Suchergebnisse

Improvement of per capita income will boost the demand for outpatient care and lead enhanced expectation of service quality of hospital. People perceived that private hospital has better services than public hospital. Based on these, we assumed that private hospital users have particularcharacteristics. This study aimed to investigate factors associated with utilization of private hospitals for outpatient care and who get the benefits, the rich or the poor. This study used data of 42,540 respondents from IFLS-4 collected in 2007. Analyses showed the higher the income the higher the demand. Insured's groups have higher demand than uninsured. Demand analyses revealed that increased price of private hospital caused higher demand. This evidence indicated that outpatient care of private hospital was perceived as luxuries goods. However increased price of public hospital didnot influence the demand of private hospital. It is indicate that private hospital has different type with patients of public hospital. It means that the two types of hospital comprise different segment of patients. The rich benefited more outpatient care in private hospital than the poor. It implies that the government should enforced Ministry of Health's regulation on hospital social function.Keywords: demand, elasticity, outpatient care, private hospitalAbstrakPeningkatan pendapatan per kapita menaikkan permintaan rawat jalan dan harapan mutu pelayanan rumah sakit. Masyarakat memiliki persepsi pelayanan rumah sakit swasta lebih bermutu daripada rumah sakit pemerintah, sehingga terdapat asumsi pelanggan rumah sakit swasta mempunyaikarakteristik khusus. Tujuan studi ini adalah menginvestigasi berbagai faktor yang berhubungan dengan utilisasi rawat jalan dan kelompok yang mendapat manfaat. Studi ini menggunakan 42.540 responden rumah sakit swasta IFLS-4 tahun 2007. Semakin tinggi pendapatan semakin tinggi pulapermintaan, kelompok jaminan/asuransi mempunyai permintaan yang lebih tinggi daripada non-jaminan. Kenaikan tarif rawat jalan rumah sakit swasta yang dipersepsi masyarakat sebagai barang mewah meningkatkan permintaan. Namun, kenaikan tarif rawat jalan rumah sakit pemerintah tidak memengaruhi permintaan rawat jalan rumah sakit swasta. Hal tersebut mengindikasikan karakteristik pasien rumah sakit swasta yang berbeda dari rumah sakit pemerintah. Kelompok kaya mendapatkan manfaat rawat jalan rumah sakit swasta lebih besar daripada kelompok miskin. Untuk mengoreksikeadaan ini pemerintah perlu menegakkan peraturan menteri kesehatan tentang fungsi sosial rumah sakit.Kata kunci: permintaan, elastisitas, rawat jalan, rumah sakit swasta

Theoretical considerations suggest that nonlinear health care price schedules have heterogeneous effects on health care demand. In this paper, we develop and apply a finite mixture bivariate probit model to analyze whether there are heterogeneous reactions to the introduction of a nonlinear price schedule in the German statutory health insurance system. In administrative insurance claims data from the largest German health insurance plan, we find that some individuals strongly react to the new price schedule while a second group of individuals does not react. Post-estimation analyses reveal that the group of the individuals who do not react to the reform includes the relatively sick. These results are in line with forward-looking behavior: Individuals who are already sick expect that they will hit the kink in the price schedule and thus are less sensitive to the co-payment.

PurposeOutpatient care delivery is one of the key revenue sources of a hospital which plays a salient role in timely care delivery. The key purpose of the study is to propose a multi-objective simulation-based decision support model that considers the cost of care delivery and patient dissatisfaction as its two key conflicting objectives. Patient dissatisfaction considers service fairness. Patient idiosyncrasies such as no-show, unpunctuality and balking have been considered in the model involving multiple classes of patients.Design/methodology/approachA model has been designed using data collected from field investigations. In the first stage, queuing theory based discrete event simulation model has been developed. Genetic algorithm has been used to solve the scalarized problem and obtain actionable insights. In the second stage, non-dominated sorting genetic algorithm II (NSGA-II) has been involved to achieve the Pareto optimal fronts considering equal priority of the two objectives.FindingsThe computational results considering various parameter settings can help in efficient resource planning while ensuring better care delivery. The model proposed in the study provides structural insights on the business strategy of healthcare service providers on optimizing the dual goals of care delivery cost and service fairness.Originality/valueThe study is one of the early works that helps to improve the care delivery process by taking into consideration the environmental factors as well as service fairness. The study demonstrates the usage of simulation-based multi-objective optimization to provide a more sustainable patient centric care delivery.

China's New Co-operative Medical Scheme (NCMS), a government-subsidized health insurance programme, was launched in 2003 in response to deterioration in access to health services in rural areas. Initially designed to cover inpatient care, it has begun to expand its benefit package to cover outpatient care since 2007. The impacts of this initiative on outpatient care costs have raised growing concern, in particular regarding whether it has in fact reduced out-of-pocket (OOP) payments for services among rural participants. This study investigates the impacts on outpatient costs by analysing data from an individual-level longitudinal survey, the China Health and Nutrition Survey, for 2004 and 2009, years shortly before and after NCMS began coverage of outpatient services in 2007. Various health econometrics strategies were employed in the analysis of these data, including the Two-Part Model, the Heckman Selection Model and Propensity Score Matching with the Differences-in-Differences model, to estimate the effects of the 2007 NCMS initiative on per episode outpatient costs. We find that NCMS outpatient coverage starting in 2007 had little impact on reducing its participants' OOP payments for outpatient services. The new coverage may also have contributed to an observed increase in total per episode outpatient costs billed to the insured patients. This increase was more pronounced among village clinics and township health centres—the backbone of the health system for rural residents—than at county and municipal hospitals.

Summary
This article examines the place of alcoholic patients in French psychiatry in the 1950s and 1960s, an era of incipient psychiatric reform. Relying on medical literature, national and department archives, as well as hitherto unexploited patient files from one of the first anti-alcoholic consultations opened in the early 1950s in Paris, it shows how new therapies and drugs, such as disulfiram, revived the interest of psychiatrists for alcoholism and enabled the outpatient treatment of alcoholics. However, the study of patient trajectories reveals that ambulatory care did not substitute itself for hospitalisation. The article then analyses how the psychiatrist–patient relation was transformed in the framework of the consultation, and included new stakeholders such as social workers and family members. It finally explains why therapeutic enthusiasm gave way, at the end of the 1960s, to increasing doubts concerning the role of the psychiatrist in the cure of alcoholism.

Background:The care of chronic wounds is one of the core tasks of inpatient and outpatient care. The correct timing of changes has a significant impact on the positive course of wound healing. The VulnusMON project developed an intelligent wound plaster to determine the optimum time to change the plaster in hospital. Against the background of implementing the solution also in the outpatient sector, this article focuses on the following research questions: What is the legal framework for wound care in outpatient care? What are the differences in wound care between inpatient and outpatient care? What obstacles and barriers arise for the VulnusMON project when it is implemented in the outpatient sector? Can initial economic estimates be made for the transfer to the outpatient sector?Method:Due to the complexity of the different research questions, a mixed method design was used. The qualitative part of the study includes both focus groups and expert interviews. As part of the quantitative analysis, a data set on outpatient wound care was analyzed (n= 463).Results:In summary, it can be stated that the project VulnusMON and its intelligent wound plaster, which aims to determine the ideal time to change a wound plaster is viewed very positively by the professionals. However, there are a number of barriers that inhibit the potential transfer of the new digital solution to the outpatient setting. From an economic point of view, implementation in the outpatient sector makes sense, as travel times can be reduced. However, the study also points out important social implications, that pose several challenges for the actual transfer of the plaster to the outpatient sector.

Studying and measuring accessibility to care services has become a major concern for health care management, particularly since the global financial collapse. This study focuses on Tuscany, an Italian region, which is re-organizing its inpatient and outpatient systems in line with new government regulations. The principal aim of the paper is to illustrate the application of GIS methods with real-world scenarios to provide support to evidence-based planning and resource allocation in healthcare.