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Keywords = per diem payment

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12 pages, 1001 KiB  
Article
Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China
by Fengrong Liu, Jiayu Chen, Chaozhu Li and Fenghui Xu
Int. J. Environ. Res. Public Health 2023, 20(3), 2522; https://doi.org/10.3390/ijerph20032522 - 31 Jan 2023
Cited by 3 | Viewed by 2141
Abstract
Cost sharing and cost shifting mechanisms are of vital importance in a prospective payment system. This paper employed the difference-in-differences method to estimate the impacts of a per diem system with inverted-U-shape rates on medical costs and the length of stay based on [...] Read more.
Cost sharing and cost shifting mechanisms are of vital importance in a prospective payment system. This paper employed the difference-in-differences method to estimate the impacts of a per diem system with inverted-U-shape rates on medical costs and the length of stay based on data from a health insurance institution. The supply side cost sharing mechanism worked so that the new payment system significantly reduced medical costs by 17.59 percent while the average length of stay varied little. After further analyzing the mechanism, we found that heterogeneous effects emerged mainly due to the special rates design. The reform decreased the cases that incurred relatively high medical costs and lengths of stay. However, cost shifting existed so that physicians could be motivated to provide unnecessary services to the patients who should have been discharged before the average length of stay. Therefore, payment rates in the per diem system require a sophisticated design to constrain its distortion to medical service provision even though medical expenditures were successfully contained. Full article
(This article belongs to the Section Health Economics)
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12 pages, 600 KiB  
Article
Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status
by Chung-Yuan Wang, Hong-Hsi Hsien, Kuo-Wei Hung, Hsiu-Fen Lin, Hung-Yi Chiou, Shu-Chuan Jennifer Yeh, Yu-Jo Yeh and Hon-Yi Shi
J. Clin. Med. 2019, 8(8), 1233; https://doi.org/10.3390/jcm8081233 - 16 Aug 2019
Cited by 8 | Viewed by 3537
Abstract
Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study [...] Read more.
Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study coupled a natural experimental design with PSM to assess the impact of a medical referral system in stroke patients and to examine the longitudinal effects of the system on functional status. The intervention was a hospital-based, function oriented, 12-week to 1-year rehabilitative PAC intervention for patients with cerebrovascular diseases. The average duration of PAC in the intra-hospital transfer group (31.52 days) was significantly shorter than that in the inter-hospital transfer group (37.1 days) (p < 0.001). The intra-hospital transfer group also had better functional outcomes. The training effect was larger in patients with moderate disability (Modified Rankin Scale, MRS = 3) and moderately severe disability (MRS = 4) compared to patients with slight disability (MRS = 2). Intensive post-stroke rehabilitative care delivered by per-diem payment is effective in terms of improving functional status. To construct a vertically integrated medical system, strengthening the qualified local hospitals with PAC wards, accelerating the inter-hospital transfer, and offering sufficient intensive rehabilitative PAC days are the most essential requirements. Full article
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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