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[PMID]:29500301
[Au] Autor:Alderwick H; Shortell SM; Briggs ADM; Fisher ES
[Ad] Endereço:Center for Health and Community, University of California, San Francisco, CA, USA Hugh.Alderwick@ucsf.edu.
[Ti] Título:Can accountable care organisations really improve the English NHS? Lessons from the United States.
[So] Source:BMJ;360:k921, 2018 03 02.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Organizações de Assistência Responsáveis
Política de Saúde
Medicina Estatal/tendências
[Mh] Termos MeSH secundário: Custos de Cuidados de Saúde
Seres Humanos
Qualidade da Assistência à Saúde
Reino Unido
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180304
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k921


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[PMID]:29462152
[Au] Autor:Treacy L; Bolkan HA; Sagbakken M
[Ad] Endereço:Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
[Ti] Título:Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.
[So] Source:PLoS One;13(2):e0188280, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone. METHODS AND FINDINGS: Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made. CONCLUSIONS: Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.
[Mh] Termos MeSH primário: Tomada de Decisões
Custos de Cuidados de Saúde
Acesso aos Serviços de Saúde
População Rural
[Mh] Termos MeSH secundário: Feminino
Grupos Focais
Seres Humanos
Masculino
Gravidez
Pesquisa Qualitativa
Serra Leoa
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188280


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[PMID]:29401495
[Au] Autor:Stewart SA; Clive AO; Maskell NA; Penz E
[Ad] Endereço:Dalhousie University, Halifax, NS, Canada.
[Ti] Título:Evaluating quality of life and cost implications of prophylactic radiotherapy in mesothelioma: Health economic analysis of the SMART trial.
[So] Source:PLoS One;13(2):e0190257, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The SMART trial is a UK-based, multicentre RCT comparing prophylactic radiotherapy and symptom-based (deferred) radiotherapy in 203 patients with Malignant Pleural Mesothelioma who had undergone large bore pleural interventions. Using costs and quality of life data collected alongside the clinical trial, we will estimate the cost-effectiveness of prophylactic radiotherapy compared to deferred radiotherapy over a 1-year period. METHODS: Healthcare utilization and costs were captured during the trial. Utility weights produced by the EQ-5D questionnaire were used to determine quality-adjusted life-years (QALY) gained. The incremental cost-effectiveness ratio was calculated over the one-year trial period. RESULTS: Costs were similar in the immediate and deferred radiotherapy groups: £5480.40 (SD = £7040; n = 102) and £5461.40 (SD = £7770; n = 101) respectively. There was also no difference in QALY: 0.498 (95% CI: [0.45, 0.547]) in the prophylactic radiotherapy group versus 0.525 (95% CI: [0.471, 0.580]) in the deferred group. At a willingness to pay threshold of £30,000/QALY there was only a 24% chance that prophylactic radiotherapy was cost-effective compared to deferred radiotherapy. CONCLUSIONS: There was no significant effect of prophylactic radiotherapy on quality of life in the intervention group, nor was there any discernable decrease in healthcare costs. There is little evidence to suggest that prophylactic radiotherapy is a cost-effective intervention in this population. TRIAL REGISTRATION: ISRCTN72767336 with ISRCTN.
[Mh] Termos MeSH primário: Economia Médica
Custos de Cuidados de Saúde
Mesotelioma/radioterapia
Qualidade de Vida
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Análise Custo-Benefício
Feminino
Seres Humanos
Masculino
Meia-Idade
Radioterapia/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190257


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[PMID]:29377919
[Au] Autor:Schousboe JT; Kats AM; Langsetmo L; Taylor BC; Vo TN; Kado DM; Fink HA; Ensrud KE
[Ad] Endereço:HealthPartners Institute, HealthPartners, Minneapolis, Minnesota, United States of America.
[Ti] Título:Associations of recent weight loss with health care costs and utilization among older women.
[So] Source:PLoS One;13(1):e0191642, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. -1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.
[Mh] Termos MeSH primário: Custos de Cuidados de Saúde
Serviços de Saúde/utilização
Perda de Peso
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191642


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[PMID]:29240910
[Au] Autor:Wehby GL; Domingue BW; Ullrich F; Wolinsky FD
[Ad] Endereço:Department of Health Management and Policy, University of Iowa, Iowa City.
[Ti] Título:Genetic Predisposition to Obesity and Medicare Expenditures.
[So] Source:J Gerontol A Biol Sci Med Sci;73(1):66-72, 2017 Dec 12.
[Is] ISSN:1758-535X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures. Methods: Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data. The study included 6,628 Medicare beneficiaries who provided 68,627 complete person-year observations during the study period. Outcomes were total and service-specific Medicare expenditures and indicators for expenditures exceeding the 75th and 90th percentiles. The BMI polygenic risk score was derived from GWAS data. Regression models were used to examine how the BMI polygenic risk score was related to health expenditures adjusting for demographic factors and GWAS-derived ancestry. Results: Greater genetic predisposition to obesity was associated with higher Medicare expenditures. Specifically, a 1 SD increase in the BMI polygenic risk score was associated with a $805 (p < .001) increase in annual Medicare expenditures per person in 2010 dollars (~15% increase), a $370 (p < .001) increase in inpatient expenses, and a $246 (p < .001) increase in outpatient services. A 1 SD increase in the polygenic risk score was also related to increased likelihood of expenditures exceeding the 75th percentile by 18% (95% CI: 10%-28%) and the 90th percentile by 27% (95% CI: 15%-40%). Conclusion: Greater genetic predisposition to obesity is associated with higher Medicare expenditures.
[Mh] Termos MeSH primário: Índice de Massa Corporal
Predisposição Genética para Doença
Custos de Cuidados de Saúde/estatística & dados numéricos
Gastos em Saúde/estatística & dados numéricos
Medicare/estatística & dados numéricos
Herança Multifatorial/genética
Obesidade/genética
[Mh] Termos MeSH secundário: Idoso
Assistência Ambulatorial
Feminino
Seguimentos
Estudo de Associação Genômica Ampla
Seres Humanos
Masculino
Meia-Idade
Obesidade/economia
Obesidade/epidemiologia
Prevalência
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1093/gerona/glx062


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[PMID]:29486762
[Au] Autor:Schmid MK; Reich O; Blozik E; Faes L; Bodmer NS; Locher S; Thiel MA; Rapold R; Kuhn M; Bachmann LM
[Ad] Endereço:University of Zurich, Zurich, Switzerland.
[Ti] Título:Outcomes and costs of Ranibizumab and Aflibercept treatment in a health-service research context.
[So] Source:BMC Ophthalmol;18(1):64, 2018 Feb 27.
[Is] ISSN:1471-2415
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To compare anti-VEGF treatments for macular disease in terms of costs and clinical outcomes. METHODS: We identified patients suffering from macular disease and treated either with aflibercept, ranibizumab or both at the largest public eye clinic in Switzerland between January 1st and December 31st 2016 who were insured in one of the two participating health insurance companies. Clinical data were extracted from the electronic health record system. The health insurers provided the health claim costs for the ophthalmologic care and the total health care costs of each patient in the observation period. Using multivariate regression models, we assessed the monthly ophthalmologic and the monthly total costs of patients with no history of switching (ranibizumab vs. aflibercept), patients with a history of switching from ranibizumab to aflibercept, patients switching during the observation period and a miscellaneous group. We examined baseline differences in age, proportion of males, visual acuity (letters), central retinal thickness (CRT) and treatment history before entering the study. We investigated treatment intensity and compared the changes in letters and CRT. RESULTS: The analysis involved 488 eyes (361 patients), 182 on ranibizumab treatment, and 63 on aflibercept treatment, 160 eyes with a history of switching from ranibizumab to aflibercept, and 45 switchers during follow-up and 38 eyes of the miscellaneous group. Compared to ranibizumab, monthly costs of ophthalmologic treatment were slightly higher for aflibercept treatment + 175.0 CHF (95%CI: 1.5 CHF to 348.3 CHF; p = 0.048) as were the total monthly costs + 581.0 CHF (95%CI: 159.5 CHF to 1002.4 CHF; p = 0.007). Compared to ranibizumab, the monthly treatment intensity with aflibercept was similar (+ 0.057 injections/month (95%CI -0.023 to 0.137; p = 0.162), corresponding to a projected annual number of 5.4 injections for ranibizumab vs. 6.1 injections for aflibercept. During follow-up, visus dropped by 0.7 letters with ranibizumab and increased by 0.6 letters with aflibercept (p = 0.243). CRT dropped by - 14.9 µm with ranibizumab and by - 19.5 µm with aflibercept (p = 0.708). The monthly costs of all other groups examined were higher. CONCLUSION: These real-life data show that aflibercept treatment is equally expensive, and clinical outcomes between the two drugs are similar.
[Mh] Termos MeSH primário: Inibidores da Angiogênese/economia
Custos de Cuidados de Saúde
Ranibizumab/economia
Proteínas Recombinantes de Fusão/economia
Doenças Retinianas/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Inibidores da Angiogênese/uso terapêutico
Feminino
Pesquisa sobre Serviços de Saúde
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Ranibizumab/uso terapêutico
Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico
Proteínas Recombinantes de Fusão/uso terapêutico
Doenças Retinianas/economia
Acuidade Visual
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Angiogenesis Inhibitors); 0 (Recombinant Fusion Proteins); 15C2VL427D (aflibercept); EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor); ZL1R02VT79 (Ranibizumab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1186/s12886-018-0731-4


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[PMID]:29240473
[Au] Autor:Bird A
[Ad] Endereço:Lead Stoma Care Nurse Specialist, Colorectal and Stoma Care, Surgery Division, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust.
[Ti] Título:Stoma care in a time of financial pressures: can we cut the costs?
[So] Source:Br J Nurs;26(22):S14-S16, 2017 Dec 14.
[Is] ISSN:0966-0461
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Andrew Bird, Lead Stoma Care Nurse Specialist, Colorectal and Stoma Care, Surgery Division, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Andrew.Bird@nuh.nhs.uk.
[Mh] Termos MeSH primário: Custos de Cuidados de Saúde
Estomas Cirúrgicos/economia
[Mh] Termos MeSH secundário: Seres Humanos
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.12968/bjon.2017.26.22.S14


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[PMID]:27777282
[Au] Autor:Meka AO; Chukwu JN; Nwafor CC; Oshi DC; Madichie NO; Ekeke N; Anyim MC; Alphonsus C; Mbah O; Uzoukwa GC; Njoku M; Ntana K; Ukwaja KN
[Ad] Endereço:Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
[Ti] Título:Diagnosis delay and duration of hospitalisation of patients with Buruli ulcer in Nigeria.
[So] Source:Trans R Soc Trop Med Hyg;110(9):502-509, 2016 09.
[Is] ISSN:1878-3503
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delayed diagnosis of Buruli ulcer can worsen clinical presentation of the disease, prolong duration of management, and impose avoidable additional costs on patients and health providers. We investigated the profile, delays in diagnosis, duration of hospitalisation, and associated factors among patients with Buruli ulcer in Nigeria. METHODS: This was a prospective cohort study of patients with Buruli ulcer who were identified from a community-based survey. Data on the patients' clinical profile, delays in diagnosis and duration of hospitalisation were prospectively collected. RESULTS: Of 145 patients notified, 125 (86.2%) were confirmed by one or more laboratory tests (81.4% by PCR). The median age of the patients was 20 years, 88 (60.7%) were >15years old and 85 (58.6%) were females. In addition, 137 (94.5%) were new cases, 119 (82.1%) presented with ulcers and 110 (75.9%) had lower limb lesions. The mean time delay to diagnosis was 50.6 (±101.9) weeks. The mean duration of hospitalisation was 108 (±60) days. Determinants of time delay to diagnosis were higher disease category (p=0.001) and laboratory confirmation of disease (p=0.02). Determinants of longer hospitalisation were; multiple lesions (p=0.035), and having functional limitation at diagnosis and undertaking surgery (p=0.003). CONCLUSIONS: Patients with Buruli ulcer have very long time delays to diagnosis and long hospitalisation during treatment. This calls for early case-finding and improved access to Buruli ulcer services in Nigeria.
[Mh] Termos MeSH primário: Úlcera de Buruli/diagnóstico
Diagnóstico Tardio
Acesso aos Serviços de Saúde/normas
Hospitalização/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Úlcera de Buruli/economia
Úlcera de Buruli/microbiologia
Úlcera de Buruli/terapia
Criança
Diagnóstico Tardio/efeitos adversos
Diagnóstico Tardio/economia
Feminino
Custos de Cuidados de Saúde
Gastos em Saúde
Conhecimentos, Atitudes e Prática em Saúde
Hospitalização/economia
Seres Humanos
Tempo de Internação/economia
Masculino
Mycobacterium ulcerans/isolamento & purificação
Nigéria/epidemiologia
Reação em Cadeia da Polimerase/economia
Estudos Prospectivos
População Rural
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:29226443
[Au] Autor:Ellenberg E; Taragin MI; Hoffman JR; Cohen O; Luft-Afik D; Bar-On Z; Ostfeld I
[Ad] Endereço:National Insurance Institute of Israel.
[Ti] Título:Lessons From Analyzing the Medical Costs of Civilian Terror Victims: Planning Resources Allocation for a New Era of Confrontations.
[So] Source:Milbank Q;95(4):783-800, 2017 12.
[Is] ISSN:1468-0009
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Policy Points: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. CONTEXT: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. METHOD: Using the National Insurance Institute of Israel's (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher's Exact Test, chi-square test, and students' t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. FINDINGS: We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims' total medical costs reached $4.4 million. The NII reimbursed $2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. CONCLUSION: We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror.
[Mh] Termos MeSH primário: Assistência Ambulatorial/economia
Vítimas de Crime/economia
Vítimas de Crime/estatística & dados numéricos
Custos de Cuidados de Saúde/estatística & dados numéricos
Hospitalização/economia
Serviços de Saúde Mental/economia
Centros de Reabilitação/economia
Terrorismo/economia
[Mh] Termos MeSH secundário: Assistência Ambulatorial/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Seres Humanos
Israel
Serviços de Saúde Mental/estatística & dados numéricos
Centros de Reabilitação/estatística & dados numéricos
Terrorismo/estatística & dados numéricos
Guerra
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/1468-0009.12299


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[PMID]:29466590
[Au] Autor:Tseng P; Kaplan RS; Richman BD; Shah MA; Schulman KA
[Ad] Endereço:Duke University School of Medicine, Durham, North Carolina.
[Ti] Título:Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.
[So] Source:JAMA;319(7):691-697, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective: To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants: This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures: Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures: Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results: Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance: In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/economia
Custos de Cuidados de Saúde/estatística & dados numéricos
Seguro Saúde/organização & administração
Administração da Prática Médica/economia
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/organização & administração
Custos e Análise de Custo
Seguro Saúde/economia
Sistemas Computadorizados de Registros Médicos/economia
Modelos Organizacionais
Análise e Desempenho de Tarefas
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19148



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