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International Journal of Healthcare Policy (4 papers in press)
Advancements in the DRG system payment: an optimal volume/procedure mix model for the optimization of the reimbursement in Italian health care organizations by Cinzia Muriana, Giovan Battista Vizzini Abstract: In Italy, the reimbursement provided to health care organizations for medical and surgical procedures is based on the Diagnosis Related Group Weight (DRGW), which is an increasing function of the complexity of the procedures. This makes the reimbursement an upper unlimited function. This model does not include the relation of the volume with the complexity. The paper proposes a mathematical model for the optimization of the reimbursement by determining the optimal mix of volume/procedure, considering the relation volume/complexity and DRGW/complexity. The decreasing, linear, and increasing returns to scale have been defined, and the optimal solution found. The comparison of the model with the traditional approach shows that the proposed model helps the health care system to discern the quantity of the reimbursement to provide to health organizations, while the traditional approach, neglecting the relation between the volume and the complexity, can result in an overestimation of the reimbursement. Keywords: Diagnosis Related Group; health care reimbursement system; optimization of the reimbursement function. DOI: 10.1504/IJHP.2020.10031849
Did coal mine closure increase deaths of despair in the rural United States? by Adam Mayer Abstract: In the U.S., the coal industry has undergone significant contraction over the last several years as renewables and unconventional oil and gas have been more widely deployed. At the same time, life expectancy has declined for working-age non-Hispanic white Americans, particularly those without a college education and living in rural areasthis decline in life expectancy has been linked to deaths of despair related to alcohol and drug abuse, and suicide. Changes in traditional economic sectors like manufacturing and mining may be a root cause of this surprising rise in mortality. In this analysis, we examine how coal mine closures have impacted deaths of despair from 2002-2015. Results suggest that coal mine closure does not increase mortality due to alcohol, drugs or suicide at the county level, implying that the rise of deaths of despair may be less rooted in changes in the mining sector than previously theorized. More broadly, these results suggest that accounts that point to the poor economic fortunes of rural America as the primary cause of deaths of despair are over-simplified. Keywords: mortality; coal; causal inference.
Avoidable deaths in Britains National Health Service by Simon A. Bennett Abstract: Medical error kills significant numbers of patients around the world. This paper uses systems-thinking to reveal the causes of medical error and avoidable death in the National Health Service (NHS). It is concluded that such problems emerge from a web of factors that include defensiveness, careerism, bullying, target-chasing, under-funding, cost-cutting, overstretch and inefficient legacy capital. Efforts to transform the NHS into a learning organisation in which errors and malpractice are reported have been thwarted by intimidation, undermining and bullying. If it is to become a learning organisation in which risk is managed proactively, the NHS must transform its organisational culture, much as aviation has done over the past four decades. The aviation industrys safety journey teaches first, that detoxification takes decades of sustained effort, and secondly, that change will only happen if those at the top encourage it. Keywords: National Health Service; avoidable deaths; pathogenic culture; systems-thinking; aviation. DOI: 10.1504/IJHP.2020.10034357
Equity and Access to Care: The Role of Out-of-Pocket Spending in OECD Countries by Lynn Blewett, Jiani Yu, Megan Lahr Abstract: Rising medical out-of-pocket (OOP) spending burdens has increased concerns of equity and fairness in healthcare systems. Limited empirical evidence exists examining the impact of OOP spending on barriers to needed care and the increasing role of private supplemental health insurance. Our study uses pooled panel data on country healthcare expenditures from the Organization for Economic Co-operation and Development (OECD) to assess associations between OOP spending growth and measures of healthcare utilisation. Using both fixed effects and random effects regression models, we found a significant increase of 24.8% in OOP spending as a proportion of household income from 2000 Keywords: health equity; health systems financing; OECD. DOI: 10.1504/IJHP.2020.10035971