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Biomedical subjects

R L Amidon

Publications and source records attributed to R L Amidon.

7 recordsLinked to original sources
PubMed2001

Use factor analysis to identify difficulties in implementing a case payment reimbursement system in Taiwan.

BACKGROUND: Taiwan's National Health Insurance Program (NHIP) began on March 1, 1995. The major purpose of National Health Insurance is to remove financial barriers to care and enhance accessibility to comprehensive health care for all citizens in Taiwan. However, due to the rapid rise in medical expenses and unanticipated accumulation of overdue premiums, the program went into debt in 1999. In response to this financial crisis, the Bureau of National Health Insurance proposed to change hospital financing from a cost-based to a case-based reimbursement system. The major purpose of this study is to identify the difficulties in implementing a case payment reimbursement system in Taiwan. METHODS: This study was conducted in four stages: structured interviewing, questionnaire development and testing, surveying, and data analysis. In this study, the sampling surgeons were selected based on availability from 7 teaching hospitals and 10 regional hospitals. RESULTS: The results of factor analysis indicated that a five-factor structure has emerged in the use of the newly developed survey administered to 372 surgeons in Taiwan. These five factors accounted for approximately 97% of the overall variance. The alpha coefficient for this 22-item scale was 0.914. The researchers concluded that these five factors are considered evidence of adequate internal consistency for use in measuring difficulty in the implementation of case payment. CONCLUSIONS: These five factors were named as follows: perceived barriers to compliance, perceived barriers to quality assurance, perceived financial pressure, perceived threats to physicians' autonomy, and inadequate allowance for patient severity. Policy recommendations including annual revision of coding system, physician education, and hospital specialization were also made to address the perceived difficulties identified in this study.

Adult↗
PubMed1997

How well trained are nursing home administrators?

Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. Educational paradigms studied have strengths and weakness in furnishing various job skills. These results are helpful in defining strategic actions for addressing both current deficiencies and future training needs. A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.

Educational Status↗
PubMed1996

The relationship between resource constraints and physician problem solving. Implications for improving the process of care.

OBJECTIVES: Research suggests that physicians will engage in more vigilant problem-solving under conditions of resource constraints than under conditions of resource slack. Increased vigilance related to physicians' clinical strategies enhances care by disposing physicians toward more optimal care choices. The authors examine whether pressures for clinical resource constraints encourage increased and sustained vigilance in problem-solving among cardiologists treating acute myocardial infarction. METHODS: The physician problem-solving process is reconstructed from the medical records of all eligible cases of acute myocardial infarction treated by the physician sample set over a 6-year period. The sample period encompasses phases of both resource slack and resource constraints. The Herfindahl index is used to measure the relative amount of vigilant problem-solving activity exhibited in each of five major tactical areas of the physician care strategies in each year of the study. RESULTS: The results support the hypothesis that resource constraints initially promote a shift to increased vigilance in physician problem-solving. Only one of the five major tactical areas, however, is characterized by sustained vigilance over time. The other areas are, instead, associated with a substantial reduction in vigilant activity after the initial peak period. CONCLUSIONS: The results suggest that resource constraints do set the stage for improved clinical decision-making. Sustained vigilance, however, appears to apply only to those portions of the care strategy for which the physician can draw a clear link between optimizing clinical activity and reducing resource consumption. For those portions of the care strategy for which the physician cannot establish a clear link, ongoing pressures to conserve resources results in reduced vigilance and a potential reduction in quality of clinical decision-making.

Cardiology↗
PubMed1989

An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs.

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.

Aged↗