Reimbursement Mechanisms Research Articles

The conceptual model for reporting in children and youth projects.

IN 1965, the 89th Congress passed a set of amendments to the Social Security Act of 1935. President Johnson signed those amendments into law. One small and hardly noticed title among the many present in that law was Title II. It resulted in what has since become known as the Children and Youth Comprehensive Health Care Service Delivery Program. Title II was unique and pleasantly different from other care service acts in general, and particularly different from Titles XVIII and XIX in the same law and which are known better as Medicare and Medicaid. The major conceptual difference is that Medicare and Medicaid are merely monetary reimbursement mechanisms and have nothing to do with organizing and structuring a care delivery system as is provided in the Children and Youth legislation. Title II, which established the Children and Youth Projects, was intended to create new means of service delivery, or to substantially modify existing ones. There was no intent to accept what was extant. The service delivery projects were to be tailor-made to fit each local area geographically defined. The projects were required to include collaboratively, and cooperatively, all purveyors of services in their projects, be they in health or education or welfare. The major objective was to make possible programs which would provide comprehensive services for children of low-income families, through promotion of health, including casefinding, preventive services, diagnosis, treatment, correction of defects, and aftercare, both medical and dental.* In addition, the regulations prepared to implement Title II (better known as the Blue Book) proposed services in nursing, social service, nutrition, speech and hearing, psychology, physical therapy, and occupational therapyt Such C and Y projects were to increase availability and improve the quality of care services but not to replace or reduce prior services or state or local funds. In addition, the law stated that any treatment, correction of defects or aftercare . . . is available only to children who would not otherwise receive it because they are from low-income families or for other reasons beyond their control. Those eligible to

Plastic cements: J. B. Barnitt. ( Metallurgical and Chemical Engineering, vol. xvi, No. 6, p. 321, March 15, 1917.)

Since the fee-for-service reimbursement mechanism has been under the global budget of the National Health Insurance program, physicians' workloads have been increasing. Attending physicians in medical centers usually have long working hours because of their clinical work as well as teaching, research, and other administrative responsibilities. Many studies regarding reasonable work hours for physicians have been undertaken globally, but few have been conducted in Taiwan. In this study, we focused on the difference in working hours among physicians in different departments.Using attending physicians from a major teaching hospital as the study population, we adopted self-administered questionnaires to investigate physicians' time allocations for 4 major categories: clinical work, teaching, research, and administrative work. We distributed 432 questionnaires and received 380 filled-out questionnaires, yielding a response rate of 88%. After eliminating questionnaires with incomplete responses, the valid sample size was 376. We used t test and 1-way ANOVA to analyze the association between physicians' characteristics and workload and used multiple linear regression to examine factors influencing physicians' work hours.The average weekly work time among attending physicians was 65.6 hours; physicians under the age of 40 worked an average of 69.8 hours. Males worked an average of 66.2 hours weekly and females an average of 62.7 hours. Total work hours and hours of clinical work, teaching, research, and administrative work all reached significant differences among departments. Physicians who were under 40 years old, those with a doctoral degree, those with a teaching position as associate professor or above, and those working in anesthesiology had longer total work hours.This study found that work hours among departments differed significantly and that physicians in surgical departments spend the longest hours in clinical work. Those in administrative positions are most involved in clinical work. However, work hours do not definitely represent work intensity, and to define the workload by working hours may be inappropriate for some departments. This possible difference between work hours and work intensity merits further consideration.