No abstract available.
Prospective Payment System*

No abstract available.
Prospective Payment System* ; Prospective Studies*

No abstract available.
Prospective Payment System* ; Prospective Studies*

DPC is the diagnosis dominant classification defined by diagnosis and procedures. The comprehensive daily payment system by DPC is being implemented in 731 hospitals across Japan. Of the hospitals affiliated with the Japanese Federation of Agricultural Cooperatives for Health and Welfare, 24 hospitals introduced this system in 2008. In September 2008 we mailed a questionnaire to them, and 23 hospitals responded. The mean of the comprehensive pay amounted to 105% of the piece rate. The average length of hospital stay shortened from 15.7 to 14.2 days. The bed occupancy rate decreased from 86.5 to 81.4%. For the preservation of the bed usage, most of the respondents said it was essential to keep in contact with neighboring hospitals and clinics. The adaptation rate of clinical pathways was only 29%. The proportion of generic drugs was 5.9%. In the DPC payment system it is necessary to maintain both the quality of medicine and the cost-effectiveness.
Medicine ; payment ; System ; Diagnostic ; With quality

The comprehensive daily payment system by DPC developed the standardization of medical care and cost-effectiveness. We can exchange intelligence of other hospitals through the benchmark. Clinical pathways were useful for both the standardization and cost-benefit analysis. The production of pathways improved the communication between hospital employees. The excessive shortening of the average length of hospital stay decreased the rate of bed usage. The DPC payment system leaves much room for improvement in the quality of medical treatment and care.
payment ; System ; Combined ; Procedures ; Hospitals

The purpose of this study was to evaluate the effect of dual bonding technique by comparing microshear bond strength between two different luting methods of resin cement to tooth dentin. Three dentin bonding systems(All-Bond 2, One-Step, Clearfil SE Bond), two temporary cements (Propac, Freegenol) were used in this study. In groups used conventional luting procedure, dentin surfaces were left untreated. In groups used dual bonding technique, three dentin bonding systems were applied to each dentin surface. All specimens were covered with each temporary cement. The temporary cements were removed and each group was treated using one of three different dentin bonding system. A resin cement was applied to the glass cylinder surface and the cylinder was bonded to the dentin surface. Then, micro-shear bond strength test was performed. For the evaluation of the morphology at the resin/dentin interface, SEM examination was also performed. 1. Conventional luting procedure showed higher micro-shear bond strengths than dual boning technique. However, there were no significant differences. 2. Freegenol showed higher micro-shear bond strengths than Propac, but there were no significant differences. 3. In groups used dual bonding technique, SE Bond showed significantly higher micro-shear bond strengths in One-Step and All-Bond 2 (p < 0.05), but there was no significant difference between One-Step and All-Bond 2. 4. In SEM observation, with the use of All-Bond 2 and One-Step, very long and numerous resin tags were observed. This study suggests that there were no findings that the dual bonding technique would be better than the conventional luting procedure.
Dentin* ; Glass ; Prospective Payment Assessment Commission ; Resin Cements* ; Tooth

Systemic nosocomial infection control programs were instituted for the first time in Korea by two university hospitals in Seoul in 1991 when full-time infection control nurses were employed. Since then, infection control programs and activities have been expanded to many university hospitals throughout the country, thanks to an increasing awareness of the importance of preventing nosocomial infections by the government, medical and academic communities and citizens' groups. However, progress has been slow. The tow major problems are: 1) the lack of financial incentives for the hospitals to prevent nosocomial infections ; and 2) a shortage of trained professionals, namely, the infection control nurse and the infection control physician. This review is to summerize the components of cost-effective infection control programs, and the current state of and the problems in the infection control in Korea; and to recommend the clinical pathologist a new role as a infection control physician, which will help not only to activate the infection control programs in the country, but also to reduce the financial loss of the hospital caused by nosocomial infections under the prospective payment system based on diagnosis related groups.
Cross Infection* ; Diagnosis-Related Groups ; Hospitals, University ; Infection Control ; Korea* ; Motivation ; Prospective Payment System ; Seoul

Ratio analysis allows a hospital to evaluate its own performance over time and to compare its performance with that of other hospitals. For this study, three types of ratio analysis were conducted based on some data on hospitals in Massachusetts. First, Key ratios influencing financial performance were identified using discriminant analysis. Second, the financial structures of the teaching and the non-teaching hospitals were compared using ratios and multiple comparison method. Third, the effects of the prospective reimbursement law of the state on financial performance were examined using ratios and paired t-test. The purpose of the law is to reduce hospital costs by setting the revenue ceiling prior to the effective budget year. The findings of this study were as follows: 1) When hospitals were divided into three groups, according to their operating income, only profitability ratios showed a consistent difference among the groups. 2) In the discriminant analysis, five ratios were selected: current ratio, operating margin, return on assets, fixed assets turnover, and inventory turnover. They are the key ratios to be monitored periodically for the purpose of evaluating the financial performance of hospitals. 3) When teaching hospitals were compared with non-teaching hospitals, acid ratio, days of cash on hand, and inventory turnover were statistically significant before the law went into effect, whereas only fixed assets turnover and inventory turnover were significant afterward. Contrary to previous studies, profitability ratios of teaching hospitals were higher than those of non-teaching hospitals, although the differences were not statistically significant. 4) When the ratios between the two periods (before and after the law) were compared, three profitability ratios (operating margin, return on assets, and return on equity) were significant for teaching hospitals, whereas three activity ratios (total assets turnover, fixed assets turnover, current assets turnover) were significant for non-teaching hospitals. Furthermore, while both total operating revenue and expenses were decreased, net operating income was increased, due to a greater decrease in total operating expenses. This shows that the law can indeed, simultaneously, achieve both a reduction in costs as well as improvement in the financial situation of hospitals.
Budgets ; Hand ; Hospital Costs ; Hospitals, Teaching ; Jurisprudence ; Massachusetts ; Prospective Payment System

The united states adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses: (l) The PPS decelerated the increase in the hospital expenditure (part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the part A expenditure were greater than losses in the part B expenditure. The dependent variables are per capita hospital expenditure, per capita part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows: (l) The annual increase in the per capita part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significant (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita part B expenditure was accelerated by $l.73 (t=l.91) after the implementation of the PPS. (3) The increase in the total Medicine expenditure per capita was reduced by $4.26(t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.
Cost Savings ; Diagnosis-Related Groups* ; Health Care Costs ; Health Expenditures* ; Humans ; Inflation, Economic ; Medicare* ; Outpatients ; Prospective Payment System* ; United States

PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 +/- 1.77 days vs. 3.82 +/- 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.
Appendectomy* ; Appendicitis ; Diagnosis-Related Groups* ; Emergency Service, Hospital ; Follow-Up Studies ; Health Care Costs ; Hospitalization ; Humans ; Korea ; Length of Stay ; Local Government ; Prospective Payment System ; Seoul