Medical Fees Research Articles

Actual Situation of Home-visit Nursing Services for Children Ineligible for Government-funded Medical Fee Payments to Protect the Lives of Children Living at Home

Actual Situation of Home-visit Nursing Services for Children Ineligible for Government-funded Medical Fee Payments to Protect the Lives of Children Living at Home

Actual Situation of Rehabilitation Therapy in Japan from the Viewpoint of Medical Fees: Effects of COVID-19 Pandemic

Actual Situation of Rehabilitation Therapy in Japan from the Viewpoint of Medical Fees: Effects of COVID-19 Pandemic

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge.

ABSTRACTObjectives:The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.Methods:A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.Results:Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.Conclusions:To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Tracing all patients who received insured dialysis treatment in Japan and the present situation of their number of deaths

BackgroundThe survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan’s situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR).MethodsSubjects were patients with medical fee points for dialysis recorded in the NDB during 2014–2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases– and deaths.ResultsCompared with the JRDR, the NDB had about 6–7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6–10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes.ConclusionThe use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies.

Home-visit Nursing Services for Children Not Eligible for Government-funded Medical Fee Payments and Their Countermeasure to Stabilizing Management

Home-visit Nursing Services for Children Not Eligible for Government-funded Medical Fee Payments and Their Countermeasure to Stabilizing Management

Экономические аспекты лечения вирусной пневмонии, вызванной SARS-CoV-2

Study Objective: To conduct a cost analysis of the management of patients with viral pneumonia caused by SARS-CoV-2, and to develop nosological models of patients in order to optimise medical fees. Study Design: Statistical and economic study. Material and Methods. We studied 50,539 completed hospitalisations of patients with viral pneumonia caused by SARS-CoV-2 during a period from March 2020 to March 2021 in Municipal Clinical Hospital No. 15 named after O.M. Filatov. Using an expert evaluation, we found out 5 nosological models of patients and calculated mean duration of hospitalisation, confidence intervals (95% CI), and fee parameters using actual costs (cost of one bed-day and completed therapy). Study Results. We managed to prove the hypothesis, according to which correctness of analysis of actual costs of therapy and precise prognosis depend on the differentiation of cases of SARS-CoV-2-caused viral pneumonia using nosological models of a patient, nosological forms, and disease severity. We developed nosological models of a patient; identified a range of cost of therapy; and calculated corresponding relative factors. Conclusion. The cost of management of patients with viral pneumonia caused by SARS-CoV-2 should be analysed and planned depending on nosological models grouped on the basis of common causation of the disease, presence or absence of complications (pneumonia), presence of comorbidities and surgeries, and condition of patients. The most expensive is the management of patients with COVID-19 and npneumonia and surgery. Keywords: cost of management, nosological model, SARS-CoV-2, viral pneumonia.

Comparative Study Of Outpatient Patient Satisfaction General And Companies In Mcu Polyclinic of Rsud Sultan Imanuddin Pangkalan Bun

The quality of health services is reflected in the level of patient satisfaction. Thestandard of living of the community affects the demands of society on the quality ofhealth. Outpatient services at Sultan Imannudin Hospital are divided into twoaccording to the payment method, namely insurance and general patients. Thepurpose of this study was to determine the comparative satisfaction of general andcorporate outpatients in the MCU Polyclinic at Sultan Imanuddin Hospital.Thisstudy uses a non-experimental method: comparative. namely to determine thedifference in outpatient satisfaction with company and general guarantees.Theresults of the study are based on the Wilcoxon sigred rank test with a value of p =0.000 <0.05, which means that there is a significant difference between generaloutpatient satisfaction and company outpatient satisfaction. The level of generalpatient satisfaction is satisfied, while the company's patient satisfaction level is verysatisfied. This is due to the financing factor. The satisfaction level of outpatientcompanies is very satisfied because from a financial perspective they don't need tothink about it anymore. Insured patients (company patients) only receive theservices provided to them. While general patients feel satisfied because they have topay medical fees, so the demands on the quality of service are also high.It issuggested that the assessment of the level of patient satisfaction is carried outregularly and periodically as input for making policies in improving service quality,especially focused on the dimension of reliability (reliability).

Evaluation of a Fast Test Based on Biometric Signals to Assess Mental Fatigue at the Workplace-A Pilot Study.

Non-pathological mental fatigue is a recurring, but undesirable condition among people in the fields of office work, industry, and education. This type of mental fatigue can often lead to negative outcomes, such as performance reduction and cognitive impairment in education; loss of focus and burnout syndrome in office work; and accidents leading to injuries or death in the transportation and manufacturing industries. Reliable mental fatigue assessment tools are promising in the improvement of performance, mental health and safety of students and workers, and at the same time, in the reduction of risks, accidents and the associated economic loss (e.g., medical fees and equipment reparations). The analysis of biometric (brain, cardiac, skin conductance) signals has proven to be effective in discerning different stages of mental fatigue; however, many of the reported studies in the literature involve the use of long fatigue-inducing tests and subject-specific models in their methodologies. Recent trends in the modeling of mental fatigue suggest the usage of non subject-specific (general) classifiers and a time reduction of calibration procedures and experimental setups. In this study, the evaluation of a fast and short-calibration mental fatigue assessment tool based on biometric signals and inter-subject modeling, using multiple linear regression, is presented. The proposed tool does not require fatigue-inducing tests, which allows fast setup and implementation. Electroencephalography, photopletismography, electrodermal activity, and skin temperature from 17 subjects were recorded, using an OpenBCI helmet and an Empatica E4 wristband. Correlations to self-reported mental fatigue levels (using the fatigue assessment scale) were calculated to find the best mental fatigue predictors. Three-class mental fatigue models were evaluated, and the best model obtained an accuracy of 88% using three features, (C3), and the (O2 and C3) ratios, from one minute of electroencephalography measurements. The results from this pilot study show the feasibility and potential of short-calibration procedures and inter-subject classifiers in mental fatigue modeling, and will contribute to the use of wearable devices for the development of tools oriented to the well-being of workers and students, and also in daily living activities.

Relationships between management factors in dairy production systems and mental health of farm managers in Japan

To facilitate sustainable dairy farming, it is essential to assess and support the mental health of dairy farm workers, which is affected more than that of workers in other industries, as indicated by the relatively few studies to date. In addition, the limited investigations on mental health in dairy workers minimize the opportunities to suggest practical approaches of improvement of their mental health. Therefore, further data acquisition and analysis is required. In the present study, we undertook quantitative surveys on 17 management factors and administered a mental health questionnaire to 81 dairy farm managers (80 male, 1 female) in Hokkaido, northern Japan. The management factors were categorized into 3 groups: production input, production output, and facility indicator; mental health was evaluated based on the Center for Epidemiologic Studies Depression Scale (CES-D). Principal component analysis assigned the factors into 2 groups: intensiveness factors of dairy production systems (PC1: livestock care cost, fat- and protein-corrected milk, stocking density, medical consultation fee per unit time per animal unit, nonfamily wages, fertilizer and pesticide expenses, and net agricultural income ratio) and basic dairy management factors (PC2: net agricultural income ratio, quantity of concentrate feed, and milk quality variable). The depression symptoms of dairy farm managers were not significantly associated with PC1 and milking methods; however, they were significantly negatively associated with PC2, which integrated 3 management factors, including factors related to finances, feeding, and milk quality. According to the findings of the present study, the efforts needed for stable economic farm management, adequate feed supply, and milk quality maintenance may increase the depression levels of dairy farm managers and negatively affect their mental health. These findings could be the basis for future studies on the relationship between the mental health of farm managers and sustainable dairy farm management and production.

The Impact of the COVID-19 Pandemic on Physician Visits in Japan.

Background: Emerging from the coronavirus disease 2019 (COVID-19) scenario, fears of social distancing and contagion have led to a decline in the number of physician visits in Japan, placing severe financial strain on most hospitals and clinics. In this context, this study examined the impact of the spread of COVID-19 on the utilization of outpatient services.Methods: This study used monthly data drawn from the monthly statistics report of the social insurance medical fee payment fund in Japan and estimated fixed-effects models.Results: The results showed that the decline in the number of physician visits because of the first state of emergency declaration in Japan was greater than that caused by COVID-19's spread during the same period. However, there was a decline in the impact of the declaration over time. After the second state of emergency declaration, the decline in the number of physician visits caused by the spread reduced by almost half. The nationwide preschool closure under the declaration of the first state of emergency also adversely impacted the number of physician visits. The reduced healthcare per capita costs of preschool children were greater among prefectures taking specific precautions. The results showed non-negligible regional differences in physician visits of preschool children during the sample period.Conclusions: The findings imply that we should not overestimate the negative impacts of the state of emergency declaration without lockdown on physician visits. To restore the number of physician visits to its pre-pandemic level, it is crucial to facilitate a smooth transition of COVID-19 patients between hospitals and an effective compensation program for hospitals with COVID-19 patients.

Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey.

Objective As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care. Methods We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management. Results The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions. Conclusion Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

Financial Estimation of the Uncertainty in Medicine Using Present Value of Medical Fees and a Mortality Risk Prediction Model: a Retrospective Cohort Study.

This study aimed to develop a method to enable the financial estimation of each patient’s uncertainty without focusing on healthcare technology. We define financial uncertainty (FU) as the difference between an actual amount of claim (AC) and the discounted present value of the AC (DAC). DAC can be calculated based on a discounted present value calculated using a cash flow, a period of investment, and a discount rate. The present study considered these three items as AC, the length of hospital stay, and the predicted mortality rate. The mortality prediction model was built using typical data items in standard level electronic medical records such as sex, age, and disease information. The performance of the prediction model was moderate because an area under curve was approximately 85%. The empirical analysis primarily compares the FU of the top 20 diseases with the actual AC using a retrospective cohort in the University of Miyazaki Hospital. The observational period is 5 years, from April 1, 2013, to March 31, 2018. The analysis demonstrates that the proportion of FU to actual AC is higher than 20% in low-weight children, patients with leukemia, brain tumor, myeloid leukemia, or non-Hodgkin’s lymphoma. For these diseases, patients cannot avoid long hospitalization; therefore, the medical fee payment system should be designed based on uncertainty. Our method is both practical and generalizable because it uses a small number of data items that are required in standard electronic medical records. This method contributes to the decision-making processes of health policymakers.

Cost-effectiveness analysis using lifetime attributable risk of proton beam therapy for pediatric medulloblastoma in Japan.

Compared to conventional X-ray therapy, proton beam therapy (PBT) has more clinical and physical advantages such as irradiation dose reduction to normal tissues for pediatric medulloblastoma. However, PBT is expensive. We aimed to compare the cost-effectiveness of PBT for pediatric medulloblastoma with that of conventional X-ray therapy, while focusing on radiation-induced secondary cancers, which are rare, serious and negatively affect a patient's quality of life (QOL). Based on a systematic review, a decision tree model was used for the cost-effectiveness analysis. This analysis was performed from the perspective of health care payers; the cost was estimated from medical fees. The target population was pediatric patients with medulloblastoma below 14years old. The time horizon was set at 7.7years after medulloblastoma treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER), which was defined as the ratio of the difference in cost and lifetime attributable risk (LAR) between conventional X-ray therapy and PBT. The discount rate was set at 2% annually. Sensitivity analyses were performed to model uncertainty. Cost and LAR in conventional X-ray therapy and PBT were Japanese yen (JPY) 1 067 608 and JPY 2436061 and 42% and 7%, respectively. The ICER was JPY 3856398/LAR. In conclusion, PBT is more cost-effective than conventional X-ray therapy in reducing the risk of radiation-induced secondary cancers in pediatric medulloblastoma. Thus, our constructed ICER using LAR is one of the valid indicators for cost-effectiveness analysis in radiation-induced secondary cancer.

RESEARCH ON FACTORS AFFECTING CUSTOMER SATISFACTION WITH HEALTHCARE SERVICE QUALITY AT TRA VINH UNIVERSITY HOSPITAL

This study aims to examine the factors affecting customer satisfaction with the quality of medical examination and treatment services at Tra Vinh University Hospital. In the study, 220 customers who had undergone medicalexamination and treatment at Tra Vinh University Hospital were selected as the sample to participate in the survey. The study was conducted by using the methods of assessing the reliability of the scale by Cronbach’s Alpha, exploratory factor analysis (EFA) and regression analysis. The results show that there are six factors affecting customer satisfaction with the quality of medical examination and treatment services including (1)Information, (2) Continuity and efficiency, (3) Respect and consideration, (4) Conformity, (5) Facilities and (6) Payment of medical fees at Tra Vinh University Hospital. Based on the influence of the factors as reflected in the research results, the authors propose the administrative implications in order to improve the quality of medicalexamination and treatment services as well as to better meet the people’s needs in the services.

Health literacy levels and correlates among refugees in Mount Lebanon

ObjectivesThe study aimed to assess the levels and correlates of health literacy among refugees. Study designThis is a cross-sectional study design. MethodsHealth literacy was assessed through face-to-face interviews in eight primary healthcare centers (PHCs) in Mount Lebanon. The questionnaire consisted of the Arabic Functional Health literacy scale, the short version of the European Health Literacy Survey (HLS-EU-Q16), socio-economic questions (sex, age, nationality, marital status, educational level, and ability to pay for medical fees at PHCs), and health-related questions (self-perceived health, long-term illness, recent visit to health care, and freedom to make health decisions). Statistical analyses were performed to evaluate the association between functional health literacy (FHL), comprehensive health literacy (CHL), and potential explanatory variables. ResultsOf 263 participants (61.6% females), mean age 38.49 ± 12.80 years, 52.1% had inadequate FHL and 35.7% had inadequate CHL. The likelihood of having inadequate CHL was higher in refugees who were ever married (odds ratio [OR] = 2.794; 95% confidence interval [CI]: 1.187–6.576) or had average ability to pay for medical expenses at PHC (OR = 4.562; 95% CI: 1.554–13.393). The odds of having inadequate FHL was lower in refugees with some level of education (OR = 0.211; 95% CI: 0.077–0.580). Furthermore, their perceived lack of freedom to make personal health decisions was associated with inadequate levels of CHL (OR = 5.195; 95% CI: 2.693–10.022) and FHL (OR = 4.676; 95% CI: 2.610–8.376). ConclusionsHealth messages and delivery should be tailored to refugee health literacy levels. Initiatives should seek to improve refugee interaction with the health system, promote uptake of available health services and facilitate health-related decision-making in daily life.

Prevalence and socio-economic factors affecting the use of traditional medicine among adults of Katikekile Subcounty, Moroto District, Uganda.

In Uganda generally and in rural areas in particular, use of traditional medicine is a common practice, yet there remains lack of evidence on the overall utilization of traditional medicine and there are many aspects that remain unclear. To determine the use of traditional medicine and factors associated with this among the adults of Katikekile Subcounty in Moroto district. A descriptive cross-sectional study using quantitative and qualitative methods. Interviews among 323 respondents, and focus group discussions were carried out among village traditional birth attendants, village health team members, and traditional health providers. Use of traditional medicine among the adults of Katikekile Subcounty was 68%. Usage was more prevalent among older people, and the majority of the adults used traditional medicine often as their first line-treatment for any illness. Herbs used for traditional medicines are usually locally available and free-of-charge. Long distance to health-facility based health care services, and medical fees contributed to the use of traditional medicine. Use of traditional medicine among adults of Katikekile Subcounty in Moroto in the Karamoja region in Uganda was high, and majority of the adults often used traditional medicine as first line-treatment. Both socioeconomic and health sector factors were associated with use of traditional medicine.

Aspek kepastian hukum terkait restitusi dalam perkara perlindungan anak

THE ASPECT OF LEGAL CERTAINTY IN RELATION TO RESTITUTION IN THE CASES OF CHILD PROTECTION (A CASE STUDY OF LUBUK PAKAM’S STATE COURT’S VERDICT NUMBER 975/Pid.Sus/2019/PN.Lbp)
 
 Article 71 D section (1) of the Act Number 35 Year 2014 on the amendment of the Act Number 23 Year 2002 concerning child protection guarantees that a child who has been a sex crime victim is permitted to lay claim to restitution from the criminal, which is intended to compensate for the loss of wealth, suffering from the crime, and/or medical fees, and/or psychological damage as a form of the criminal’s recompense. Besides, restitution is also intended to soothe the sex crime victim’s distress and enforce justice for them. 
 This study is normative legal research which fostered the descriptive analytic method based on constitutional interpretation, especially that in connection with child protection, and the case interpretation of Lubuk Pakam’s State Court’s verdict number 975/Pid.Sus/2019/Pn.Lbp. This research employed the data collection technique of library review and qualitative data analysis.
 The verdict number 975/Pid.Sus/2019/PN.Lbp of Lubuk Pakam’s State Court’s judicial panel ordered the convict to pay a restitution of Rp. 1,200,000 (one million two hundred thousand rupiahs) to the victim. The verdict was not apart from the consideration of the fact that it was proven the convict had done the crime referred to by Article 81 section (2) in association with Article 76 D of the Act of Child Protection and the misdeed has caused the victim embarrassment. Moreover, in meting out the sentence, the judicial panel had to take into account the convict’s and social senses of justice. However, in this case, the convict did not pay the specified restitution. From the verdict, it is obvious that there is no guarantee restitution can be paid to the victim soon. What commonly happens is that the convict is not willing or able to pay it. In anticipation of the problem, the prosecutors as the verdict executors can apply Article 38 in association with Article 40 of the Act of Witness and Victim Protection to ensnare the criminal/convict who does not pay restitution to establish the legal certainty of restitution payment to the victim.

Role of Climate-Smart Agriculture in Enhancing Farmers' Livelihoods and Sustainable Forest Management: A Case of Villages Around Songe-Bokwa Forest, Kilindi District, Tanzania

Climate change and variability are happening in Tanzania, and their impacts are felt in the socioeconomic sectors, as they have resulted in the decline of agricultural productivity and increased deforestation. This study assessed the actual changes in deforestation levels and improved livelihoods caused by the adoption of climate-smart agriculture (CSA) practices. Data were collected through semi-structured household questionnaires, focus group discussions, key informants, GIS tools, and observations. Quantitative data were analyzed using Arc GIS 10.3 software, SPSS version 16.0, and Excel Spreadsheet, while qualitative data were analyzed through content analysis techniques. The findings show that farmers' livelihoods have improved and also deforestation levels decreased as a result of increased adoption of CSA during the past 30 years. Deforestation levels have been reduced from 64.6 ha per year during 1985–1995 to 11.8 ha per year during 1995–2005 and to 10.4 ha per year during 2005–2017. Further findings showed that the agricultural area had been decreased from 4,534 ha in 1995 to 4,039 ha in 2017, which is evidence that after the scale-up of CSA from the year 1992, agricultural practices were not contributing much to deforestation, while increased crop production and income were observed, which in turn supported farmers in enhancing food security, purchasing production tools, livestock, and payment for medical services, school fees, and construction of modern houses. We found that adoption of CSA systems such as agroforestry (i.e., agrisilviculture) is very crucial for improving farmer's livelihoods and reducing deforestation. Therefore, farmers need close mentoring on climate-resilient agroforestry systems, such as agrisilviculture.

Peritoneal dialysis in Indonesia: Current status, challenges and prospects.

Despite an increase in incident peritoneal dialysis (PD) use of 20% per year, the overall PD prevalence in Indonesia is only 1-2%, with the goal of 30% yet to be reached by 2019. In the absence of contraindications, increasing continuous ambulatory PD (CAPD) use may be an attractive option for Indonesia to reduce the high costs of end-stage kidney disease (ESKD) treatment. The implementation of CAPD in Indonesia faces several challenges, including the cost of PD, the unique archipelagic geography, limited facilities and trained medical personnel in rural areas, inadequate reimbursement rates and incentive fees, high rates of PD discontinuation, as well as insufficient knowledge regarding CAPD by the general public and health professionals. Changes in the policy of medical service incentive fees and improvements in the national health insurance system regulation over CAPD may improve the utilization of PD for ESKD patients in Indonesia. Nationwide promotional and preventive efforts on chronic kidney disease, dialysis modality education and establishment of PD training programs for medical professionals are necessary.

Effects of medical service fee revision on reducing irrational psychotropic polypharmacy in Japan: an interrupted time-series analysis

PurposeAccording to the revised Japanese medical service fees aimed at reducing irrational psychotropic polypharmacy, medical service fees are reduced if the number of simultaneously prescribed psychotropic drugs exceeds the standard. This study primarily aims to examine the effect of the 2018 revision.MethodsUsing a large Japanese administrative claims database, we retrospectively identified five groups (April 2013–September 2018) prescribed at least one drug from the following drug groups: anxiolytics, hypnotics, sum of anxiolytics and hypnotics, antipsychotics, and antidepressants (study population in each group: 547,511, 406,524, 759,137, 112,929, and 201,046, respectively). We used an interrupted time-series design to evaluate changes in the proportion of patients prescribed more than the standard number of drugs.ResultsAfter the 2018 revision, the proportion of patients prescribed more than the standard number of drugs significantly decreased only for the sum of anxiolytics and hypnotics; estimated changes in level and trend were − 0.60% [− 0.69%, − 0.52%] and − 0.04% [− 0.06%, − 0.02%] per month, respectively. The proportion of patients exhibiting a decrease in the number of prescribed drugs from more than the standard to within the standard increased when the revision was enforced (April 2018); this proportion in April 2018 was 36.3%, while all other proportions were in the range of 12.1–22.3%.ConclusionThe 2018 revision promoted a reduction in the number of prescribed drugs, which served as an important factor in the decrease in the proportion of patients prescribed more than the standard number of drugs for the sum of anxiolytics and hypnotics.