2013 to 2016. A cross-sectional study using multinomial logistic regression analysis was performed to find the factors influencing use of care. Records of patients were identified from electronic health records from public medical institutions.Results: There were 95,445 elderly inpatients with chronic diseases in public medical institutions, 17.78% in community health centers, 68.44% in secondary hospitals, and 13.78% in tertiary hospitals. Compared with those over 80 years old, the 60–69 age group showed a preference for secondary hospitals (OR = 2.980, P &lt; 0.001) and tertiary hospitals (OR = 4.497, P &lt; 0.001), a trend also observed in the 70–79 age group (OR = 1.353, P &lt; 0.001; OR = 1.673, P &lt; 0.001). Compared with those using urban employee basic medical insurance, inpatients using urban resident basic medical insurance were less likely to visit secondary hospitals than community health centers (OR = 0.237, P &lt; 0.001) or tertiary hospitals (OR = 0.293, P &lt; 0.001). Compared with those inpatients who were married, inpatients who were widowed were less likely to go to secondary hospitals (OR = 0.391, P &lt; 0.001) or tertiary hospitals (OR = 0.045, P &lt; 0.001) than community health centers.Conclusions: The utilization of different levels of medical institutions by elderly people is not well-suited to the respective functions of these medical institutions. Most care services should be provided by community health centers, but our findings indicate that elderly people are more inclined to seek inpatient care at secondary hospitals and tertiary hospitals with some variation based on the patients' sex, age, medical insurance, expenses, and expected length of stay.

Systems of Oppression in Geriatric Clinical Service Delivery

2021 ◽  
pp. 1-3
Author(s):  
Diane L. Kendall
Keyword(s):  
Higher Education ◽  
Service Delivery ◽  
Clinical Setting ◽  
Service Providers ◽  
Hard Work ◽  
Clinical Service ◽  
Meaningful Change ◽  
Important Work ◽  
Speech Language Pathologists ◽  
Medical Institutions

Purpose The purpose of this article was to extend the concepts of systems of oppression in higher education to the clinical setting where communication and swallowing services are delivered to geriatric persons, and to begin a conversation as to how clinicians can disrupt oppression in their workplace. Conclusions As clinical service providers to geriatric persons, it is imperative to understand systems of oppression to affect meaningful change. As trained speech-language pathologists and audiologists, we hold power and privilege in the medical institutions in which we work and are therefore obligated to do the hard work. Suggestions offered in this article are only the start of this important work.

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