Analysis of Impact on National Health Insurance Service Occupational Therapy Cost of treatment, Number of patients, and Number of treatments Based on Public Data: 2017~2019

2020 ◽  
Vol 12 (2) ◽  
pp. 13-24
Author(s):  
Seung-Hyun Cho
BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033365 ◽  
Author(s):  
Yuta Hayashi ◽  
Naoki Yoshinaga ◽  
Yosuke Sasaki ◽  
Hiroki Tanoue ◽  
Kensuke Yoshimura ◽  
...  

ObjectivesTo clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme.DesignRetrospective observational study.SettingNational Database of Health Insurance Claims and Specific Health Checkups of Japan.ParticipantsPatients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015.Primary and secondary outcome measuresWe estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors.ResultsWe found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (−1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT.ConclusionsThe provision of CBT did not increase in the first 6 years (FY2010–2015) after its coverage in Japan’s national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.


2019 ◽  
Vol 7 (1) ◽  
pp. 33
Author(s):  
Christyana Sandra

Background: In 2014, National Health Insurance Program (BPJS Kesehatan) implemented Back-Referral Program (BRP) to facilitate access to health care for patients with chronic diseases in stable conditions. However, the program did not run well at District General Hospital of Balung which had the lowest back-referral program (6 participants) in 2015-2016.Aim: The study aims to examine the BRP at Balung District General Hospital of Jember in 2017.Methods: This study is designed as qualitative case study. The informants consisted of head of treasury verification, secretary of JKN service controlling, officers of local government’s free care scheme, coordinator of internal and neurological disease, specialists in internal and neurological diseases, officers of Social Security Agency for Health, officers of patient eligibility verification, and participants of Back-Referral Program. The study was conducted from October to December 2017.Results: Results show that the attendance of BPJS Kesehatan officers has no contribution to the services of BPJS Kesehatan in the hospital. Participants also find it difficult to follow the steps of BRP due to unavailability of drugs at primary healthcare centers. Moreover, neurologists have not written any referral recommendation since 2016, so there was no patient admittance.Conclusions: The BRP at Balung District General Hospital did not achieve its target (<5 cases/week). In the contrary, the average number of patients referred to the hospital was 86 patients per week. Balung District General Hospital should implement Standard Operating Procedure for letters signed by responsible physician for patients and evaluate the BRP. Keywords: National Health Insurance, Back-referral program, Hospital, Social security.


2021 ◽  
Vol 32 (4) ◽  
pp. 611-616
Author(s):  
Hasna Qatrunnada ◽  
Suharjono ◽  
Siprianus Ugroseno Yudho Bintoro ◽  
Siti Wahyuni

Abstract Objectives The main therapy of β-thalassemia major are blood transfusion and iron chelation drugs. However, those therapies also have some adverse effects and problems such as iron overload, transfusion reactions, nutritional deficiencies, and patient compliance problems. Those arising problems also have an impact on therapy cost. Hence, this study was designed to analyze drug utilization study and cost of therapy in β-thalassemia major adult patients at Dr. Soetomo General Hospital Surabaya. Methods This research was conducted in descriptive observational-retrospective design using secondary data obtained from patient’s medical records and billing registrations from January 1–December 31, 2019. Results There were 18 patients out of 233 patients that were analyzed. Deferasirox was the most administered drug with doses between 500 mg/day–1,500 mg/day while deferiprone was ranged between 1,500 and 4,500 mg/day. Patients also received transfusion reaction drugs with dexamethasone injection 5 mg/ml which was administered the most. The most administered supplement was folic acid 1 mg. Patients had an increase in serum ferritin due to low compliance. Deferasirox had the most adherence number of patients with decrease of serum ferritin. The two highest costs of direct medical components were top-up medicines and consumable medical supplies. Overall, the hospital gained profit from national health insurance claims. Conclusions The most administered chelating agent was deferasirox. Deferasirox also had the most adherence number of patients with decreased number of serum ferritin. However, deferasirox also yielded the highest cost. Yet, overall, the hospital gained profit from national health insurance claims.


Author(s):  
Junhui Jeong ◽  
Jung Kyu Choi ◽  
Hyun Seung Choi ◽  
Chang Eui Hong ◽  
Hyang Ae Shin ◽  
...  

Abstract Introduction The association between tonsillectomy with adenoidectomy (T&A) with appendicitis is controversial, and the association of T&A with pneumonia has not been investigated. Objective To investigate the associations of T&A with pneumonia and appendicitis using data from the Korean National Health Insurance Service National Sample Cohort. Methods We selected patients between the ages of 3 and 10 years who had undergone T&A in 2005 and were monitored since the performance of the T&A until 2013. The control group was established to have similar propensities for demographic characteristics compared to the T&A group. For eight years after the T&A, the number of patients with a diagnosis of pneumonia, patients who were admitted due to pneumonia, and those who underwent appendectomy were analyzed. The risk factors for pneumonia and appendectomy were analyzed. Results The number of pneumonia diagnoses was significantly higher in the T&A group than in the control group (p = 0.023), but there were no significant differences in the number of admissions due to pneumonia between the 2 groups (p = 0.155). Younger age and T&A were significant risk factors for the development of pneumonia. There were no significant differences in the number of appendectomies between the T&A and the control groups (p = 0.425), neither were there significant risk factors for appendectomy. Conclusion Tonsillectomy with adenoidectomy was associated with an increase in pneumonia diagnoses, but it was not associated with the number of appendectomies. The associations of T&A with pneumonia and appendicitis were analyzed in this population-based study.


2020 ◽  
Author(s):  
Surya Krishnamurthy ◽  
Kapeleshh KS ◽  
Erik Dovgan ◽  
Mitja Luštrek ◽  
Barbara Gradišek Piletič ◽  
...  

ABSTRACTBackground and ObjectiveChronic kidney disease (CKD) represent a heavy burden on the healthcare system because of the increasing number of patients, high risk of progression to end-stage renal disease, and poor prognosis of morbidity and mortality. The aim of this study is to develop a machine-learning model that uses the comorbidity and medication data, obtained from Taiwan’s National Health Insurance Research Database, to forecast whether an individual will develop CKD within the next 6 or 12 months, and thus forecast the prevalence in the population.MethodsA total of 18,000 people with CKD and 72,000 people without CKD diagnosis along with the past two years of medication and comorbidity data matched by propensity score were used to build a predicting model. A series of approaches were tested, including Convoluted Neural Networks (CNN). 5-fold cross-validation was used to assess the performance metrics of the algorithms.ResultsBoth for the 6 month and 12-month models, the CNN approach performed best, with the AUROC of 0.957 and 0.954, respectively. The most prominent features in the tree-based models were identified, including diabetes mellitus, age, gout, and medications such as sulfonamides, angiotensins which had an impact on the progression of CKD.ConclusionsThe model proposed in this study can be a useful tool for the policy-makers helping them in predicting the trends of CKD in the population in the next 6 to 12 months. Information provided by this model can allow closely monitoring the people with risk, early detection of CKD, better allocation of resources, and patient-centric management


BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e024344 ◽  
Author(s):  
Yong Ik Kim ◽  
Yeon-Yong Kim ◽  
Jong Lull Yoon ◽  
Chang Won Won ◽  
Seongjun Ha ◽  
...  

PurposeThe National Health Insurance Service (NHIS)-Senior was set up to provide high-quality longitudinal data that can be used to explore various aspects of changes in the socio-economical and health status of older adults, to predict risk factors and to investigate their health outcomes.ParticipantsThe NHIS-Senior cohort, a Korean nationwide retrospective administrative data cohort, is composed of older adults aged 60 years and over in 2002. It consists of 558 147 people selected by 10% simple random sampling method from a total of 5.5 million subjects aged 60+ in the National Health Information Database. The cohort was followed up through 2015 for all subjects, except for those who were deceased.Findings to dateThe healthcare utilisation and admission rates were the highest for acute upper respiratory infections and influenza (75.2%). The age-standardised (defined with reference to the world standard population) mortality rate for 10 years (through 2012) was 4333 per 100 000 person-years. Malignant neoplasms were the most common cause of death in both sexes (1032.1 per 100 000 person-years for men, 376.7 per 100 000 person-years for women). A total of 34 483 individuals applied for long-term care service in 2008, of whom 17.9% were assessed as grade 1, meaning that they were completely dependent on the help of another person to live daily life.Future plansThe data are provided for the purposes of policy and academic research under the Act on Promotion of the Provision and Use of Public Data in Korea. The NHIS-Senior cohort data are only available for Korean researchers at the moment, but it is possible for researchers outside the country to gain access to the data by conducting a joint study with a Korean researcher. The cohort will be maintained and continuously updated by the NHIS.


2020 ◽  
Vol 38 (4) ◽  
pp. 253-259
Author(s):  
Hyun Kyung Kim ◽  
Sungchan Kang ◽  
Seo-Young Lee

Background: Status epilepticus is a severe neurologic emergency comprising significant morbidity and mortality. This study investigated the epidemiologic features of status epilepticus in Korea from 2010 to 2019.Methods: We used the Healthcare Bigdata Hub of the Korea National Health Insurance Database to identify records with principal diagnostic codes for status epilepticus (G41) using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems from January 2010 to December 2019. This database only included patients with health insurance and not those with medical aid. The annual number of patients, costs, and regional differences were evaluated. The patients hospitalized under the principal diagnostic code for status epilepticus were considered as incident cases.Results: The total number of patients with a diagnosis of status epilepticus increased annually from 3,110 in 2010 to 5,840 in 2019 at a compound annual growth rate of 7.3%. The incidence of status epilepticus per 100,000 population increased steadily from 2.21 in 2010 to 5.33 in 2019. Health care expenditures showed continued growth at a faster rate of 18.4%. When categorized by age groups, the growth rate was markedly higher in age groups >60 years.Conclusions: In Korea, the incidence and cost of status epilepticus have increased from 2010 to 2019. Considering a possible underestimation of the incidence owing to data characteristics, the real incidence of status epilepticus may be higher. This trend in the incidence of status epilepticus can be mostly attributed to the increase of status epilepticus in the older population.


Author(s):  
Jiying Wu ◽  
Jean-Jacques Dominique Beraud ◽  
Evans Tekyi Ankomah-Asare

This study sought to assess the efficiency of the National Health Insurance Scheme (NHIS) in Ghana. Data was obtained from the National Health Insurance Authority (NHIA) website in Ghana. We divided the NHIS into four main zones (Northern, Southern, Eastern and Western zone) and grouped per the number of facilities under the NHIA (hospital, clinic, pharmacy, government disbursement) weighted against the number of referrals, the number of professional staffs and funding. Network analysis and regression methodology was used to study and analyze the data. Our result showed that the number of professional staff and funding were insignificant in some zones. However, the overall analysis showed that the number of professional staff had a positive influence on the NHIA network; there was a positive flow of information within the network, which facilitate the number of referrals within the network. Funding was insignificant because the first aim of the NHIA was to meet subscribers’ satisfaction and alleviate the cost of treatment. Efficiency can be improved by establishing a system that validates and controls the bodies under the NHIA.


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