(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012-2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.
- MeSH
- dávkové mechanismy * MeSH
- klasifikační systém DRG * MeSH
- lidé MeSH
- nemocnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Evropa MeSH
1. vydání 126 stran : ilustrace, tabulky ; 30 cm
Vysokoškolská učebnice, která se zaměřuje na řízení nákladů ve zdravotnických zařízeních.
Background: Cardiovascular diseases have the highest mortality rates and the costs for treatment are very high so far. Cardiovascular rehabilitation helps to reduce the risk of relapses or deterioration of cardiovascular diseases, however, the number of patients that participate is insufficient, especially in later stages of the rehabilitation process. The aim of the study is to evaluate cost-effectiveness of cardiovascular rehabilitation care using cost-utility analysis. Methods: The study evaluate the Cardio ambulance Late Phase, Late Phase of The Spa treatment and for comparison also Early Phase of The Spa treatment in Konstantin Spa. The research was conducted in outpatient facility and spa facility. For QALY, a prospective questionnaire survey was conducted in patients with cardiovascular disease using generic EQ-5D-5L questionnaires. The costs were calculated from the perspective of the health care payer. The cost-utility analysis was carried out at the end of the study and results are presented in incremental cost-utility ratio. Results: The average cost per patient in outpatient facility is CZK 12,459. The average amount for an overall early phase of spa treatment per patient is CZK 35,161. The average amount for an overall late phase spa treatment per patient is CZK 30,503. QALY obtained from Index Value was 0.092 (Konstantin Spa Early Phase), 0.054 (Konstantin Spa Late Phase), 0.26 (Cardio ambulance Late Phase). For Konstantin Spa Late Phase, the ICUR value was 644,436 and for Konstantin Spa Early Phase was 343,981 (comparator is the Cardio ambulance Late Phase). Konstantin Spa Early Phase compared to Konstantin Spa Late Phase had an ICUR value of 122,592. Conclusions: The results of this study suggest that the spa treatment in later stage of the cardiovascular rehabilitation process is cost effective with use of cost effectiveness threshold three times the Gross Domestic Product (GDP) per capita.
- Publikační typ
- časopisecké články MeSH
The study is aimed at quantifying the actual costs related to the MAST (Minimal Access Spine Technique) operative technique with the MIDLF (Midline Lumbar Fusion) instrumentation as compared to the costs related to the classic technique with transpedicular instrumentation complemented with PLIF (Posterior Lumbar Interbody Fusion) in the treatment of a degenerative disc disease in the lumbar spine. The costs were calculated using the Activity-Based Costing method. The total costs for the surgery of one segment amount to CZK 166,371 for MIDLF, and CZK 160,160 for PLIF. The cost difference of CZK 6,210.46 primarily accounts for higher costs associated with separately charged materials consumed in MIDLF. Further, the study pointed out the fact that the actual costs necessary for both operative techniques are underfinanced in terms of reimbursements from the public health insurance system.
Cílem práce bylo analyzovat reálná data o dodržování léčebných opatření při diabetu mellitu 2. typu u příjemců invalidního důchodu a kvantifikovat závislost progrese onemocnění na (ne)dodržování předepsané farmakologické léčby a režimových opatření. Výzkum probíhal formou dotazníkového šetření zaměřeného na zjištění míry compliance, dodržování režimových opatření a progresi diabetu mellitu 2. typu u invalidních důchodců. Úplnou compliance uvedlo 69,47 % respondentů, částečnou compliance vykázalo 26,32 % oslovených a noncompliance uvedlo 4,21 % pacientů. Závislost mezi mírou compliance a progresí choroby (podle počtu komplikací diabetu a stupně invalidity) se statistickými metodami nepodařilo prokázat. Výsledky dotazníkového šetření byly konzultovány s odbornými i praktickými lékaři, se kterými autorka vedla strukturovaný rozhovor.
The objective of the paper was to analyse real data about adherence to treatment in patients with type 2 diabetes mellitus that are disability pension benefi ciaries, and to quantify the progression of the disease dependent on (non-)adherence to pharmacotherapy and curative regimen. The research was conducted using a questionnaire to determine the compliance rate, curative regimen adherence and the progression of type 2 diabetes mellitus in disability retirees. The full compliance was stated by 69.47% of respondents, a partial compliance by 26.32% respondents, and the non-compliance was admitted by 4.21% of respondents. The dependence between the compliance rate and disease progression (measured by the number of complications and the disability stage) was not proved by statistical methods. The results of the survey were discussed with clinicians and GPs using structured interviews.
- MeSH
- adherence k farmakoterapii * statistika a číselné údaje MeSH
- diabetes mellitus 2. typu * farmakoterapie MeSH
- komorbidita MeSH
- komplikace diabetu MeSH
- lidé MeSH
- postižení statistika a číselné údaje MeSH
- primární zdravotní péče statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
Cílem předkládané studie je analýza strategické aliance nemocnic spojených ve společnosti Jihočeské nemocnice, a.s. V rámci studie byl porovnán stav po vzniku strategické aliance s předchozím stavem. Analýza byla provedena prostřednictvím finanční analýzy, procesních map a komparativní analýzy. Z výsledků vyplývá, že v oblasti finančních ukazatelů došlo ke zlepšení, zejména pokud jde o aktivitu a likviditu, z čehož plyne efektivnější hospodaření nemocnic se svými aktivy a zlepšení jejich schopnosti splácet své krátkodobé závazky. U většiny nemocnic se v oblasti likvidity jedná spíše o nadbytečnou hotovost, vzhledem k nestabilnímu vnějšímu prostředí je ale opatrný přístup managementu nemocnic pochopitelný. U většiny nemocnic můžeme také pozorovat zvyšování podílu cizího kapitálu v oblasti finančních zdrojů. Tvorbou procesních map se prokázalo odstranění duplicitních služeb, které do vzniku společnosti Jihočeské nemocnice, a.s., prováděla každá nemocnice samostatně. Z komparativní analýzy výhod a nevýhod, provedené prostřednictvím řízených rozhovorů, vyplynula jednoznačná převaha pozitiv této strategické aliance.
The aim of the paper is an analysis of the strategic alliance of hospitals united in the company Jihočeské nemocnice, a.s. The comparison of the situations before and after the establishment of the alliance is performed by means of a financial analysis, process maps and a comparative analysis. The results show an improvement mainly in the area of activity and liquidity indicators, which is related to a more effective management of hospitals with their assets and a better ability to repay their short-term liabilities. For most hospitals, the area of liquidity is represented rather by redundant cash, however, considering the unstable external environment, this cautious approach of a hospital management is understandable. For most hospitals, we can also observe an increase in the share of foreign capital in the area of financial resources. The process maps proved an elimination of duplicate services performed, up to the establishment of the company Jihočeské nemocnice, a.s., by each hospital separately. The comparative analysis of the advantages and disadvantages carried out by means of structured interviews revealed a clear predominance of positive effects of the alliance.
