Predicting Medical Fees for Hospitalized Inpatients and the Determination of Inflection Point

Background: Taiwan’s Bureau of National Health Insurance (BNHI) implemented an inpatient DRG payment system scheduled for January 2008. Many hospital managers urgently invent initiatives to decrease the impacts of DRGs. Predicting medical fees for hospitalized inpatients every day and the corresponding inflection points (IPs) are required for investigations. The aims of this study include (1) verifying the efficacy of the exponential growth model on accumulative publications of mobile health research between 1997 and 2016 in the literature; (2) building the model of predicting medical fees for hospitalized inpatients and determining the inflection points; and (3) demonstrating visualizations of the prediction model online in use for hospital physicians.Methods: An exponential growth model was applied to determine the IP and predict the medical fees to help physicians contain the medical fees of a specific patient during hospitalization. The IP is equal to the item difficulty proven using the differential equation in calculus. An online visual display of the medically contained and predicted inpatient hospitalization was demonstrated in this study.Results: We observed (1) a model accuracy (R2 = 0.99) higher than that (R2 = 0.98) in the literature based on identical data; (2) 231 samples of medical fees for inpatients in the study module with a length of days between 6 and 20 and an IPS falling in the range between 1 and 10 (Q1=0.98, Q3=1.00); and (3) online visualization demonstration of medical fees predicted for hospital inpatients and IP determination on ogive curves.Conclusion: The exponential growth model can be applied to a clinical setting to help physicians consecutively predict medical fees for hospitalized inpatients and upgrade the level of hospital management in the future.

Evaluation of a Fast Test Based on Biometric Signals to Assess Mental Fatigue at the Workplace—A Pilot Study

Non-pathological mental fatigue is a recurring, but undesirable condition among people in the fields of office work, industry, and education. This type of mental fatigue can often lead to negative outcomes, such as performance reduction and cognitive impairment in education; loss of focus and burnout syndrome in office work; and accidents leading to injuries or death in the transportation and manufacturing industries. Reliable mental fatigue assessment tools are promising in the improvement of performance, mental health and safety of students and workers, and at the same time, in the reduction of risks, accidents and the associated economic loss (e.g., medical fees and equipment reparations). The analysis of biometric (brain, cardiac, skin conductance) signals has proven to be effective in discerning different stages of mental fatigue; however, many of the reported studies in the literature involve the use of long fatigue-inducing tests and subject-specific models in their methodologies. Recent trends in the modeling of mental fatigue suggest the usage of non subject-specific (general) classifiers and a time reduction of calibration procedures and experimental setups. In this study, the evaluation of a fast and short-calibration mental fatigue assessment tool based on biometric signals and inter-subject modeling, using multiple linear regression, is presented. The proposed tool does not require fatigue-inducing tests, which allows fast setup and implementation. Electroencephalography, photopletismography, electrodermal activity, and skin temperature from 17 subjects were recorded, using an OpenBCI helmet and an Empatica E4 wristband. Correlations to self-reported mental fatigue levels (using the fatigue assessment scale) were calculated to find the best mental fatigue predictors. Three-class mental fatigue models were evaluated, and the best model obtained an accuracy of 88% using three features, β/θ (C3), and the α/θ (O2 and C3) ratios, from one minute of electroencephalography measurements. The results from this pilot study show the feasibility and potential of short-calibration procedures and inter-subject classifiers in mental fatigue modeling, and will contribute to the use of wearable devices for the development of tools oriented to the well-being of workers and students, and also in daily living activities.

Prevalence and socio-economic factors affecting the use of traditional medicine among adults of Katikekile Subcounty, Moroto District, Uganda

Background: In Uganda generally and in rural areas in particular, use of traditional medicine is a common practice, yet there remains lack of evidence on the overall utilization of traditional medicine and there are many aspects that remain unclear. Objective: To determine the use of traditional medicine and factors associated with this among the adults of Katikekile Subcounty in Moroto district. Methods: A descriptive cross-sectional study using quantitative and qualitative methods. Interviews among 323 respond- ents, and focus group discussions were carried out among village traditional birth attendants, village health team members, and traditional health providers. Results: Use of traditional medicine among the adults of Katikekile Subcounty was 68%. Usage was more prevalent among older people, and the majority of the adults used traditional medicine often as their first line-treatment for any illness. Herbs used for traditional medicines are usually locally available and free-of-charge. Long distance to health-facility based health care services, and medical fees contributed to the use of traditional medicine. Conclusion: Use of traditional medicine among adults of Katikekile Subcounty in Moroto in the Karamoja region in Uganda was high, and majority of the adults often used traditional medicine as first line-treatment. Both socioeconomic and health sector factors were associated with use of traditional medicine. Keywords: Intercultural medicine; indigenous; herbalists.

Gestão e sustentabilidade econômico-financeira em empresas de oftalmologia

A sustentabilidade, conceito tradicionalmente associado à preservação do meio ambiente em benefício de gerações futuras, hoje, liga-se também aos objetivos de manutenção econômico-financeira da própria organização. Alinhamento de processos, visão corporativa, desenvolvimento de cultura, uso de indicadores para medição de resultados, adaptabilidade do planejamento e metas, manutenção da contabilidade dentro dos critérios de boas práticas, difusão interna de conhecimento e abertura para inovações são os fundamentos mais importantes para a sustentabilidade econômico-financeira. Além disso, ter um olhar social, retribuir a sociedade os bons resultados é sustentabilidade no seu conceito mais nobre. Para ser competitiva, a organização precisa se tornar sustentável. Em saúde, o atual desafio para se manter é conhecer seus custos, para que se possam reduzi-los sem prejuízo na entrega. Esse é o grande desafio para ser competitivo: agregar valor à entrega. Na oftalmologia, os honorários médicos nem sempre são somados ao resultado da empresa, o fluxo de caixa é confundido com lucro e traz problemas sérios à saúde financeira, a dedicação do profissional de saúde é posta acima valendo mais um hospital equipado que um resultado financeiro positivo, o amor exagerado dos médicos pelos próprios interesses gera uma dificuldade grande de trabalhar em equipe, entre outros motivos, estes têm impedido o crescimento das clínicas e mesmo levado ao seu encerramento. Resultados sustentáveis associados à boas práticas preparam as empresas para tempos de crise, como a do coronavírus, e preparam para novos desafios, como o mercado de aquisições e fusões, superaquecido.Palavras-chave: sustentabilidade; administração em saúde; oftalmologia Management and economic and financial sustainability in ophthalmology companies ABSTRACTSustainability, a concept traditionally associated with preserving the environment for the benefit of future generations, today is also linked to the organization's economic and financial maintenance objectives. Process alignment, corporate vision, culture development, use of indicators to measure results, adaptability of planning and goals, keeping accounting within the criteria of good practices, internal dissemination of knowledge and openness to innovations are the most important foundations for the economic and financial sustainability. In addition, having a social view, giving society good results is sustainability in its most noble concept. To be competitive, the organization needs to become sustainable. In health, the current challenge to maintain is to know your costs, so that you can reduce them without prejudice to delivery. This is the great challenge to be competitive: add value to delivery. In ophthalmology, medical fees are not always added to the company's results, the cash flow is confused with profit and brings serious problems to financial health, the dedication of the health professional is put above worth an equipped hospital rather than a positive financial result , the doctors' exaggerated love for their own interests creates a great difficulty to work as a team, among other reasons, these have impeded the growth of clinics and even led to its closure. Sustainable results associated with good practices prepare companies for times of crisis, such as the coronavirus, and prepare for new challenges, such as the overheated acquisitions and mergers market. Keywords: sustainability; health administration; ophthalmology

Dividindo a experiência de gestão médica no maior serviço privado de urgência pediátrica do país

O autor relata a sua experiência de oito anos (2013-2021) a frente da gestão médica do pronto-socorro do Sabará Hospital Infantil, São Paulo SP, maior serviço privado de urgência pediátrica do país. O gestor, neste período, enfrentou excessiva demanda de atendimento com insatisfação de pacientes, dificuldades para gerir equipes desmotivadas por pobre modelo de atendimento e de remuneração. Foram formuladas ações, em um planejamento de cinco anos, baseadas na: a) integração pelo conhecimento não técnico, ensinando ao profissional como o mercado o valoriza; b) predileção pela qualidade em grupo: simbolizada pela conquista da acreditação Joint Commission InternationaI; c) atratividade competitiva: equiparação de honorários com mercado e remuneração por mérito; e d) desenvolvimento de novo conceito de produtividade médica com o comprometimento do profissional com a eficiência operacional. As ações levaram ao aumento na velocidade de atendimento da equipe entre 15% e 25%, dependendo do mês. Houve um salto de honorários na ordem de 15% a 100% dependendo da faixa. Foi possível reduzir o desperdício de horas médicas da escala em 7,4%. O engajamento relacionado a protocolos clínicos se estabeleceu, e a equipe contava com 60% mais pediatras. No quinquênio que se seguiu, dificuldades colocaram à prova os valores desenvolvidos pela equipe, sendo a principal relacionada à pandemia do covid-19, com a redução abrupta do volume de atendimento. Como resposta houve redução de horas de escala em 45%, com garantia de honorários médicos mensais mínimo de 65% e desligamento de apenas 10% dos profissionais. Ao fim do quinquênio foram criados projetos de melhorias que hoje diferenciam a instituição, tais como: a) Supervia (2019) – protocolo para atendimento de casos menos urgentes que permite alta logo após a triagem, reduzindo o tempo de espera do paciente; b) Telemedicina (2020) – além das consultas de urgência, utilizada também na reavaliação de pacientes; c) Short stay (2021) – espaço destinado a internações de baixa complexidade com previsão de duração inferior a 48 horas, observada uma lista de vinte diagnósticos selecionados.Palavras-chave: Organização e administração de serviços de saúde; Remuneração médica, Carga de trabalho; Pediatria; Pandemia de covid-19 Sharing the experience of medical management in the largest private pediatric emergency service in the country ABSTRACTThe author reports his experience of eight years (2013-2021) in front of the medical management of the emergency room at Sabará Hospital Infantil, São Paulo SP, the largest private pediatric emergency service in the country. The manager, in this period, faced excessive demand for care with patient dissatisfaction, difficulties to manage teams unmotivated by a poor service and remuneration model. Actions were formulated in a five-year plan based on: a) integration through non-technical knowledge, teaching the professional how the market values it; b) predilection for group quality: symbolized by the achievement of Joint Commission International accreditation; c) competitive attractiveness: matching fees with the market and merit pay; and d) development of a new concept of medical productivity with the professional's commitment to operational efficiency. The actions led to an increase in the team's service speed between 15% and 25%, depending on the month. There was a jump in fees in the order of 15% to 100% depending on the range. It was possible to reduce the waste of medical hours on the scale by 7.4%. Engagement related to clinical protocols was established, and the team had 60% more pediatricians. In the five years that followed, difficulties put to the test the values developed by the team, the main one being related to the covid-19 pandemic, with the abrupt reduction in the volume of care. In response, there was a 45% reduction in hours of work, with a minimum monthly medical fee of 65% guaranteed and dismissal of only 10% of professionals. At the end of the five-year period, improvement projects were created that today differentiate the institution, such as: a) Supervia (2019) - protocol for the treatment of less urgent cases that allows discharge immediately after the screening, reducing the patient's waiting time; b) Telemedicine (2020) - in addition to emergency consultations, also used to reassess patients; c) Short stay (2021) - space destined to hospitalizations of low complexity with a prediction of less than 48 hours, observing a list of twenty selected diagnoses. Keywords: Organization and administration of health services; Medical fees; Workload; Pediatrics; Covid-19 pandemic

International Students’ Experience With Health Care in Japan

The number of foreign residents and visitors in Japan is increasing, which necessitates culturally competent care in hospitals. This study aimed to describe the experience of international students who visited hospitals in Japan. In total, nine international graduate students in a medical university participated in semi-structured interviews in English. The interview contents were transcribed and analyzed using content analysis. While participants were satisfied with an efficient medical system and kind staff, they also had difficulty communicating with staff and receiving health care due to language and cultural differences. Participants desired Japanese health care staff speak English, as well as have English documents. The differences from their own countries were mainly medical fees, insurance, the medical system itself, and use of English to communicate with foreign patients. It is necessary to improve staff’s English skills, provide English documents, use multilanguage interpreter services, and explain Japanese hospitals’ medical system.

Public financing versus private billing in a public hospital under management of a Social Health Organization

ABSTRACT Introduction: to assess the efficiency of management by a Social Health Organization (Organização Social de Saúde - OSS) compared with the private sector; to verify if there are savings for the State Health Secretariat (SES) in management contracts for financing the production of a public hospital versus its production values billed by private methods; and to establish if the amounts billed by the Unified Health System (SUS) table would finance the same procedures. Methods: we compiled and tabulated all procedures performed and the materials and drugs dispensed in the Euryclides Jesus Zerbini Transplant Hospital (HTEJZ), managed by the OSS Associação Paulista Para o Desenvolvimento da Medicina (SPDM), in September, October, and November 2018, according to the Brasíndice® table for drugs, the Simpro® table for materials, the CBHPM® table for medical fees, and tables SIGTAP SUS and SIA SUS. We then compared the average values obtained in the private billing with the costing amount reimbursed by the State Health Secretariat and the billing calculated in the SIA-SUS. Results: the average SUS revenue was R$ 2,774,086.91; the monthly reimbursement by the SES was R$ 13,055,700.00; and the average private revenue was R$ 25,084,440.31. Conclusions: the management by the OSS SPDM in the Euryclides de Jesus Zerbini Transplant Hospital was more efficient in the financing / production ratio than it would be to a private hospital. The economy of public funds was significant. The current SUS table reimbursement values would not meet the need for funding for an overly complex hospital.

The effects of service quality and perceived price on revisit intention of patients: the Malaysian context

Purpose This paper aims to investigate the effects of service quality and perceived price (monetary and behavioural price) on the revisit intention of patients to hospitals, as well as the mediating role of perceived price on the relationship between service quality and revisit intention. Design/methodology/approach This paper distributes questionnaires to outpatients in three major cities in Malaysia, namely, Penang, Melaka and Johor. Patients who were in the foyer, dispensary area and waiting area were intercepted where their responses were sought. The responses obtained from 400 patients were analysed using the structural equation modelling technique. Besides analysing the path coefficients, this study has examined the common method variance, bias and indirect effects of the relationships. Findings The results suggest that patients pay more attention to certain values in their search for the best health-care service and subsequently move on to new values. Pricing is an effective strategy to promote favourable behavioural intentions amongst patients. Better service quality is reflected in the reasonableness of monetary costs incurred by patients in acquiring health-care services. Patients who received poor services will be more likely to compare such services to the medical costs incurred to ascertain the worthiness of the amount paid. In addition, service quality also influences how patients perceive spending their time and efforts (waiting for nurses and physicians, as well as queueing in hospitals) as worthy and vice-versa. Their revisit intention will also be affected by the extent of which they invest their time, energy and efforts to search for relevant information. Practical implications The hospitals which desire to charge additional fees should enhance their service quality to reflect price equity. This is imperative in view of the pricing structure which can be relatively complex in subsequent follow-up treatments that may affect the decision of patients on the sources of health-care services. Originality/value Given the inevitable increase in medical fees, the perceived price can be a key determinant to the overall judgement patients had in terms of the health-care services received and the time and efforts sacrificed. However, the importance of monetary price and the behavioural price is still relatively unstudied, particularly their influence on revisit intention in the health-care setting.