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[PMID]:28893894
[Au] Autor:Collier R
[Ad] Endereço:CMAJ.
[Ti] Título:Fees for medical liability protection decrease in populous regions.
[So] Source:CMAJ;189(36):E1174, 2017 09 11.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Honorários e Preços/legislação & jurisprudência
Honorários Médicos/tendências
Seguro de Responsabilidade Civil/economia
Responsabilidade Legal/economia
Imperícia/legislação & jurisprudência
[Mh] Termos MeSH secundário: Canadá
Seres Humanos
Imperícia/economia
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.1095492


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[PMID]:28472226
[Au] Autor:Bhatia J; Tobey R; Hochman M
[Ad] Endereço:The Keck School of Medicine, University of Southern California, Los Angeles.
[Ti] Título:Value-Based Payment Models for Community Health Centers: Time to (Cautiously) Take the Plunge?
[So] Source:JAMA;317(22):2275-2276, 2017 Jun 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Centros Comunitários de Saúde/economia
Medicaid/economia
Mecanismo de Reembolso/economia
Seguro Baseado em Valor/economia
[Mh] Termos MeSH secundário: California
Capitação
Centros Comunitários de Saúde/legislação & jurisprudência
Honorários Médicos
Seres Humanos
Oregon
Sistema de Pagamento Prospectivo
Estados Unidos
Seguro Baseado em Valor/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170706
[Lr] Data última revisão:
170706
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.5174


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[PMID]:28377024
[Au] Autor:Elkins RK; Schurer S
[Ad] Endereço:School of Economics, University of Sydney, Sydney, Australia.
[Ti] Título:Introducing a GP copayment in Australia: Who would carry the cost burden?
[So] Source:Health Policy;121(5):543-552, 2017 May.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Recent policy changes designed to contain unsustainable health expenditure growth imply that many more Australians may soon be charged a copayment to consult a GP. We explore the distributional consequences associated with a range of hypothetical GP copayment scenarios using nationally-representative Australian survey data. For each scenario, we estimate the cost burden that individuals and households across the income distribution would need to absorb to maintain their current GP service utilisation. Even when concessional patients are charged a third or a quarter of the non-concessional copayment rate, the average estimated cost burden in the lowest income quartile is typically between three and six times that of the highest, and the average cost burden for women is significantly higher than for men within every income quartile. These disparities are intensified for those with a chronic illness. We conclude that the widespread implementation of GP copayments would disproportionately burden lower-income families, who experience higher rates of chronic illness, higher demand for GP services, and lower capacity to absorb price increases. The regressive nature of GP copayments is reduced when concessional and child patients are exempted entirely, highlighting the importance of supporting GPs-particularly in disadvantaged areas-to maintain bulk-billing arrangements for vulnerable patient groups.
[Mh] Termos MeSH primário: Custo Compartilhado de Seguro/economia
Medicina Geral/economia
Gastos em Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Austrália
Criança
Doença Crônica/economia
Estudos Transversais
Honorários Médicos
Feminino
Seres Humanos
Masculino
Meia-Idade
Programas Nacionais de Saúde/economia
Pobreza
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE


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[PMID]:28114631
[Au] Autor:Reddy AK; Bounds GW; Bakri SJ; Gordon LK; Smith JR; Haller JA; Berrocal AM; Thorne JE
[Ad] Endereço:Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland.
[Ti] Título:Differences in Clinical Activity and Medicare Payments for Female vs Male Ophthalmologists.
[So] Source:JAMA Ophthalmol;135(3):205-213, 2017 Mar 01.
[Is] ISSN:2168-6173
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The number of women in ophthalmology is rising. Little is known about their clinical activity and collections. Objective: To examine whether charges, as reflected in reimbursements from the Centers for Medicare & Medicaid Services (CMS) to ophthalmologists, differ by sex and how disparity relates to differences in clinical activity. Design, Setting, and Participants: Retrospective review of the CMS database for payments to ophthalmologists from January 1, 2012, through December 31, 2013. The dates of the analysis were February 1 through May 30, 2016. After exclusion of J and Q codes, the total payments to and the number of charges by individual ophthalmologists were analyzed. The mean values were compared using a single t test, and the medians were compared by the nonparametric Wilcoxon rank sum test. Main Outcomes and Measures: Primary outcome measures were the mean and median CMS payments to male and female ophthalmologists in outpatient, non-facility-based settings. Secondary outcome measures included the number of charges submitted by men and women and the types of charges most commonly submitted by men and women. Results: This study included 16 111 ophthalmologists (3078 women [19.1%] and 13 033 men [80.9%]) in 2012 and 16 179 ophthalmologists (3206 women [19.8%] and 12 973 men [80.2%]) in 2013. In 2012, the average female ophthalmologist collected $0.58 (95% CI, $0.54-$0.62; P < .001) for every dollar collected by a male ophthalmologist; comparing the medians, women collected $0.56 (95% CI, $0.50-$0.61; P < .001) for every dollar earned by men. Mean and median collections were similar when comparing female vs male ophthalmologists in 2013 (P < .001). The mean payment per charge was the same for men and women, $66 in 2012 and $64 in 2013. There was a strong association between collections and work product, with female ophthalmologists submitting fewer charges to Medicare in 2012 (median, 1120 charges; difference -935; 95% CI, -1024 to -846; P < .001) and in 2013 (median, 1141 charges; difference -937; 95% CI, -1026 to -848; P < .001) than male ophthalmologists. When corrected by comparing men and women with similar clinical activity, renumeration was still lower for women. In both years, women were underrepresented among ophthalmologists with the highest collections. Conclusions and Relevance: Remuneration from the CMS was disparate between male and female ophthalmologists in 2012 and 2013 because of the submission of fewer charges by women. Further studies are necessary to explore root causes for this difference, with equity in opportunity and parity in clinical activity standing to benefit the specialty.
[Mh] Termos MeSH primário: Gastos em Saúde/estatística & dados numéricos
Reembolso de Seguro de Saúde/economia
Medicare/economia
Oftalmologistas/economia
Oftalmologia/recursos humanos
[Mh] Termos MeSH secundário: Honorários Médicos/estatística & dados numéricos
Feminino
Seres Humanos
Reembolso de Seguro de Saúde/estatística & dados numéricos
Masculino
Medicare/estatística & dados numéricos
Oftalmologia/economia
Otolaringologia/estatística & dados numéricos
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170124
[St] Status:MEDLINE
[do] DOI:10.1001/jamaophthalmol.2016.5399


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[PMID]:28114540
[Au] Autor:Bai G; Anderson GF
[Ad] Endereço:Johns Hopkins Carey Business School, Baltimore, Maryland.
[Ti] Título:Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region.
[So] Source:JAMA;317(3):315-318, 2017 01 17.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Capitação
Economia Médica
Honorários e Preços
Medicare/economia
[Mh] Termos MeSH secundário: Honorários Médicos
Seres Humanos
Distribuições Estatísticas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170628
[Lr] Data última revisão:
170628
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170124
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2016.16230


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[PMID]:26952688
[Au] Autor:Burgette LF; Mulcahy AW; Mehrotra A; Ruder T; Wynn BO
[Ad] Endereço:RAND Corporation, Arlington, VA.
[Ti] Título:Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records.
[So] Source:Health Serv Res;52(1):74-92, 2017 Feb.
[Is] ISSN:1475-6773
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The median time required to perform a surgical procedure is important in determining payment under Medicare's physician fee schedule. Prior studies have demonstrated that the current methodology of using physician surveys to determine surgical times results in overstated times. To measure surgical times more accurately, we developed and validated a methodology using available data from anesthesia billing data and operating room (OR) records. DATA SOURCES: We estimated surgical times using Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times. Estimated times were validated using data from the National Surgical Quality Improvement Program. We compared our time estimates to those used by Medicare in the fee schedule. STUDY DESIGN: We estimate surgical times via piecewise linear median regression models. PRINCIPAL FINDINGS: Using 3.0 million observations of anesthesia and OR times, we estimated surgical time for 921 procedures. Correlation between these time estimates and directly measured surgical time from the validation database was 0.98. Our estimates of surgical time were shorter than the Medicare fee schedule estimates for 78 percent of procedures. CONCLUSIONS: Anesthesia and OR times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule.
[Mh] Termos MeSH primário: Anestesia/estatística & dados numéricos
Honorários Médicos/estatística & dados numéricos
Salas Cirúrgicas/estatística & dados numéricos
Duração da Cirurgia
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
[Mh] Termos MeSH secundário: Anestesia/economia
Documentação
Seres Humanos
Medicare/organização & administração
Medicare/estatística & dados numéricos
New York
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170501
[Lr] Data última revisão:
170501
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160309
[St] Status:MEDLINE
[do] DOI:10.1111/1475-6773.12474


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[PMID]:28028284
[Au] Autor:Kondo S; Kondo Y; Fuse M
[Ad] Endereço:Medical Corporation Seijyu Kai, Sakura Home Clinic.
[Ti] Título:[Revision of Medical Fee System for Treatment at Nursing Homes - The Influential Consideration of the Introduction of One-Patient-Per-Visit Method on the Welfare of Elderly Patients at Nursing Homes].
[So] Source:Gan To Kagaku Ryoho;43(Suppl 1):69-70, 2016 Dec.
[Is] ISSN:0385-0684
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:The 2014 revision of the medical fee system includes the introduction of a one-patient-per-visit method at nursing homes, which should be followed to avoid a drastic reduction in medical fees. We followed the new method, resulting in much more frequent visits to nursing homes(For example, we visit a facilitythree times per week instead of the previous two times per month). Frequent visits to multiple facilities are time- and effort-consuming on our side as a clinic, but, on the other hand, patients have more opportunities to see a doctor when theyare sick even if theyare not scheduled to do so. In this study, we examined how the new method affects the welfare of elderlypatients at nursing homes.
[Mh] Termos MeSH primário: Honorários Médicos
Casas de Saúde/economia
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170519
[Lr] Data última revisão:
170519
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161229
[St] Status:MEDLINE


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[PMID]:27927217
[Au] Autor:Chama-Chiliba CM; Koch SF
[Ad] Endereço:Department of Economics, University of Zambia, Lusaka, Zambia. chitalu.chiliba@unza.zm.
[Ti] Título:An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.
[So] Source:BMC Res Notes;9(1):504, 2016 Dec 07.
[Is] ISSN:1756-0500
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. METHODS: Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. RESULTS: The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. CONCLUSION: The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.
[Mh] Termos MeSH primário: Honorários Médicos
Custos de Cuidados de Saúde
Serviços de Saúde Materna/economia
Serviços de Saúde Materna/utilização
[Mh] Termos MeSH secundário: Assistência à Saúde
Parto Obstétrico/economia
Características da Família
Feminino
Instalações de Saúde
Política de Saúde
Acesso aos Serviços de Saúde/economia
Acesso aos Serviços de Saúde/estatística & dados numéricos
Seres Humanos
Parto
Gravidez
Análise de Regressão
Saúde da População Rural
População Rural
Zâmbia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161209
[St] Status:MEDLINE


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[PMID]:27755558
[Au] Autor:Shan L; Li Y; Ding D; Wu Q; Liu C; Jiao M; Hao Y; Han Y; Gao L; Hao J; Wang L; Xu W; Ren J
[Ad] Endereço:Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China.
[Ti] Título:Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.
[So] Source:PLoS One;11(10):e0164366, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. METHODS: We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. FINDINGS: About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. CONCLUSION: At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.
[Mh] Termos MeSH primário: Pacientes Internados/psicologia
Satisfação do Paciente
Qualidade da Assistência à Saúde
Confiança
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Honorários Médicos
Feminino
Inquéritos Epidemiológicos
Seres Humanos
Cobertura do Seguro
Entrevistas como Assunto
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Assistência ao Paciente
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170531
[Lr] Data última revisão:
170531
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161019
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0164366


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[PMID]:27493159
[Au] Autor:Kaiser J
[Ti] Título:BIOMEDICINE. Antiaging trial using young blood stirs concerns.
[So] Source:Science;353(6299):527-8, 2016 Aug 05.
[Is] ISSN:1095-9203
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Envelhecimento/sangue
Transfusão de Sangue/métodos
Voluntários Saudáveis
Plasma
Rejuvenescimento
[Mh] Termos MeSH secundário: Animais
Doadores de Sangue
Transfusão de Sangue/economia
Ensaios Clínicos como Assunto
Honorários Médicos
Seres Humanos
Camundongos
Estados Unidos
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1609
[Cu] Atualização por classe:160805
[Lr] Data última revisão:
160805
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160806
[St] Status:MEDLINE
[do] DOI:10.1126/science.353.6299.527



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