Background: The Universal Health Care Law seeks to optimize financing of personnel costs without compromising quality and equitable health care among the health care facilities. This position statement aimed to identify strategies and policy recommendations for the cost-effective financing of health personnel in public healthcare facilities. Methods: A systematic review of literature was done to generate policy brief and key points for roundtable discussion in collaboration with the Department of Health (DOH). The discussion was guided by the three health financing options of DOH: (a) retain Personnel Services (PS) as DOH budget but shift Maintenance and Other Operating Expenses (MOOE) to PhilHealth; (b) shift PS and MOOE to PhilHealth, and (c) rationalize part-time status in government hospitals. Results: The pros and cons of financing options were cross-examined. In Option 1, physicians in government hospitals would receive fixed salaries from DOH / Local Government Units. In Option 2, there would be a monopsony between PhilHealth and provincial power. Payment will be performance-driven, and balance billing will be eliminated. Option 3 would be a set up of retaining part-time positions for physicians. Conclusion and Recommendation Participants deduced that for Option 1, provision of salary augmentation sources and ensuring adequate plantilla items and level of remuneration in government hospitals should be considered, in order to sufficiently compete with physicians’ income from private practice. For Option 2, the PhilHealth reimbursement system should ensure timely reimbursement so as not to subject care providers to financial instabilities. For Option 3, rationalizing part-time status should be flexible and can be applied regardless of how physicians are paid, as this would incentivize caregivers to work harder and smarter.
Universal Health Insurance ; Healthcare Financing ; Physicians ; Universal Health Care ; Reimbursement Mechanisms

PURPOSE: The aim of this study is to analyze inguinal hernia in Korea based on the nationwide data. METHODS: Retrospective analysis of nationwide data obtained from the Health Insurance Review & Assessment Service database for surgical repair of inguinal hernia from January, 2007 to December, 2015 was performed. RESULTS: A total of 314,238 cases of inguinal hernia surgery were performed during 9 years. The mean number of inguinal hernia surgery per year was 34,604 (range, 30,065–36,928). The proportion of male patient was 87%. Patients between the age of 1 to 5 years (17.3%) and of 60 to 69 years (17.4%) constituted the 2 dominant groups for inguinal hernia repair. A slight increase in repair for recurrent inguinal hernia, 1.9% to 3.2%, was observed from 2007 to 2015. The rate of concurrent bowel resection decreased from 1.9% to 0.6%. The total cost of inguinal hernia surgery was increased up to 1.68 times from 2007 to 2015 ($856 to $1,439), although the number of hospital days was decreased from 4.7 to 3.7 days. The rate of laparoscopic surgery was increased to 29.5% in 2015. CONCLUSION: A mean number of 34,604 cases of inguinal hernia surgery have been carried out annually in Korea. The age distribution for inguinal hernia repair demonstrates bimodal peak at early childhood and old age. The proportion of laparoscopic surgery of inguinal hernia has been increasing for the past 9 years. The length of hospital stay and the rate of combined bowel resection have decreased.
Age Distribution ; Diagnosis-Related Groups ; Hernia, Inguinal ; Humans ; Insurance, Health ; Korea ; Laparoscopy ; Length of Stay ; Male ; Retrospective Studies

This study identified the explanatory power of the Korean rehabilitation patient group (KRPG) v1.1 for acquired brain injury (ABI) on medical expenses in the rehabilitation hospitals and the correlation of functional outcomes with the expenses. Here, the design is a retrospective analysis from the claim data of the designated rehabilitation hospitals. Data including KRPG information with functional status and medical expenses were collected from 1 January and 31 August 2018. Reduction of variance (R2) was statistically analyzed for the explanation power of the KRPG. Association between functional status and the medical expenses was carried out using the Spearman's rank order correlation (rho). From the claim data of 365 patients with ABI, the KRPG v1.1 explained 8.6% of variance for the total medical expenses and also explained 9.8% of variance for the rehabilitation therapy costs. Cognitive function and spasticity showed very weak correlation with the total medical expenses (rho = −0.17 and −0.14, respectively). Motor power and performance of activities of daily living were associated weakly (rho = −0.27 and −0.30, respectively). The KRPG and related functional status in ABI reflects the total medical expenses and rehabilitation therapy costs insufficiently in the designated rehabilitation hospitals. Thus, the current KRPG algorithm and variables for ABI may need to be ameliorated in the future.
Activities of Daily Living ; Brain Diseases ; Brain Injuries ; Brain ; Cognition ; Diagnosis-Related Groups ; Fee-for-Service Plans ; Humans ; Muscle Spasticity ; Neurological Rehabilitation ; Rehabilitation ; Retrospective Studies

BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.
Academies and Institutes ; Fee-for-Service Plans ; Fees and Charges ; Gwangju ; Hospices ; Hospitals, General ; Humans ; Insurance ; Palliative Care ; Reward

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91–0.98) was relatively low compared to the indices of other regions (0.96–1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.
Aged ; Fee Schedules ; Fee-for-Service Plans ; Health Personnel ; Humans ; Korea ; Medicare ; Relative Value Scales ; United States

In the present study, the productions of antinociception induced by acute and chronic immobilization stress were compared in several animal pain models. In the acute immobilization stress model (up to 1 hr immobilization), the antinociception was produced in writhing, tail-flick, and formalin-induced pain models. In chronic immobilization stress experiment, the mouse was enforced into immobilization for 1 hr/day for 3, 7, or 14 days, then analgesic tests were performed. The antinociceptive effect was gradually reduced after 3, 7 and 14 days of immobilization stress. To delineate the molecular mechanism involved in the antinociceptive tolerance development in the chronic stress model, the expressions of some signal molecules in dorsal root ganglia (DRG), spinal cord, hippocampus, and the hypothalamus were observed in acute and chronic immobilization models. The COX-2 in DRG, p-JNK, p-AMPKα1, and p-mTOR in the spinal cord, p-P38 in the hippocampus, and p-AMPKα1 in the hypothalamus were elevated in acute immobilization stress, but were reduced gradually after 3, 7 and 14 days of immobilization stress. Our results suggest that the chronic immobilization stress causes development of tolerance to the antinociception induced by acute immobilization stress. In addition, the COX-2 in DRG, p-JNK, p-AMPKα1, and p-mTOR in the spinal cord, p-P38 in the hippocampus, and p-AMPKα1 in the hypothalamus may play important roles in the regulation of antinociception induced by acute immobilization stress and the tolerance development induced by chronic immobilization stress.
Animals ; Diagnosis-Related Groups ; Ganglia, Spinal ; Hippocampus ; Hypothalamus ; Immobilization ; Mice ; Spinal Cord

PURPOSE: To evaluate whether mild chemical irritation of the bladder in neonatal rats is associated with persistent vanilloid receptor transient receptor potential vanilloid subfamily 1 (TRPV1) activity in adult rats. METHODS: Female Sprague-Dawley rats were used. Ten-day-old rat pups underwent bladder sensitization via intravesical infusion of 0.2% acetic acid in saline with or without prior bladder desensitization with capsaicin. After 8 weeks, 3 groups of rats (control [group 1], bladder sensitization [group 2], and bladder desensitization [group 3]) underwent cystometry. Inflammation of bladder tissue and the expression of TRPV1 in bladder tissue and dorsal root ganglia (DRG) were also evaluated. RESULTS: The bladder sensitization group showed more frequent voiding contractions. TRPV1 expression in adult bladder tissue was elevated in group 2. TRPV1 mRNA levels in the bladder and DRG were significantly higher in group 2 than in group 1. Moreover, group 2 had significantly more DRG neurons (identified by uptake of the retrograde label Fast Blue) that exhibited TRPV1 immunoreactivity. CONCLUSIONS: We found a significant association between neonatal bladder sensitization and persistent TRPV1 activity in adult rats. This is the first study to focus on the underlying pathogenesis of bladder overactivity from childhood to adulthood. Our findings could lead to the development of new strategies for the treatment and prevention of adult urinary symptoms arising from childhood urinary tract dysfunction.
Acetic Acid ; Adult* ; Animals ; Capsaicin ; Cystitis, Interstitial ; Diagnosis-Related Groups ; Female ; Ganglia, Spinal ; Humans ; Inflammation ; Neurons ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; TRPV Cation Channels ; Urinary Bladder* ; Urinary Tract ; Urinary Tract Infections

OBJECTIVES: The aims of this study were to compare the performance of machine learning methods for the prediction of the medical costs associated with spinal fusion in terms of profit or loss in Taiwan Diagnosis-Related Groups (Tw-DRGs) and to apply these methods to explore the important factors associated with the medical costs of spinal fusion. METHODS: A data set was obtained from a regional hospital in Taoyuan city in Taiwan, which contained data from 2010 to 2013 on patients of Tw-DRG49702 (posterior and other spinal fusion without complications or comorbidities). Naïve-Bayesian, support vector machines, logistic regression, C4.5 decision tree, and random forest methods were employed for prediction using WEKA 3.8.1. RESULTS: Five hundred thirty-two cases were categorized as belonging to the Tw-DRG49702 group. The mean medical cost was US $4,549.7, and the mean age of the patients was 62.4 years. The mean length of stay was 9.3 days. The length of stay was an important variable in terms of determining medical costs for patients undergoing spinal fusion. The random forest method had the best predictive performance in comparison to the other methods, achieving an accuracy of 84.30%, a sensitivity of 71.4%, a specificity of 92.2%, and an AUC of 0.904. CONCLUSIONS: Our study demonstrated that the random forest model can be employed to predict the medical costs of Tw-DRG49702, and could inform hospital strategy in terms of increasing the financial management efficiency of this operation.
Area Under Curve ; Costs and Cost Analysis ; Dataset ; Decision Trees ; Diagnosis-Related Groups ; Financial Management ; Forests ; Humans ; Length of Stay ; Logistic Models ; Machine Learning ; Methods ; Sensitivity and Specificity ; Spinal Fusion ; Support Vector Machine ; Taiwan

BACKGROUND: We investigated association between introduction of the diagnosis-related groups (DRG) system for anal operation and length of stay. Also, we investigated how it is different among hospitals with longer length of stay and among hospitals with shorter length of stay before introduction of the DRG system. METHODS: We used data from Health Insurance Review and Assessment which were national health insurance claim data. Total 13,111 cases of anal surgery cases were included which were claimed by hospitals since July 2012 to June 2014. Two-level multivariable regression was conducted to analysis the association between length of stay and characteristics of hospital and patient. RESULTS: Before introducing DRGs, the average length of stay was 5.41 days. After introducing DRGs, average length of stay was decreased to 3.92 days. After introducing DRGs, length of stay has decreased (β=−1.0450, p < 0.0001) and it was statistically significant. Among hospitals which had short length of stay (shorter than mean of length of stay) before introducing DRGs, effect of introducing DRGs was smaller (β=−0.4282, p < 0.0001). On contrary, among hospitals which had long length of stay (longer than mean of length of stay) before introducing DRGs, effect of introducing DRGs was bigger (β=−1.8280, p < 0.0001). CONCLUSION: Introducing DRGs was more effective to hospitals which had long length of stay before introducing DRGs.
Diagnosis-Related Groups ; Humans ; Insurance, Health ; Length of Stay ; National Health Programs

Beijing ; Diagnosis-Related Groups ; economics ; Health Care Reform ; Health Expenditures