Background: The German DRG (diagnosis-related groups) system has changed since the inauguration in 2005, whereby written inquiries and on-site auditing have been carried out by the medical inspection service for health insurance companies (MDK). Modifications in the G-DRG system are reflected in changes in the MDK visitations. This article describes exactly how these examinations have changed over time. In order to achieve this all auditing reports were evaluated.
Results: In the beginning correct coding and documentation were the most interesting items for the health insurance fund inspectors. Nowadays, length of in-patient treatment and specific points relating to current changes in the G-DRG system are being questioned. All areas of the hospital have now been examined during this period. There was no change in the loss resulting from the regular examinations over the years. However, the effort and input of manpower are extremely high.
Conclusions: To cope with the changes in the German DRG system hospitals have to be flexible. The experiences with the regular MDK visitations can positively influence hospital organizational structures.
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http://dx.doi.org/10.1007/s00113-009-1636-8 | DOI Listing |
Qual Manag Health Care
January 2025
Author Affiliations: Source Healthcare, Santa Monica, California.
Background And Objectives: Retrospective studies examining errors within a surgical scheduling setting do not fully represent the effects of human error involved in transcribing critical patient health information (PHI). These errors can negatively impact patient care and reduce workplace efficiency due to insurance claim denials and potential sentinel events. Previous reports underscore the burden physicians face with prior authorizations which may lead to serious adverse events or the abandonment of treatment due to these delays.
View Article and Find Full Text PDFJCO Oncol Pract
January 2025
School of Nursing, Fudan University, Shanghai, China.
Purpose: To explore strategies related to cancer-related financial toxicity (FT) from the perspectives of cancer survivors and stakeholders in China and to evaluate their views within the context of the social ecological model (SEM).
Methods: Between March and July 2022, we conducted a descriptive qualitative study with semistructured interviews of 23 cancer survivors and 14 stakeholders. Qualitative content analysis on the basis of the SEM was used to analyze the data with NVivo 12.
PLoS One
January 2025
Lagos State Health Management Agency, Lagos, Nigeria.
Background: Each year, millions of people in low-and middle-income countries such as Nigeria are forced into poverty and financial ruin due to out-of-pocket (OOP) healthcare expenses. Our study assessed the prevalence and determinants of Catastrophic Healthcare Expenditure (CHE) experienced by households in Lagos, Nigeria.
Methods: A descriptive community-based cross-sectional survey was conducted on 2492 households in Lagos from December 2022 to March 2023 in 4 Local Government Areas (LGAs) using a multistage sampling technique.
PLoS One
January 2025
Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
This study quantifies the impact of COVID-19 vaccination on hospitalization for COVID-19 infection in a South African private health insurance population. This retrospective cohort study is based on the analysis of demographic and claims records for 550,332 individuals belonging to two health insurance funds between 1 March 2020 and 31 December 2022. A Cox Proportional Hazards model was used to estimate the impact of vaccination (non-vaccinated, partly vaccinated, fully vaccinated) on COVID-19 hospitalization risk; and zero-inflated negative binomial models were used to estimate the impact of vaccination on hospital utilization and hospital expenditure for COVID-19 infection, with adjustments for age, sex, comorbidities and province of residence.
View Article and Find Full Text PDFObjective: To clarify the screening behavior and influencing factors of females with breast cancer and cervical cancer in suburban areas and to provide a scientific basis for the subsequent implementation of targeted health education, intervention measures and the formulation of relevant policies.
Methods: This study used a multi-stage stratified random sampling method to select 4, 000 women in urban and rural areas of Beijing to analyze their behavior, basic situation, and influencing factors regarding cervical and breast cancer screening.
Results: The sample size of the final included valid analysis was 3861 people, and the screening rate was 27.
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