Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propaensity-score-matched control group using data from Guizhou province, China

Background Provider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China. Methods Inpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases. Results After the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality. Conclusions The inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.

Scientific research and innovation response to the COVID-19 pandemic in Peru

Background: COVID-19 has shaken countries at all levels, putting public health at risk. Global efforts have allocated funding for the development of research for the development of vaccines, digital tools, epidemiologic, social, and economic studies. Although these efforts have been developed worldwide, not all countries have prioritized the same topics and may have a different impact on solving problems and containing the spread of COVID-19. Methods: A descriptive study was conducted with secondary data of "Special Projects COVID-19” in order to analyze the prioritization of proposals and projects to Peruvian needs in the face of pandemic. Two calls were made by the Peruvian research council (CONCyTec); the first with five areas and the second with seven. The global amounts financed by each call were 342,857 USD (1,200,000 soles) and 700,000 USD (1,750,000 soles), respectively. Results: A total of 1,101 research projects were presented, 600 (54.5%) in the first call. In this call, 176 (29.3%) projects were from technological development and innovation and 29 were winners (with a global budget of 1,711,907.25 USD /6,077,270.75 soles). In the second call, 120 (23.9%) projects were from the area of Social and economic research and 21 were winners (global budget of 1,284,002.25 USD/558,208.55 soles) (p=0.043). The largest proportion of winning projects in both calls was 12 (41.4%) in Technological developments and innovation, then five (17.2%) each in telehealth and mobile health, and epidemiological and social studies. Across both calls, 214 (55.8%) and 160 (51.9%) projects were of private organizations and universities, respectively. Conclusions: This research shows ~2% of rapid response "Special Projects COVID-19” were financed by the CONCyTec call with over a million dollars of funds. Although the main topics were technological innovation, detection systems, and vaccines, these priorities have not had a global impact on the epidemiological development of the pandemic in Peru.

Gaps in Network Infrastructure limit our understanding of biogenic methane emissions in the United States

Understanding the sources and sinks of CH4 is critical to both predicting and mitigating future climate change. There are large uncertainties in the global budget of atmospheric CH4, but natural emissions are estimated to be of a similar magnitude to total anthropogenic emissions. The largest sources of uncertainty in scaling bottom-up CH4 estimates stem from limited ground-based measurements and the misalignment between drivers of CH4 fluxes and current land use classifications. To understand the CH4 flux potential of natural ecosystems and agricultural lands in the United States (US) of America, a multi-scale CH4 observation network focused on CH4 flux rates, processes, and scaling methods is required. This can be achieved with a network of ground-based observations that are distributed based on climatic regions and landcover. To determine the gaps in physical infrastructure for developing this network, we need to understand the representativeness of current measurements. We focus here on eddy covariance (EC) flux towers because they are essential for a bottom-up framework that bridges the gap between point-based chamber measurements and airborne or satellite platforms, informing the remote sensing and modelling communities and policy decisions, all the way to IPCC reports. Using multidimensional scaling and a cluster analysis, the US was divided into 10 clusters that were distributed across temperature and wetness gradients. We evaluated the distance to the medoid condition within each cluster for research sites with EC tower infrastructure to identify the gaps in existing infrastructure that limit our ability to constrain the contribution of US biogenic CH4 emissions to the global budget. These gaps occurred across all EC flux tower networks and independently managed sites as well as in some environmental clusters. Through our analysis using climate, land cover, and location variables, we have identified priority areas to target for research infrastructure to provide a more complete understanding of the CH4 flux potential of ecosystem types across the US.

Balancing Efficiency and Access: Discouraging Emergency Department Boarding in a Global Budget System

Reducing cost without sacrificing quality of patient care is an important yet challenging goal for healthcare professionals and policymakers alike. This challenge is at the forefront in the United States, where per capita healthcare costs are much higher than in similar countries around the world. The state of Maryland is unique in the hospital financing landscape due to its “capitation” payment system (also known as “global budget”), in which revenue for hospital-based services is set at the beginning of the year. Although Maryland’s system has yielded many benefits, including reduced Medicare spending, it also has had unintentional adverse consequences. These consequences, such as increased emergency department boarding and ambulance diversion, constrain Maryland hospitals’ ability to fulfill their role as emergency care providers and act as a safety net for vulnerable patient populations. In this article, we suggest policy remedies to mitigate the unintended consequences of Maryland’s model that should also prove instructive for a variety of emerging alternative payment mechanisms.

Participatory Budgeting with Project Groups

We study a generalization of the standard approval-based model of participatory budgeting (PB), in which voters are providing approval ballots over a set of predefined projects and---in addition to a global budget limit---there are several groupings of the projects, each group with its own budget limit. We study the computational complexity of identifying project bundles that maximize voter satisfaction while respecting all budget limits. We show that the problem is generally intractable and describe efficient exact algorithms for several special cases, including instances with only few groups and instances where the group structure is close to being hierarchical, as well as efficient approximation algorithms. Our results could allow, e.g., municipalities to hold richer PB processes that are thematically and geographically inclusive.

SISTEM PEMBAYARAN MIXED METHOD INA-CBGs DAN GLOBAL BUDGET DI RUMAH SAKIT: TAHAP I UJI COBA MIXED METHOD INA-CBGS-GLOBAL BUDGET DI INDONESIA

Tidak ada sistem pembayaran pelayanan Kesehatan yang sempurna dalam penerapannya termasuk sistem pembayaran DRG (Diagnosis-Related Groups) yang lebih dikenal dengan nama INA-CBGs (Indonesia Case-Based Groups) di Indonesia. Beberapa negara yang mengadopsi DRG telah menerapkan kebijakan pembayaran mixed method DRG-Global Budget dengan variasi implementasinya demi menjaga kesinambungan sistem jaminan kesehatan nasional di negaranya. BPJS Kesehatan menginisiasi studi operasional penerapan sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget mulai tahun 2018. Terdapat tiga tahapan dalam uji coba sistem pembayaran rumah sakit mixed-method INA-CBGs dan Global Budget ini. Tahap pertama adalah Global Budget Tanpa Resiko yang bertujuan untuk menguji metode penghitungan global budget dan mengidentifkasi tantangan yang dihadapi bila kebijakan mixed method INA-CBGs dan Global Budget ini diberlakukan. Studi dilakukan di 5 (lima) kabupaten/kota di 30 rumah sakit (RS). Hasil studi menunjukkan bahwa metodologi penghitungan global budget yang diterapkan cukup akurat untuk memprediksi realisasi klaim di RS. Penghitungan global budget di tingkat kabupaten/kota lebih akurat hasilnya dibandingkan dengan menghitung global budget di tingkat RS karena mengakomodir shifting pasien dari RS yang satu ke RS yang lainnya akibat perubahan kapasitas RS. Perubahan kapasitas RS di tahun berjalan dan adanya pandemi COVID-19 menyebabkan adanya selisih antara penghitungan global budget dan realisasi klaim.

Scientific research and innovation response to the COVID-19 pandemic in Peru

Background: COVID-19 has shaken countries at all levels, putting public health at risk. Global efforts have allocated funding for the development of research for the development of vaccines, digital tools, epidemiologic, social, and economic studies. Although these efforts have been developed worldwide, not all countries have prioritized the same topics, and may have a different impact on solving problems and containing the spread of COVID-19. Methods: A descriptive study was conducted with secondary data of "Special Projects COVID-19” in order to analyze the prioritization of proposals and projects to Peruvian needs in the face of pandemic. Two calls were made by the Peruvian research council (CONCyTec); the first with five areas and second with seven. The global amounts financed by each call were 342,857 USD (1,200,000 soles) and 700,000 USD (1,750,000 soles), respectively. Results: A total of 1,101 research projects were presented, 600 (54.5%) in the first call. In this call, 176 (29.3%) projects were from the technological development and innovation and 29 were winners (with a global budget of 1,711,907.25 USD /6,077,270.75 soles). In the second call, 120 (23.9%) projects were from the area of Social and economic research and 21 were winners (global budget of 1,284,002.25 USD/558,208.55 soles) (p=0.043). The largest proportion of winning projects in both calls was 12 (41.4%) in Technological developments and innovation, then five (17.2%) each in telehealth and mobile health, and epidemiological and social studies. Across both calls, 214 (55.8%) and 160 (51.9%) projects were of private organizations and universities, respectively. Conclusions: This research shows ~2% of rapid response "Special Projects COVID-19” were financed by the CONCyTec call with over a million dollars of funds. Although the main topics were technological innovation, detection systems, and vaccines, these priorities have not had a global impact on the epidemiological development of the pandemic in Peru.