Examination Fee Research Articles

Outpatient service tariff determination based on unit cost analysis mixed with community ability and willingness to pay

Purpose: The study aims to calculate the rational outpatient tariff based on unit cost analysis, ability and willingness to pay. 
 Method: The research is an observational study with a qualitative approach. Secondary data are obtained retrospectively to calculate unit costs and tariffs. Primary data is collected through questionnaires to see the ability and willingness to pay (WTP). 
 Result: The calculation using the step-down method obtained the unit cost for general practice IDR 79,337, dental care IDR 151,635, psychologist consultation IDR 115,283, and fitness center IDR 236,555. The respondent's ATP value is IDR 138,808, with an average examination fee of IDR 56,093. When coupled with an improvement in service and facility quality, 58.1% of respondents agreed to a 10% rate increase. With a 20% rate increase, the willingness to pay decreases to 40.6%. In the bivariate analysis using the chi-square test, the variables significantly affecting WTP are patient perceptions of the suitability of service costs (p = 0.000). In contrast, age, gender, occupation, education, income, number of family members, and insurance ownership do not significantly influence WTP. 
 Conclusion: The service rate is lower than the unit cost calculation. By looking at the ability and willingness to pay, it is possible to evaluate the tariff.

Comparisons of the diagnostic accuracy of the ultrasonic sign-score method and MRI for PA, PI and PP in high-risk gravid women: a retrospective study.

The diagnosis and management of placenta accrete spectrum (PAS) is a great challenge to obstetricians. Ultrasound (US) and magnetic resonance imaging (MRI) are two main methods to detect PAS. MRI has high resolution, but the examination fee is expensive. US machine and examination fee is cheap, but the resolution is relatively low. Balancing the cost and accuracy for PAS diagnosis is very important. The ultrasonic sign-score method and MRI findings for 49 pregnant women at high risk of placental implantation were retrospectively analyzed. Inclusion criteria: (I) at high risk for PA as described in the Guidelines to Placenta Accreta Spectrum Disorders issued by the American College of Obstetricians and Gynecologists (ACOG) in 2018; (II) complete records of ultrasonic sign-scoring method and MRI data; (III) cesarean section; (IV) definite surgical and/or pathological findings. The results were validated by the gold-standard surgical or postoperative pathological findings, and the efficacy of the 2 imaging approaches in diagnosing placenta PAS was compared. Kappa test was used to analyze the consistency. Receiver operating characteristic (ROC) curves were used to compare the sensitivity and specificity. The mean maternal age was 32.6±4.4 years. The mean gestational week was 35.9±2.0 weeks. The mean gravidity was 3.3±1.1. The surgical or histopathological findings revealed PA in 26, placenta increta (PI) in 19 and placenta percreta (PP) in 4 of the 49 women. The diagnosis accuracy of PA, PI, and PP was higher using the ultrasonic sign-scoring method than MRI (75.51%, 73.47%, and 97.96% vs. 61.22%, 57.14% and 91.84%, respectively). The areas under the ROC curve for the sensitivity and specificity of the ultrasonic sign-scoring method and MRI in the diagnosis of PA, PI, and PP were 0.757 [95% confidence interval (CI): 0.613, 0.868], 0.725 (95% CI: 0.579, 0.843), 0.989 (95% CI: 0.907, 1.000), and 0.607 (95% CI: 0.457, 0.743), 0.544 (95% CI: 0.395, 0.687), 0.614 (95% CI: 0.464, 0.749), respectively. Although the sensitivity and specificity were lower than 0.8, the ultrasonic sign-scoring method was still superior to MRI in the detection of PI and PP. US can be used to help identify high-risk gravid women.

실손의료보험에서 백내장 수술 진료비의 보상책임에 관한 판례 평석

Cataract is a disease in which the lens becomes cloudy due to aging and causes loss of vision. It is treated with surgery to remove the cloudy lens and insert an artificial lens. There are single vision lenses and multifocal lenses as types of intraocular lenses, which are the treatment materials used at this time. Monofocal lenses have the disadvantage of requiring separate corrective glasses for near vision even after insertion, but they are inexpensive and require medical treatment under the National Health Insurance Act. On the other hand, multifocal lenses have the advantage of correcting both near and far vision, but they are expensive and do not qualify for medical care benefits under the National Health Insurance Act.
 In this case, while the state determines the price of the salary, the non-insurance price is set by the medical institution, so the medical institution has an incentive to make a profit by arbitrarily setting the cost of treatment for non-insured items. In particular, in the case of non-insured items covered by medical insurance for indemnity insurance, the patient can claim most of the medical expenses from the insurance company as insurance money. There may be cases in which overpayment or overtreatment may occur.
 In relation to cataract surgery, some eye clinics, mainly in the Gangnam area of Seoul, arbitrarily adjust the cost of examination or multifocal lenses, which are representative non-covered items, according to changes in the health insurance benefit system or medical insurance policy, without reasonable standards. It is confirmed that they are taking advantage of the business by misusing them. For example, in September 2020, when health insurance was applied to the examination fee, it was no longer possible to claim high medical expenses for the examination fee. Excessive indemnity payments are being made in the medical insurance for loss by processing hospitalization and issuing a confirmation of hospitalization, and the damage is being passed on to good medical consumers and insurance organizations.
 However, in the recent judgment of 2021 na 2013354 of the Seoul High Court on January 20, 2022, the scope of claims for medical insurance for medical loss for insured persons who underwent cataract surgery was limited to the amount of out-of-patient insurance, not hospitalization. Based on the Supreme Court’s general definition, it was emphasized that ‘the substance of hospitalization’ should be provided in addition to the standards of the Ministry of Health and Welfare notification. He also pointed out that the fact that the comprehensive fee-for-service system is applied in cataract surgery is completely different from judging whether or not the patients were actually ‘hospitalized’.
 As such, it can be said that the above judgment on the criteria for ‘hospitalization’ for cataract surgery is not limited to the clinic in this case, but is also applied to general ophthalmology clinics performing cataract surgery. Although there is regret in the interpretation of the terms and conditions related to the exemption, I hope that the judgment of the subject judgment regarding hospitalization will be an opportunity to suppress unnecessary and reckless cataract surgery.
 It seems to be a very desirable direction for government ministries, financial supervisory authorities, and the industry to take an interest in the recent cataract surgery and other problems of the surge in medical expenses and to make various efforts and attempts. As a member of society, the court also expects effective and rational judgments that can effectively suppress turmoil in the medical market and protect the rights and interests of good medical care and insurance consumers.

Predicting Mental Disorders Using Data Mining Techniques

Over the last few years, data mining makes a transition to new applications in medicine. Many people suffer from mental disorders because of absence of care in the health care sector, especially in the mental care. Lack of health records for patients of mental health, has been caused by many reasons, for example, patients’ hesitation to go the psychiatrist to follow-up their condition due high cost of examination fee, waiting time for their turn, and diagnosis inaccuracy. Classifiers are used to predict normal, addiction without disorder, addiction with disorder, or disorder without addiction patients’ cases. However, a rise in the cases of personality disorder and substance abuse. We used Naive Bayes and K-Nearest Neighbor classification technique on dataset consists of opioid addicts patients derived from the United States of America to obtain high accuracy of mental disorder prediction. The precision of the NB classifier is (87%), and the precision of KNN classifier is (92%). This paper presents a new method for diagnosing mental disorders through data mining.

How to Reassure Program Directors of International Medical Graduates' Preparedness for Residency With the Fall of the USMLE Step 2 CS Exam.

To the Editor: The demise of the Step 2 Clinical Skills (CS) exam of the United States Medical Licensing Examination (USMLE), together with the USMLE Step 1’s transition to a binary reporting format, means that applicants for medical licensure have a single objective opportunity (Step 2 Clinical Knowledge) in proving their candidacy. 1 Programs may be reluctant to hire international medical graduates (IMGs) whom they have not previously observed in a clinical setting. As a potential substitute for the Step 2 CS exam, we propose that direct clinical observation of several new patient interactions during clerkships, or online assessment of communication and interpersonal skills while interacting with standardized patients, be included in respective clerkship evaluations. Structuring away-rotation evaluations for an IMG to include this scored component could reassure program directors of an IMG candidate’s preparedness for residency. To understand why an alternative clinical scoring component is needed for IMGs applying for residency, we need to examine the rise and fall of the Step 2 CS exam. The rise of the Step 2 CS exam has an interesting history. In the 1980s, U.S. residency program directors were concerned that the clinical competence of some IMGs was grossly deficient compared with their medical knowledge. 2 Subsequent events 3 led to the inception of the Clinical Skills Assessment (CSA) in 1981. The CSA’s validation led to its incorporation as a mandatory component for Educational Commission for Foreign Medical Graduates certification of IMGs in 1998 and subsequently for U.S. medical students as well. 4 Concerns voiced about subjecting only IMGs to the CSA were among the reasons for this change 4; this paved the path for the introduction of the Step 2 CS exam in 2004. Step 2 CS was not well received by U.S. medical students, though. The limit of taking the exam at only 5 U.S. centers, necessitating travel, plus an additional $975 examination fee, was unpopular. Despite growing questions regarding the utility of the exam and the high pass rate of nearly 97%, passing this exam was made a prerequisite for taking the USMLE Step 3—the final exam needed for obtaining medical licensure. 4 In the end, the COVID-19 pandemic, which necessitated travel restrictions and social distancing precautions, pushed the Step 2 CS exam to extinction. The Step 2 CS exam may have been flawed, but IMGs applying to U.S. residency programs need a new way to demonstrate their clinical competency. Structuring away-rotation evaluations for IMGs to include direct clinical observation or an online assessment could fill this gap.

Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on ‘System of Health Accounts 2011’ and multiple-layer perceptron neural network

ObjectivesTo study the medical expenditure and influencing factors of patients with hypertension in Shanxi Province, China.DesignA cross-sectional study.Setting1088 medical institutions, including general hospitals, traditional Chinese medicine hospitals, special hospitals, basic...

The appearance and increase in the quantity and proportion of the clinical research coordinator\u2019s service fee in drug clinical trial research fund and its impact on trial quality

ObjectiveThe changes of absolute value and relative value of clinical research coordinator service fee and its influence on the quality of drug clinical trial were analyzed.MethodsThis study compared the amount and structural changes of drug clinical trial costs in before 3 years and after 3 years of self-examination and inspection initiated by the China Food and Drug Administration, identified the increase number and composition of each individual cost of a clinical trial research funds which including clinical research coordinator service fee, investigator labor fee, subjects examination fee, subjects traffic subsidy, documents management fee, drug management fee, etc.ResultThe most significant appearance of increase in volume and proportion was the clinical research coordinator service fee. From the initial few to the global multicenter tumor drug clinical trials RMB31,624 or 34.92% of the proportion and domestic multicenter tumor drug clinical trials RMB16,500, accounted for 33.74%.DiscussionIt has become common for more money to be spent on clinical trials to be accompanied by improved quality, but the occurrence and continuous increase of clinical research coordinator service fee were divided into two aspects, On the one hand, the quality of clinical trials was promoted by the large amount of low-skill trivial work undertaken by clinical research coordinator; on the other hand, the quality of clinical trials was undermined by the fact that clinical research coordinator did too much treatment evaluation work that should have been done by the investigator.ConclusionThe clinical research coordinators’ access standards, pre-employment training and examination, job and performance evaluation, in addition to the SMO specification management and avoiding malicious competition between the industry, are important factors in the quality assurance of drug clinical trials.

Artificial intelligence-assisted reduction in patients\u2019 waiting time for outpatient process: a retrospective cohort study

BackgroundMany studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.MethodsWe developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides.ResultsTwelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05).ConclusionsUsing XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals.

Decentralising the patent system

Modern patent systems are slow, inefficient, expensive, and may result in outcomes that actively harm technological progress. This paper proposes a substantive re-think of these systems and lays a foundation upon which practical solutions can be built. Many solutions proposed in the past, such as prior-art bounties, outsourced examination, and dynamic fee setting, have gone unheeded due to the cost of administering them and the rigidity of the patent system. We explore how distributed ledger technologies (DLTs) enable these major changes by altering the way stakeholders are able to interact with the patent records system. We find that transitioning to a DLT-based patent records system can enable many previously suggested improvements to current patent systems in a flexible, scalable, and transparent manner. The case for such a transition is strengthened when jointly considering the complex but common roots of problems facing modern patent systems, rather than a balkanised set of technical solutions to address each issue independently. Noting that a DLT-based system is not a panacea, we also provide comment on the political, legal, and organisational challenges that must be overcome for such changes to be implemented at scale.

In Reply to Tallia et al.

We thank Dr. Tallia and his colleagues on the National Board of Medical Examiners (NBME) Executive Board for their response to our Perspective. Though their reply alleges that our article “raise[d] serious allegations intermixed with speculation and anecdote,” we note no material corrections to the facts we presented and continue to stand by our work. Instead, we challenge some of the assertions made by Dr. Tallia and colleagues. We question whether the self-assessments sold by the NBME “protect the health of the public” any more than practice materials provided by the numerous for-profit entities that operate in this space. Similarly, although it is true that United States Medical Licensing Examination (USMLE) fee increases have approximated the Consumer Price Index (CPI), it remains unclear why any increase in registration fees was necessary when, as we reported, the NBME’s revenue was growing at more than 5 times the CPI. Some of the information provided by Dr. Tallia and colleagues may be helpful to readers. Yet when considered in full, their response seems to sidestep the key points in our article. We presented data showing how the rise of USMLE Step 1 mania has financially benefitted the NBME and how these benefits have been achieved by offering products and services other than the USMLE. We showed how the NBME’s revenues more than tripled from 2001 to 2017, with salaries for top executives rising in lockstep with the rise in revenue. We emphasized that conflict of interest is a condition, not a behavior, and asserted that the NBME’s current business model and unique market position create conditions sufficient for a problematic financial conflict of interest. Both our article and the associated, independent Invited Commentary by Dr. Gesundheit1 included multiple specific and actionable proposals that could resolve this conflict of interest and restore trust in the NBME—though few of these were addressed in their response. We appreciate that the NBME is conducting a review of its governance, and we thank the executive board members for their pledge to consider carefully all concerns raised regarding conflict of interest. We continue to hope they will seriously consider those raised in our article. J. Bryan Carmody, MD, MPHAssistant professor of pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; [email protected]; ORCID: https://orcid.org/0000-0001-9079-1835.Senthil Rajasekaran, MDSenior associate dean for curricular affairs and undergraduate medical education, Wayne State University School of Medicine, Detroit, Michigan; ORCID: https://orcid.org/0000-0002-6445-5931.

Decentralising the Patent System

Modern patent systems are slow, inefficient, expensive, and may result in outcomes that actively harm technological progress. This paper proposes a substantive re-think of these systems and lays a foundation upon which practical solutions can be built. Many solutions proposed in the past, such as prior-art bounties, outsourced examination, and dynamic fee setting, have gone unheeded due to the cost of administering them and the rigidity of the patent system. We explore how distributed ledger technologies (DLTs) enable these major changes by altering the way stakeholders are able to interact with the patent records system. We find that transitioning to a DLT-based patent records system can enable many previously suggested improvements to current patent systems in a flexible, scalable, and transparent manner. The case for such a transition is strengthened when jointly considering the complex but common roots of problems facing modern patent systems, rather than a balkanized set of technical solutions to address each issue independently. Noting that a DLT-based system is not a panacea, we also provide comments on the political, legal, and organizational challenges that must be overcome for such changes to be implemented at scale.

The effectiveness and safety of precision cardiac anesthesia in patients undergoing cardiac surgery

Objective To investigate the effectiveness and safety of precision cardiac anesthesia. Methods A total of eighty subjects[New York Heart Association(NYHA) grades Ⅰ-Ⅳ] undergoing selective cardiac surgery were enrolled. They were randomly divided into two groups (n=40): a precision cardiac anesthesia group (group P) and a conventional cardiac anesthesia group (group C). Group P was primarily administrated with a low-dose of sufentanil, in combination with target - controlled infusion to accurately adjust the blood concentration of anesthetics as well as bispectral index to monitor anesthesia depth. The aim of this protocol of precision cardiac anesthesia was to achieve the rationalization of anesthetic use. The timing of tracheal extubation following cardiac surgery was determined by pre- and intra-operative individual general condition in group P. Routine dosage sufentanil was traditionally administrated in group C, and patients were transferred to intensive care unit (ICU) with tracheal intubation after surgery. All patients′ data were recorded including baseline characteristics, intraoperative sufentanil dosage, cases with cardiopulmonary bypass(CPB), operation time, lowest temperature, duration of mechanical ventilation, poor events, ICU length of stay, post - operative hospitalization stay and cost of hospital care. Results The total amount of sufentanil used intra-operatively was significantly less in group P than that in group C (P<0.05). The number of patients developing pneumonia after surgery in group C was revealed to be significantly greater than that in group P (P<0.05). Compared to group C, patients in group P had significantly decreased length of mechanical ventilation, ICU stay and post - operative hospital stay (P<0.05). Both total hospital expenditure and medical examination fee were significantly less in group P (P<0.05). Conclusions Precision cardiac anesthesia is of effectiveness and safety in adults undergoing cardiac surgery. It can reduce ICU and post-operative hospitalization stay. It is beneficial to cut the cost of health care, so as to improve efficiency of medical resources. Key words: Cardiac surgery; Precision cardiac anesthesia; Fast track

Analysis of patients’ attitudes towards medical service prices in different regions based on grey relational theory

PurposeThe purpose of this paper is to understand the attitude of patients towards the current medical service price and the effect of policy implementation, and explore the existing problems of the current medical service price policy in the region in order to provide a research basis for the dynamic adjustment mechanism of the medical service price.Design/methodology/approachLiterature analysis and expert interviews are used to design the questionnaire of the dynamic adjustment of medical service price formation mechanism. A convenient sampling method is used to extract data of 600 patients from the five areas, namely Beijing, Tianjin, Hebei, Shandong and Liaoning, on-site to fill out the paper-based questionnaire and electronic questionnaire. The grey relational analysis is used to explore the difference in the attitudes of patients towards the price of the medical service. Combined with the research results and expert interview results, some improvement suggestions related to the current price policy of medical service in five areas are put forward.FindingsThe overall average score of respondents in the five areas, namely Beijing, Tianjin, Hebei, Shandong and Liaoning, is found to be 3.861. In terms of surgical operation fee and examination fee, the average score is higher than 4, i.e. 4.097 and 4.011, respectively, indicating “relatively high” nodes. According to grey relevancy sorting, the correlation between the health service price attitude and the overall score in the five regions is in the following order: Shandong &gt; Tianjin &gt; Beijing &gt; Liaoning &gt; Hebei.Originality/valueIn this study, patients’ attitude towards the current price of medical services in their local areas, Beijing, Tianjin, Hebei, Shandong and Liaoning, is investigated in order to explore the existing problems of medical service price reform and thus provide the basis for further improvement in the medical service price policy.

Can single disease payment system based on clinical pathway reduce hospitalization costs in rural area? A case study of uterine leiomyoma in Anhui, China

BackgroundSingle disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example.MethodsThe study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years.ResultsThe total hospitalization expenditure (per-time) dropped from 919.08 ± 274.92 USD to 834.91 ± 225.29 USD and length of hospital stay reduced from 9.96 ± 2.39 days to 8.83 ± 1.95 days(P < 0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P < 0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (− 0.360); while the CV of materials expense increased the most (0.186).ConclusionThere existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.

Abdominal aortic aneurysm screening attendance: Effect of removing the examination fee.

The organized population-based screening programme for abdominal aortic aneurysm in Stockholm, Sweden, started in 2010. An examination fee was initially charged, but later removed because of a policy change. We examined the effect on screening attendance of removing the fee. The periods before and after removing the examination fee were compared with regard to screening attendance, overall, by municipality and by district. Screening attendance was 79.2% in the period with an examination fee and 79.9% in the period without an examination fee (p = 0.1787), with no significant change in screening attendance between the periods. Although removing examination fees has been shown to have a positive impact on attendance in other screening programmes, we did not find this association in our study.

Study on effect of clinical pathway implementation in advanced schistosomiasis with ascites

To evaluate the effect of clinical pathway (CP) on the implementation of advanced schistosomiasis patients with ascites. Totally 1 129 cases of advanced schistosomiasis patients with ascites but without other complications were selected randomly from the Performance Evaluation and Management System for Medical Treatment of Advanced Schistosomiasis Patients in Hubei Province from year 2011 to 2013. Among the patients, 754 cases were treated by CP (CP group), and 375 cases were treated with traditional methods (NCP group), and the hospitalization days, hospitalization expenses, medicine proportions, treatment outcomes and degrees of satisfaction and health knowledge rates of the two groups were compared. Meanwhile, the variation of CP was calculated. The average length of hospital days of the CP group and NCP group were (13.85 ± 5.60) d and (17.92 ± 5.80) d, respectively, and the average hospitalization costs of the two groups were (4 699.14 ± 1 520.59) Yuan and (5 692.01 ± 1 616.66) Yuan, respectively, both the differences were statistically significant (both P ＜ 0.05). Also the hospitalization cost structures of the two groups were remarkably different, the composition ratios of the inspection fee and accommodation fee in the CP group were lower than those in the NCP group, but the constituent ratios of the examination fee, diagnosis and treatment fee, drug charges and other expenses were higher than those in the NCP group (all P < 0.05). The awareness rate of health knowledge in the CP group was higher than that in the NCP group (P < 0.05), but there were no statistically significant differences in the treatment outcome and the degree of satisfaction between the two groups (both P > 0.05). The variation rate of CP was 9.02% (68/754). The implementation of CP can decrease the days of hospital stay and medical expenses, improve the awareness rate on health knowledge of the patients. The CP treatment with low variation rate is applicable to advanced schistosomiasis patients with ascites but without complications.

U.S. patent office seeks higher fees for 2017

The U.S. Patent & Trademark Office (PTO) plans to increase patent application fees next year to help it cover operational costs that are nearing the $3 billion mark. The last fee hike was in 2013. “The proposed fee adjustments are needed to provide the office with a sufficient amount of revenue to recover its cost of patent operations, while maintaining momentum toward achieving strategic goals,” PTO says. The fee increases are projected to produce approximately 5% more revenue each fiscal year once fully implemented, according to the office. Among the 205 proposed adjustments, the filing fee for large entities, such as big corporations, for utility patents—which protect new inventions or improvements on existing inventions—would rise to $300, a $20 increase. The examination fee for large entities would rise to $760, an increase of $40. Discounts remain available for “small entities,” which include universities, small businesses, individual inventors, and nonprofits. PTO

Poor Affordability and Low Access to Primary Education with special reference to Eastern Uttar Pradesh: Reflections from DISE Data

“Access to basic education” continues to be a matter of serious concern in India. While the quantitative expansion of the system appears to be very impressive, the achievement of the goal of universalisation of primary education has still remained elusive. This is because the government continues its celebration through reflecting on increased access to the basic facilities, based on apparent increase in enrolment-ratios, literacy rate and other infrastructural facilities; a deeper look reveals the progress to be grossly un-satisfactory. Availability of education facilities and attainment reflected in the form of increase in literacy rate, enrolment ratio, availability of educational infrastructure etc. cannot ensure access, as these facilities are beyond reach of the vulnerable section still fighting a grim battle to make their both ends meet. Although the government has provided free education to the children making the direct cost of education minimal, yet there are high indirect cost i.e., cost on books, stationery, examination fee, transportation, uniform, bags, etc. as well as opportunity cost i.e., the loss of wages to parents when the child is sent for schooling, which have not been taken into consideration by the government while subsidizing education. Therefore, instead of relying on availability alone, the issue of affordability needs to be equally stressed upon. The present paper highlights the issue as to whether mere creating the facilities and providing free education ensures access in real sense. It attempts to measure affordability in access to primary education in Uttar Pradesh with the help of DISE data for the year 2013–14.

Effects of diagnosis-related group payment on health-care provider behaviors: A consecutive three-period study

BackgroundThis study aimed to evaluate the impact of diagnosis-related group (DRG) payments on health-care providers' behavior and the potential best course of action to make a profit under a DRG payment mechanism. MethodsThis is a natural experiment study with a tertiary hospital-based dataset. Under a consecutive three-period (3 years) or 12-period (12 seasons) design, length of stay, medical cost with detailed items, the percentage of general anesthesia (GA), and the percentage of receiving additional operations were compared. Furthermore, the differences between negative- and positive-profit groups were also examined. ResultsThere was no difference in the length of stay and total medical cost after the launch of the DRG payment scheme. However, the percentage of additional operations increased significantly. In addition, there were reduced costs of radiological images and medication, a reduced percentage of GA, fewer patients undergoing additional operations, and a higher rate of complications or comorbidities in the “positive-profit group.” ConclusionThe introduction of DRG payment resulted in significantly reduced examination fee, slightly decreased medical costs without significant difference in several detailed items, a reduced number of GA cases without statistical significance, and more patients receiving additional operations. The possible solution to make a profit under the DRG payment scheme is to curtail the costs of radiological images and medication, lower GA percentage, perform fewer additional operations, and correct recording of complications or comorbidities.

Direct economic burden and influencing factors in patients with hepatitis B virus related diseases in Jiangsu, China.

The purpose of this study was to explore direct economic burden and its influencing factors in patients with hepatitis B virus (HBV) related diseases. Time phasing continuous sampling was used to select patients from August 1, 2012, to December 31, 2012, in 3 county hospitals of 3 model regions in Jiangsu Province, China. A total of 436 outpatients and 196 inpatients were observed. The average direct economic burden of HBV-associated admission was US$107.11 for outpatients, and drug fees accounted for 74%; the burden was US$3193.47 for inpatients, and the direct medical costs accounted for 96%. Multivariate linear regression analysis showed that drug fee, examination fee, and antiviral therapy were influencing factors for outpatients, while hospitalization stay, drug ratio, and patient's age were influencing factors for inpatients. It can be concluded that the direct economic burden of patients with HBV-related diseases was high compared to their household income. Measures should be taken to reduce the economic burden of patients.