Financing Of Medical Care Research Articles

Организационно-финансовые аспекты выбора интраокулярных линз при хирургии катаракты в условиях ценностно-ориентированной системы здравоохранения.

Relevance. In modern conditions, value-based healthcare provides for the provision by medical organizations of medical care of appropriate quality with mandatory control of its cost. Treatment outcomes that are important to the patient become no less significant than clinical performance indicators and payment for medical services, regardless of the profile of medical care. The gradual change in paradigms of healthcare systems from a paternalistic to a person-centric model required changes in organizational, legislative and financial approaches when introducing health-saving healthcare technologies. Purpose of the study: analysis of the current organizational, legal, financial and clinical models of surgical treatment of patients with age-related cataracts, astigmatism and development of proposals for the implementation of the patient’s right to choose intraocular lenses, taking into account his modern expectations from the results of treatment. Materials and methods. Statistical and analytical methods were used (content analysis methods, expert assessment methods, analysis and synthesis methods). Results. An analysis of the legislation in organizing the provision and financing of medical care to the adult population in the field of ophthalmology is presented, and state guarantees for the use of medical products – types of intraocular lenses implanted into the human body for the surgical treatment of senile cataracts and astigmatism – are considered. Clinical models of the disease are systematized, taking into account the frequency and frequency of provision of medical services and the list of medical devices implanted into the human body, professional, medico-economic, medico-legal and reputational risks are described when exercising the patient’s right to choose intraocular lenses in the treatment of ophthalmological pathology. Proposals have been developed to change clinical recommendations, standards of medical care for senile cataracts and astigmatism, and improve payment for ophthalmological care. Conclusions. The transition to value-based healthcare requires the consolidation of the efforts of all structures of the healthcare industry to achieve the best results in the treatment of ophthalmic diseases and increase the clinical effectiveness associated with the choice of intraocular lenses in the surgical treatment of adults in the field of ophthalmology.

Simple Geographic Distribution of Patients with Stroke According to their Medical Care Financing System in a Private University Hospital

Aims: To reveal the geographical distribution of stroke patients in a private university hospital in Jakarta, Indonesia according to their address and further divide them into three sub group of using universal health coverage (UHC) vs other type of insurance ((OTI) vs private non insurance patient (private) Study Design: simple retrospective cross-sectional study. Place and Duration of Study: Sample: Medical record from patients of the Department of Neurology, Rumah Sakit Universitas Kristen Indonesia, Jakarta Indonesia; a private university hospital located in Jakarta Indonesia, between January 2021 and December 2023. Methodology: We analyzed medical record of 162 patients (90 men, 72 women; age range 15-87 years (mean age 61.12 SE± .82) with history of stroke and at the present routinely underwent routine medical control (outpatient) or with current diagnosis of stroke (inpatient in our hospital). We further divided them based on their medical care financing system (UHC vs OTI vs private) and using the help from GPS service made available by Google Maps™ we simply try to make a geographical distribution of those patients based on their address/residence location Results: Geographical distribution of patients using UHC were closer to the hospital compared to the other 2 non UHC medical care financing users. Conclusion: Our analysis regarding stroke patients in our hospital (2021-2023), we found that 55.6% male patients, 42% were in the range of age between 55-64 years old, most of the patient (94.4%) using BPJS as their medical care financing system, with 27.7% came from sub district Makkasar which is near from our hospital. Further analysis using the help of Google maps™ we can show that the UHC or BPJS health referral system has facilitated patients receiving health services at the health facility closest to their residence.

Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics.

The enhanced recovery after surgery (ERAS) protocol is not routine management in paediatric orthopaedics. Cultural differences or assumptions about the financing of medical care in different countries encourage creative adaptation of general assumptions in local communities. The aim of this study was to compare the quality of the perioperative period before and after the introduction of an interdisciplinary protocol adopted to organisational conditions. A group of 4098 children were included in the "before-after" observational study. The data of 1553 patients (BEFORE group) were analysed in terms of compliance with the enhanced recovery after surgery protocol guidelines and the time and cost of hospitalisation over a 20-month period. A novel interdisciplinary protocol was developed, including an education and training app called BackOnFeet (BOF®), standardised hospital management, and the introduction of methods novel to Poland (intraoperative nerve cryoanalgesia in children). A further 2545 patients (AFTER group) were reassessed over a period of 20 months. It was found that the groups differed in hospitalisation time (p < 0.001), type of procedures, and percentage ratio of costs incurred to revenue generated. The usefulness of the BOF® app as an effective educational tool was demonstrated. The optimisation of perioperative management in paediatric orthopaedics based on novel tools and the interdisciplinary ERAS protocol is possible and brings tangible benefits in psychological, organisational, and financial terms.

Review of foreign healthcare systems and ongoing reforms in China and Vietnam

The article is devoted to the review of some aspects of health care reform abroad, the emphasis is placed on the study of measures to achieve universal health coverage (HEU) in China and Vietnam. There is a significant similarity of problematic issues in the health care of most countries, which include ensuring equal access to quality medical care, shortage of medical personnel, financing of medical care. A review of the studied reforms showed that those that are addressed to a specific health problem achieve greater success, especially in the field of public health reform. The experience of reforms in China and Vietnam in the field of increasing the availability of medical care demonstrates the importance of improving the financing of the medical industry in the implementation of most reforms. Both countries have implemented reforms in the field of health insurance, but in China basic health insurance was introduced, while in Vietnam more attention was paid to vulnerable groups of the population. Despite the fact that the two countries have made progress in health coverage, inequality in access to medical care has been significantly reduced in Vietnam. It is concluded that the effectiveness of reforms will be more successful if such measures as the use of strategic procurement, improvement of primary health care, improvement of the quality of services, provision of political support and increased financing of health care are implemented.

Порядок и источники финансирования здравоохранения в субъектах Российской Федерации

Introduction. Currently, human rights to medical care and health protection in our country are regulated by the Constitution of the Russian Federation, federal laws and by-laws. And, accordingly, to realize these rights, the state needs to form, allocate and effectively spend a sufficient amount of financial resources. The purpose of the study is to analyze the procedure and sources of healthcare financing in the constituent entities of the Russian Federation. Methods. The analysis of modern scientific literature, as well as the regulatory framework on the procedure and sources of healthcare financing in the Russian Federation is carried out. For this purpose, the methods of bibliographic, informational and semantic search of sources in various databases are used. Results. The sources of financing the healthcare system in the Russian Federation are employers’ insurance premiums for Compulsory Health Insurance (CHI) of the working population, insurance premiums from the budgets of the constituent entities of the Russian Federation for CHI of the non-working population, as well as expenditures of regional budgets and inter-budgetary transfers. The CHI system is currently the main source of funding for the state healthcare system in the Russian Federation. Single-channel financing made it possible to increase the efficiency of the healthcare system and played a positive role during the pandemic, which allowed the system to compensate for epidemiological risks quite quickly, but currently there are problems that require the reform of the healthcare system. The disadvantages of the CHI system are the complexity of the medical care financing chain, as well as the problems of distributing the capacity of medical care between medical organizations within the framework of the territorial CHI program. From the standpoint of the objective situation of insufficient financing of healthcare in the Russian Federation, it is advisable not so much to increase financial resources as to increase the efficiency of the use of allocated funds, which requires the legislative consolidation of responsibility for their irrational use, as well as strengthening the state control of resources allocated to healthcare. Conclusions. The activities of the Compulsory Health Insurance system require strengthening public control measures.

Analysis of sources of financing of medical care in the Russian Federation

The subject of the study is the sources of financial support for state guarantees of free medical care to citizens in the Russian Federation. Particular attention is paid to the analysis of the composition and structure of the financial support of state guarantees of free medical care to citizens (including the volume of contributions received by the budget of the Federal Compulsory Medical Insurance Fund for working citizens and for non-working citizens). The authors also assessed the potential volume of MHIF budget revenues from the payment of insurance premiums and compared the results obtained with actual data. Research methods used: structural and dynamic analysis, synthesis, comparison, as well as graphical presentation of the results obtained. Based on the results of the study, it was revealed that contributions for the non-working population are paid from regional budgets. Taken together with the use of funds from the federal budget for the implementation of the program of state guarantees for the provision of free medical care to citizens, this allows us to conclude that the budgetary financial mechanism is predominantly used in financial support for the implementation of state guarantees of free medical care to citizens in Russia. In order to maximize the volume of funds for solving problems in the field of healthcare, as well as ensuring their more efficient use, the authors propose expanding the list of objects subject to insurance premiums, as well as a more reasonable approach to establishing various preferential regimes that reduce the volume of budget revenues of the Federal Compulsory Health Insurance Fund. The author’s calculations showed that the actual revenues of the MHIF budget are approximately half of the potential ones.

Legal regulation of medical care with the use of telemedical technologies by regulatory acts of the Russian Federation

Introduction. The development of the information component of the health care system, as part of the social security system, is an inevitable process. Since 2018, the possibility of providing medical care using telemedicine technologies has been enshrined at the legislative level in the Russian Federation [1]. The purpose of the study was to determine the regulation of relations for the provision of medical care using telemedicine technologies by the regulations of the Russian Federation. Materials and methods. The authors conducted a system-structural study based on the study of the legislative framework presented in the Consultant Plus system. To ensure the greatest completeness of information by the introduced limitation of the study, a requirement was adopted for the relevance of the action of the legal acts in question. Results. The issues of legal regulation of the provision of medical care using telemedicine technologies at the legislative level are spelled out in detail. The Constitution of the Russian Federation defines the fundamental provisions on medical care and health protection. No. 323-FZ Federal law is a law [9] that regulates the rights of citizens in the field of health care, it contains rules on the use of telemedicine technologies in the provision of medical care [10]. Acts of the Government of the Russian Federation on the provision of medical care using telemedicine technologies can be divided into groups: acts on the management of health care, on the financing of medical care, and acts of a program nature. Discussion. However, the current regulation is not without its shortcomings. Thus, the establishment of many formal requirements for the conditions and procedure for the provision of medical services using telemedicine technologies is seen as ambiguous. Conclusion. The study showed that the system of sources of legal regulation of the provision of medical care using telemedicine technologies: fixed at all levels with the priority of acts of the federal level, regulated by the Constitution of the Russian Federation only in general matters, mainly prescribed by Federal Law No. 323-FZ [1], defined in detail by Order No. 965n [2], needs to maintain the constant relevance of the sources of legal regulation.

Does It Still Show a Deficit? Arguing Post-COVID-19 Health Financing System in Bogor, Indonesia

Before the COVID-19 pandemic, the Bogor City Government regulated to cover the health financing claim during the Indonesian National Health Insurance (NHI) integration period due to the lower amount of health care claim per episode in regional hospitals compared to ones that NHI paid. This study aimed to address post-COVID-19 health financing at two hospitals in Bogor City, West Java Province, Indonesia. Descriptive analysis using the aggregate statistical summaries was taken to explore the medical care episodes of the data series at two hospitals for the last two years. Of the 890 checked medical records data, the deficit occurred in 197 (22.1%) medical care episodes, while five (0.6%) exceeded the hospitals' tariffs. The remaining 688 (77.3%) medical care episodes had suits with the Indonesian Case Based Groups. Almost a quarter of medical care episodes in aggregate experienced a deficit in the two years before the pandemic. This study is the first to provide new insight into the discussion on medical care financing in a developing country's post-pandemic era in a newly-implemented NHI system.

Impact of Health Financing on Healthcare Quality and Affordability in Malaysia: A Conceptual Review

In comparison to the majority of essential health indices, the health care system in Malaysia has performed exceptionally well. Despite this, it is still behind the techniques used in many other Asian countries, despite its great potential. The primary reason for this is that patients in Malaysia are subjected to a significant amount of financial risk while seeking medical treatment. The implications of health care finance in Malaysia are investigated in this study, with a particular focus on access and equality issues. This exemplifies the urgent requirement for novel ways to the financing of medical care that are compliant with the norms that have been established. According to the findings of this study, it is recommended that efforts should be increased by employing policy changes to include money pooling and risk sharing, subsidization for the poor and the vulnerable, and mandatory enrollment. In addition, it is recommended that the efforts be increased by employing policy changes to include money pooling and risk sharing. Finally, the implication for public policy indicates that the government ought to commit to the tremendously feasible improvement of the nation's healthcare system through spending.

Новая классификация национальных систем финансирования общественного здравоохранения

R e l e v a n c e : The variety of methods and approaches to the financing of medical care accumulated by the world experience determines the importance of classification. However, the existing capabilities of classification systems seem to be limited and unsuitable for practice and management decision-making. P u r p o s e : development of a new classification of health care financing systems to improve the efficiency of managerial decisions taken when modeling long-term strategies for the development of health care in the Russian Federation. M e t h o d s : A method was used based on a functional and structural analysis of the main links of the technological cycle of financing public (free at the place of delivery) medical care: coverage, determination of sources of revenues, their redistribution, consolidation, payment for medical care and management expenses for creating a new classification of health care financing systems. R e s u l t s a n d c o n c l u s i o n s : A new classification has been developed and tested to analyze the national health systems of different countries and model the most relevant changes in the health financing system. A p p l i c a t i o n o f t h e r e s u l t s : public health, public financial management, consolidation of revenues.

Review of methods for planning the scope of medical care and financing of the healthcare system by the subjects of the Russian Federation

The article presents a review of current and alternative methods for planning the scope and financing of medical care in the subjects of the Russian Federation. The relevance of the issue is due to the imperfection of the current planning model, which stimulate representatives of the profile bodies and independent experts to develop alternative methods. The current approaches and legal documents regulating the procedure for distributing the scope of medical care and financial resources to pay for this care are discribed. The analysis of alternative methods shows how different demographic and infrastructural features of regions can be used to redistribute the scope of medical care and the corresponding financial support.

Financing of Medical Care in Russia: Sources and Problems of Their Evaluation

To form an effective mechanism for financial support of health care in Russia, it is necessary to introduce into scientific and practical activities clearly-defined concepts that characterize medical services and sources of their financing. The analysis of the definitions such as «medical care» and «medical services» described in this article showed a lack of orderliness in basic terminology, as well as the possibility of replacing these concepts in practice. The article discusses the types of medical services in relation to the Program of state guarantees for providing citizens with free medical care. The sources of financial support for medical services in Russia are systematized and their features are highlighted. The research of the problems of financing health-care expenditures from various sources made it possible to suggest the main criteria for sharing these expenditures among the budgets of the budget system of the Russian Federation. The volume of budget financing of healthcare in Russia, compulsory and voluntary health insurance, and paid services in the healthcare sector are evaluated in the article, and also, the problems of estimating the volume of medical care in total from all sources, including the income of private medical organizations are identified.

The normative legal regulation of expertise of medical care quality in the Russian Federation

In modern conditions, the support of quality of medical care is one of key issues in health care management. Therefore, quality control issues are most important ones. The effective tool for monitoring quality of medical care is the medical care quality expertise. Hence, the legal regulation of this type of activity acquires special relevance. The article considers absence of uniform approaches to medical care quality expertise that does not allow to apply comparative analysis to processes of medical care support in medical organizations of various affiliations and to monitor both medical care quality and prevalence of medical errors to implement strategy of ensuring medical care quality. The identified legal aspects determine the need for further improvement of normative legal regulation of medical care quality expertise, specifying its role in the system of quality control and safety of medical care, unification of corresponding approaches, regardless of type of financing of medical care, departmental or territorial affiliation.

Foreign experience in determining the need for medical care financing based on regional features

Foreign experience in determining the need for medical care financing based on regional features

Overview of the existing opportunities and limitations of the state guarantees program for provision of free medical care to citizens

Introduction. The state guarantee program for provision of free medical care to citizens is a key regulatory document that describes the actual guarantees of citizens for medical care. The standards of the extent and financing of medical care established in it, determine the level of state guarantees throughout the Russian Federation. The aim is to determine possible limitations of the state guarantee program within the formation of indicators for the extent of medical care provided in the regions of the Russian Federation and the corresponding financial support. Materials and methods . As part of the study, the federal and regional regulatory legal acts were analyzed, in terms of the methodology for the formation of regional programs of state guarantees, the extent of medical care and financing, as well as the methodology for the formation of these standards. Results. The existing mechanisms for adapting the federal program of state guarantees at the regional level have been identified, and it has been shown that in most regions of the Russian Federation these methods are not used. Objective criteria for differentiating the standards of medical care exist in 77 regions, these standards correspond to the federal level in the vast majority of the regions of the Russian Federation, however there is a financing gap of the territorial programs in 2017 using the regional budget in 70 regions of the Russian Federation. Findings. The current recommendations on formation of the territorial program of state guarantees are applied to a limited extent. Calculation of the per capita financing standard for a region of the Russian Federation depends only on the differentiation coefficient; incidence rate, age and gender structure of population in a region are not taken into account while calculating the subvention amount.

THE MEDICAL SOCIOLOGICAL ASSESSMENT OF SOCIAL EFFICIENCY OF FUNCTIONING OF MEDICAL INSURANCE COMPANY IN THE SYSTEM OF MANDATORY MEDICAL INSURANCE OF RUSSIA

The article considers medical sociological study of evaluation of efficiency of functioning of insurance medical organization in the mandatory medical insurance system. The study was carried out on the basis of data survey of insured patients. The analysis established main problems related to financing of medical care within the framework of mandatory medical insurance system of the Russian Federation.

ІННОВАЦІЇ В ДЕРЖАВНІЙ ПОЛІТИЦІ ФІНАНСУВАННЯ МЕДИЧНОЇ ДОПОМОГИ В УКРАЇНІ

Мета: визначення інноваційної складової у державному фінансовому гарантуванні медичної допомоги для прогнозу стратегічної рентабельності даної інновації.Матеріали і методи. Використовуючи бібліосемантичний метод та метод системного аналізу, проаналізовано низку законодавчо-нормативних актів України, спрямованих на реформування системи охорони здоров’я.Результати. Вивчали особливості інноваційного запровадження в реформу системи охорони здоровʼя нової моделі фінансування та державних фінансових гарантій медичної допомоги населенню. Проаналізовано ризики, які можуть виникнути при запровадженні тих чи інших інновацій в систему фінансування медичної допомоги в Україні.Висновки. Отримані результати можуть бути використані при подальшій розробці стратегічних планів розвитку системи медичної допомоги.

Introduction: State-of-the-Art on Child Health Disparities.

Thirteen years ago, the Institute of Medicine issued a report entitled “Crossing the Quality Chasm.” This report highlighted gaps in quality health care and recommended that health care be safe, effective, patient-centered, timely, efficient, and equitable.1 The aim of equity in quality care addressed characteristics including gender, ethnicity, geographic location, and socioeconomic status. Two years later, the Institute of Medicine released another landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.”2 This report reviewed the literature and documented racial/ethnic disparities in health care, concluding with recommendations for improvements in medical care financing, allocation of care, availability of language … Address correspondence to Tina L. Cheng, MD, MPH, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University, 200 North Wolfe St, Suite 2055, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

Resource allocation strategies in Southeastern European health policy

The past 23 years of post-socialist restructuring of health system funding and management patterns has brought many changes to small Balkan markets, putting them under increasing pressure to keep pace with advancing globalization. Socioeconomic inequalities in healthcare access are still growing across the region. This uneven development is marked by the substantial difficulties encountered by local governments in delivering medical services to broad sectors of the population. This paper presents the results of a systematic review of the following evidence: published reports on health system reforms in the region commissioned by WHO, IMF, World Bank, OECD, European Commission; all available published evidence on health economics, funding, reimbursement in world/local languages since 1989 indexed at Medline, Excerpta Medica and Google Scholar; in depth analysis of official website data on medical care financing related legislation among key public institutions such as national Ministries of health, Health Insurance Funds, Professional Associations were applicable, in local languages; correspondence with key opinion leaders in the field in their respective communities. Contributors were asked to answer a particular set of questions related to the issue, thus enlightening fresh legislative developments and hidden patterns of policy maker's behavior. Cost awareness is slowly expanding in regional management, academic and industrial establishment. The study provides an exact and comprehensive description of its current extent and legislative framework. Western Balkans policy makers would profit substantially from health-economics-based decision-making to cope with increasing difficulties in funding and delivering medical care in emerging markets with a rapidly growing demand for health services.

Collaborative Governance of Multiinstitutional Graduate Medical Education: Lessons from The McGaw Medical Center of Northwestern University

The governance of graduate medical education (GME) and management of its interface with clinical care is a shared responsibility of teaching hospitals and medical educators. Significant changes in the structure and financing of medical care over the last few decades, along with a recent shift in the educational paradigm for GME, have made this collaboration all the more challenging. Calls for increased institutional accountability for GME from the Association of American Medical Colleges and the Accreditation Council on Graduate Medical Education have highlighted the need for more effective models of GME governance. With these challenges in mind, this article examines the recent experiences of The McGaw Medical Center of Northwestern University, a multiinstitutional, not-for-profitcorporation that serves as the vehicle for educational collaboration between Northwestern University Feinberg School of Medicine and the teaching hospitals/health systems that provide the clinical homes for McGaw-sponsored GME programs. The authors explore the rationale for pursuing a new model of GME governance at McGaw, and various factors important to its success. These "critical success factors" may be of use in other, similarly complex GME settings.