Health Service Charges Research Articles

Hospitals and Superutilization

A small percentage of patients consume most of the health services in the US. These cases of superutilization affect hospitals, but little is known about what it is, the impact on hospitals, or how hospitals can identify potential cases of superutilization. We conducted exploratory research using the Medical Expenditure Panel Survey (MEPS) datasets for 2019 to examine superutilization as it relates to hospitals. Using total charges for health services to identify superutilization, we found a surprising amount of superutilization was not related to hospital care. When superutilization did occur in hospitals, there was reduced reimbursement for care in superutilization as measured by the reimbursement relative to charges. Demographic variables had limited utility in predicting superutilization. Our demographic analysis suggested that there are potential cases of superutilization that are not accessing hospital care. Our analyses suggest that given the amount of care that cases of superutilization require, the decreased reimbursement for the high levels of care and the untapped potential of superutilization, hospitals should consider developing capabilities to manage these challenging cases.

Analysis of District Reg. Magelang Number 6 of 2011 Concerning Health Service Charges at the Muntilan Regional General Hospital Reg. Magelang

Regional regulations (perda) are a manifestation of the authority granted to regional governments in the context of implementing regional autonomy and co-administration tasks as well as accommodating special regional conditions and/or further elaboration of higher laws and regulations. What is the process of forming the Regional Regulation of Magelang Regency Number 6 of 2011 concerning Health Service Retribution at the Muntilan General Hospital, Kab. Magelang, whether it represents local wisdom or not. Local wisdom in foreign languages is often conceptualized as local wisdom (local wisdom), local knowledge (local knowledge) or local intelligence (Ideal genious). Local wisdom is the attitude, view, and ability of a community in managing its spiritual and physical environment, which gives the community resilience and power to grow in the area where the community is located. In other words, local wisdom is a creative answer to geographical-geopolitical, historical and situational situations.

Exploring Care Management for Older Adults with Illnesses as Family Members’ Responsibility : The Need for Social Workers’ Support Services in Nigeria

Introduction: Aging oftentimes comes with health-related issues. Usually, family members are obliged to provide care management for older adults. They must perform this task despite their limited knowledge of their patients’ health conditions. Hence, securing care management for older adults with illnesses becomes a dilemma for consideration. Aims: Older adults require support in managing health conditions. This study hopes to promote the following: First, provide understanding of how family members perceive caregiving. Second, provide insight into family members’ management of health care challenges. Third, explore the need for geriatric support services in providing care for older adults. Methods: The study employed a qualitative research method. Focus Group Discussion was utilized to elicit data from 24 participants admitted to four health care facilities at Enugu-North, Nigeria. Results: Findings indicated that participants perceived care management for the older adults as a filial responsibility that should be provided till their demise. However, the majority experienced difficulties to this effect, other major concerns found include age and the older adult’s attitude, financial challenges, the changing contemporary society, and caregiving stress due to the care recipient’s health status. While many of the participants indicated a preference for traditional medicine as an alternative to rapidly increasing health service charges owing to lagging geriatric support; others were less reliant on the governmental welfare support services. Conclusions: With the government implementing aging and health care policies, Non-Governmental Organizations (NGOs) and Civil Society Organizations (CSOs) in collaboration with geriatric social workers can help develop care-aid programs for older adults’ healthy wellbeing.

Pengaruh Jumlah Penduduk Dan Pertumbuhan Ekonomi Terhadap Penerimaan Retrubusi Pelayanan Kesehatan Kabupaten Berau

Abstract:This study aims to determine the population, the rate of economic growth and the amount of health service fees retribution and also to determine the effect of population and economic growth on the acceptance of health service charges. This study takes place at the District Health Office of Berau and the Central Bureau of Statistics of Berau District. The research method used is documentation study method which comes from financial report and other related documents from Berau District Health Office and Central Bureau of Statistics of Berau Regency. Proving The hypothesis of this study using the F test to test the level of significance of the influence of independent variables on the dependent variable simultaneously. The results obtained in this study is calculated F calculated by 61.34> from F table with a number of 6.94 using α = 5% so it can be concluded that the population and economic growth together have a significant effect on Acceptance of health service chargesKeywords: Population, Economic Growth, Health Service Levy.

The Removal of Charges for Health Services in the Jamaican Public Health System: Impact on the Health Practitioners' Performance

There is an ongoing discussion between governments, international agencies, and advocacy groups on whether user fees imposed at government health facilities in poor countries should be removed. Proponents argue that abolition of charges would lead to greater access for the poor, therefore offering the underserved the opportunity to access health services. There are limited studies that examined how health practitioners, an important stakeholder are affected. This research examined the impact of the 2008 removal of charges for health services on health practitioners in Jamaica. Using a mixed method evaluation design, we found that main health practitioners - nurses, doctors and pharmacists were not satisfied with the policy change. When compared to that before removal of charges, 10% less practitioners felt that performance on the job was good. Health practitioners alluded to increased workload, negative effects on their physical and emotional status and dissatisfaction with their work environment. Other problems encountered by health practitioners included unavailability of resources, shortage of staff, lack of equipment and lack of administrative support. The lesson learned for policymakers is that the critical problems identified will eventually outweigh the substantial health gains if adequate resources (financial and human), administrative support as well as improved service management are not soon injected into the public health system.

PHS130 - Severe Sepsis In Adults: Impact of Diagnostic Coding on Hospital Resource Utilization

Adult severe sepsis is one of the most expensive conditions treated in hospitals and represents an economic burden to western health-care systems. However, there is presently no uniform standardized ICD-9-CM algorithm to identify severe sepsis at a population-level. Our aim is to compare two established diagnostic coding strategies in terms of hospital resource utilization. Population-based longitudinal study using the 2006-2011 nationwide hospital discharge database. Episodes of severe sepsis were identified by two ICD-9-CM coding strategies: a) those assigned explicit ICD-9-CM codes (995.92, 785.52); and b) those assigned combined ICD-9-CM infection and organ dysfunction codes by modified Martin criteria. We calculated hospital charges based on the National Health Service charges for DRGs. Trends were assessed as to annual percent changes (APC) using joinpoint regression analysis. Roughly 62% of severe sepsis episodes identified were assigned explicit ICD-9-CM codes and 38% combination codes. Trend analysis showed that despite a shorter hospital stay in the explicit code cohort (12 vs. 14 days, p<0.001), mean cost per case was significantly higher in this cohort (14 665 € versus 12 404 €, p<0.001) and differences in this variable increased over the six-year period with an APC of 5.1% in the combination and of 7.8% in the explicit cohort. Of note, average costs per case showed an especially increasing trend in hospitalizations captured as 785.52 (septic shock). The great use of explicit codes in Spain has an extensive influence on adult severe sepsis hospital resource utilization estimates. Variability in coding practices must be taken into account when interpreting severe sepsis hospital-related financial burden. These data will help inform health care decision-making and resource planning.

Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria.

The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health.

The relationship between access to and use of dental services following expansion of a primary care service to embrace dental team training

ObjectivesTo investigate changes in the patient population and treatment case-mix within an expanded primary care dental training facility in Southern England. Study designCross-sectional analysis of patient management system data. MethodElectronic data for patients with a closed/completed treatment plan in the 12-month period prior to, and following, dental service expansion were extracted for analysis (n = 4343). Descriptive analysis involved age, sex, payment status, deprivation status and treatment activity. Logistic regression was used to model the likelihood of treatment involving laboratory constructed devices (crowns, bridges, dentures), in relation to demography and deprivation in each time period. ResultsThe volume of patients using the service increased by 48.3% (1749 cf 2594). The average age increased from 31.97 (95%CI: 30.8, 32.5) to 36.4 years (95%CI: 35.6, 37.1); greatest increase was in the over 75 years age-group (96%). The patient base became less deprived: patients exempt from payment reduced from 43.2% (n = 755) to 28.6% (n = 741) (P = 0.001) and the mean population deprivation score (IMD) reduced from 24.5 (95%CI: 23.8, 25.2) to 22.3 (95%CI: 21.7, 22.8). The volume and proportion of care involving laboratory constructed devices increased from 8.3% (n = 145) to 15.8% (n = 411) whilst assessments without interventive care decreased (34.5%–26.3%). On a logistic regression, the odds of having treatment involving laboratory constructed devices, increased with increasing age in both time periods 7% (95% CI: 1.06–1.08) and 6% (95% CI: 1.05–1.07) respectively. Furthermore, the odds increased by 38% OR: 1.38 (95% CI: 1.01–1.89) in period 2, for white patients. After adjusting for these effects, the odds of having care that involved laboratory constructed devices were less in period 2 than period 1 (100% cf 43%) for those who were technically exempt from payment (OR = 2.0; 95% CI 1.34 to 2.90 cf, OR = 1.43; 95% CI 1.13–1.81). ConclusionThe patient population altered in relation to age and socio-economic status. The expanded service had greater uptake by older people while users were less likely to be deprived. The expanded service, free at the point of delivery, attracted a higher proportion of patients who would normally have to pay health service charges. The service also showed an increase in treatment case-mix that involved laboratory constructed dental devices.

Direct Medical Costs of Traumatic Lumbar Puncture in the Setting of Possible Subarachnoid Hemorrhage

Direct Medical Costs of Traumatic Lumbar Puncture in the Setting of Possible Subarachnoid Hemorrhage

Universal health coverage and user charges

There has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

PIN58 Hospital Outcomes and Costs of Care for Severe Sepsis: A Population-Based Study

Despite recent advances in critical care, severe sepsis is one of the world's leading causes of death and remains both an important clinical challenge and an economic burden to western health care systems. Our aim is to analyze the costs and discharge status of severe sepsis in Spain and to examine the impact of age in terms of hospital outcomes Analysis of the 2008 nationwide hospital discharge database. We identified cases based on the ICD-9-CM codes for sepsis and organ dysfunction. We examined demographics, comorbidities, clinical outcomes and hospital costs and performed a logistic regression analysis to identify factors associated with in-hospital mortality. We calculated hospital charges based on the National Health Service charges for DRGs. To depict the amount of resources spent to procure a given level of desired outcome (hospital survival) we also determined the cost per survivor. A total of 37,746 cases were analyzed. Median age was 73 year (p25:59; p75:82); 58% were men, 28% surgical cases, 31% of cases had no associated comorbidity. In-hospital mortality was 45%. An inverse relationship between survival rate and age was consistently observed after adjusting by other clinical variables. Total costs of hospitalizations exceeded €500 million with 35% spent in patients aged >74 years. Age-related costs per survivor were €19,538 in cases aged <1 year; €12,390 in those aged 1-14 years; €16,703 in patients aged 15-44 years; €15,917 in patients 45-64 years, €13,828 in patients 65-74 years and €9,366 in those aged >74 years. Severe sepsis associates with high mortality and hospital-resources utilization. Age has a significant impact on outcomes both from clinical and economic perspectives. Age is an independent predictor of mortality. Costs per survivor, however, are substantially lower in elderly patients. These data will help inform health care decision-making and resource planning in the face of an ageing population.

“If I cannot access services, then there is no reason for me to test”: the impacts of health service charges on HIV testing and treatment amongst migrants in England

Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. Of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake.

Factors influencing adherence to referral advice following pre‐referral treatment with artesunate suppositories in children in rural Tanzania

WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers' adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories. The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions taken post-referral: taking their children to a drug shop, a traditional healer, or not seeking further treatment, and added to a random selection of patients who complied with referral advice. Caretakers of the children were interviewed about their socio-economic status (SES), knowledge about malaria, referral advice given and actions they took following pre-referral treatment. Interview data for 587 caretakers were matched with symptoms of the children, the time of treatment, arrival at a health facility or other actions taken post-pre-referral treatment. The majority (93.5%) of caretakers reported being given referral advice by the community drug dispenser. The odds of adherence with this advice were three times greater for children with altered consciousness and/or convulsions than for children with other symptoms [odds ratio (OR) 3.47, 95% confidence interval (CI) 2.32-5.17, P < 0.001]. When questioned, caretakers who remembered when (OR 2.19, 95% CI 1.48-3.23, P < 0.001) and why (OR 1.77, 95% CI 1.07-2.95, P = 0.026) they were advised to proceed to health facility - were more likely to follow referral advice. Cost did not influence adherence except within a catchment area of facilities that charged for services. In these areas, costs deterred adherence by four to five times for those who had previously paid for laboratory services (OR = 0.25, 95% CI: 0.09-0.67, P = 0.006) or consultation (OR 0.20, 95% CI: 0.06-0.61, P = 0.005) compared with those who had not. When given referral advice, caretakers of patients with life-threatening symptoms adhere to referral advice more readily than other caretakers. Health service charges deter adherence.

Cost to the Patient or Cost to the Healthcare System? Which one Matters the Most for GP Prescribing Decisions? A UK-Italy Comparison

Charges for health services help contain healthcare costs. Despite showing that medicine consumption decreases when charges are increased research has not yet identified how doctors 'manage' the charge system to help patients who cannot afford treatment. This paper describes how the charge system influences the prescribing decisions of Italian and UK physicians. The data are from the qualitative stage of a multi-stage study exploring cost related influences on GP and patient decision-making regarding medicine use. The analysis presented is based on transcripts of focus groups conducted with general practitioners. To help patients who have difficulties affording their medication Italian GPs rely on a smaller number of cost reduction strategies compared to their UK counterparts. They use 'samples' left by pharmaceutical companies, or diagnose patients with pathologies that allow exemption. Occasionally they recommend some delay or change therapy to a cheaper but less effective alternative. Italian and UK GPs have firm views about patients abusing the NHS and believe costs to the system are as important as costs to the individual patient. Prescribing budgets were not viewed in a positive light by Italian GPs. Due to the nature of the charge system in Italy GPs there are able to choose a reimbursable product for patients, so have less need than UK doctors to look for other means of reducing costs. Conversely, the UK GPs have developed a large number of cost reduction strategies, probably because of the charge system itself and the relatively high charges incurred by patients.

The History of NHS Charges

Health Service charges have been a feature of the National Health Service (NHS) since it was established in 1948, though they form only a small part of NHS revenue. This article looks at why they have been levied. It shows that the arguments for them primarily lie outside the NHS in foreign and defence policy and above all general management of the economy. The article suggests that the reasons given for charges do not withstand close scrutiny but they are Treasury orthodoxy. There is consistency across Conservative and Labour governments and across the decades of the NHS in the substance and language of the arguments. These arguments have wider implications for the debate between spending departments and the Treasury about economic management.

User charges for rural health services in Papua New Guinea

This paper reports on a review of user charges for health services in rural areas of Papua New Guinea. Facilities implementing both fee for service and community risk sharing schemes were studied. This study found that there is a lack of any policy framework or practical guidelines on cost recovery. In some areas fees are being used as a fiscal tool rather than to further health policy. This study from Papua New Guinea raises serious questions about the virtue of cost recovery for health services in rural areas. Equity is an issue and the fees are creating a barrier both for entry and continuation in the health system; accountability is poor, and issues of cross subsidization are not addressed; fee revenues from rural health services are small and primarily of local significance; and are not being used to improve quality of health services. Cost recovery schemes in rural areas have the potential to provide a valuable contributory source of income to operate and improve health services. In practice, few are achieving this. It is concluded that health sector financing focus could be more fruitfully directed to financing mechanisms with greater potential to improve and expand health services.

Access to health care for children in low‐income families

This paper draws on data from the Health Care for Children Project to consider issues of access to health care for children in low-income families in three geographic areas. Group and individual interviews were held with mothers in an innercity area and two outlying suburbs. Financial, geographic, sociocultural and other barriers to use of health services are discussed. Major obstacles to access to health care for their children identified by the mothers included cost of medication, hours of opening, transport and language. The paper highlights the impact of even quite small charges for health services on low-income families.

User charges for health services in developing countries: A review of the economic literature

Literature suggests that in theory, the efficiency of user charges for health services is related to the level of externality, the price elasticity of demand, the proportion of total costs which are private access costs, and the level of the government budget constraint. Theoretical models predict that price elasticity of demand for health services is likely to be higher for lower income groups and that user charges are therefore unlikely to promote equity, or reduce the discrepancies between the utilisation rates of the rich and poor, 'ceteris paribus'. Empirical evidence tends to confirm the latter prediction but to suggest that user charges in many countries provide the scope for welfare gains for the majority. Unfortunately, this scope is seldom exploited in practice. It is argued that many countries have little choice but to try to exploit the potential for majority gains, but that more emphasis should be placed on ensuring quality improvements than on superficial financial measures of success.

A price to pay, part 2: The impact of user charges in the Volta region of Ghana

AbstractThis paper looks at what happened in Ghana following increases in government health service charges in 1983 and 1985. A combination of analysis of records, interviews and discussion with community groups was used.Utilization in rural areas was affected drastically by the substantial increase of 1985. The effect on urban utilization was less extreme and less durable. The age composition of users changed. After the 1985 increase, proportionately more of the 15‐45 age group used the government services—this was particularly at the expense of the over‐45s. The population was obviously concerned with the cost of health care, but were even more concerned about the quality of care and receiving value‐for‐money. They were unwilling to pay if drug supplies were unreliable or staff behaved unpleasantly.Some problems were encountered with implementing the policy of charges. Many facilities did not spend the revenue to which they were entitled—an interesting point, as the existence of the skill to spend money is often tacitly assumed!Charges also had significant indirect resource consequences. Reduced utilization freed up staff time which should be used to provide other services, particularly preventive ones. This opportunity has not, as yet, been exploited.Fee revenue can be dangerously attractive, particularly if it is administratively more accessible than general government allocations. There is a danger that revenue collection becomes a disproportionately important evaluative criterion in a system which is, after all, ultimately intended to improve health status.

A price to pay: The impact of user charges in ashanti‐akim district, Ghana

AbstractIn present constrained economic circumstances, many governments have introduced or increased user charges for health services. This has been advocated by the World Bank, justified by reference to the raising of revenue, efficiency and, controversially, even the promotion of equity. This paper examines the impact of user charges on utilisation in the Ashanti‐Akim district of Ghana since the introduction of charges in 1985. In many ways, user charges have been a success: in recovering fees and maintaining urban utilisation. However some advantages have not materialised because the health infrastructure has not changed adequately. More importantly, equity and affordability have been problematical. For some of the population, services are no longer affordable.