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Wolfgang Böcking Ulrich Ahrens Wilhelm Kirch Mishael Milakovic 《Zeitschrift fur Gesundheitswissenschaften》2005,13(3):128-137
In spite of numerous discussions and programs aimed at reducing public health care costs in Germany, the country has seen a massive increase in health care costs at an annual average rate of 7% since 1972. When German policymakers decided to reform the health care system by passing legislative measures on 22 December 1999, one of the key elements was to oblige hospitals and health insurance providers to replace the existing retrospective and procedural reimbursement system with a new prospective and diagnostic system based on diagnosis-related groups (DRGs). German policymakers are hoping to accomplish two feats with the introduction of DRGs: firstly, to improve the profitability of the health care system, and secondly, to improve the quality of health care services because DRGs require documentation and coding, which leads to increased transparency and allows for an external comparison of rendered services (benchmarking), as well as for an analysis and assessment of how appropriate and how successful the rendered services were in each particular case. Although the intentions underlying the introduction of DRGs are unquestionable, it remains to be determined whether the introduction has negative effects as well, and to which extent these negative effects have shown up so far. Hence the purpose of our survey will be to provide an extensive and systematic overview of results from other countries, along with preliminary results from Germany. In order to judge the trade-off between the desired and negative effects in a DRG system, we will define the set of parameters that determine the incentives of health care agents in such a system before surveying the economic and medical literature in light of these parameters in Section 3 and summarizing the results in Section 4. In view of the literature analysed, we find that the introduction of DRGs hasstarted a tendency towards a reduction in costs and towards a focus on profitability. If the legislator takes the necessary actions to reduce possible negative effects like manipulation and upcoding, the introduction of G-DRGs will lead to an increase in economic effectiveness and efficiency, while bringing more transparency into the quality of medical services at the same time.
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Wolfgang BöckingEmail: |
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Ciraj-Bjelac O Avramova-Cholakova S Beganovic A Economides S Faj D Gershan V Grupetta E Kharita MH Milakovic M Milu C Muhogora WE Muthuvelu P Oola S Setayeshi S Schandorf C Ursulean I Videnovic IR Zaman A Ziliukas J Rehani MM 《European journal of radiology》2012,81(9):2161-2168
Purpose
The objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality.Materials and methods
This prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units.Results
The fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5 mGy (mean and range 0.59–3.2 mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities.Conclusions
Poor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography. 相似文献5.
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Paul Kruszka Yonit A. Addissie Daniel E. McGinn Antonio R. Porras Elijah Biggs Matthew Share T. Blaine Crowley Brian H. Y. Chung Gary T. K. Mok Christopher C. Y. Mak Premala Muthukumarasamy Meow‐Keong Thong Nirmala D. Sirisena Vajira H. W. Dissanayake C. Sampath Paththinige L. B. Lahiru Prabodha Rupesh Mishra Vorasuk Shotelersuk Ekanem Nsikak Ekure Ogochukwu Jidechukwu Sokunbi Nnenna Kalu Carlos R. Ferreira Jordann‐Mishael Duncan Siddaramappa Jagdish Patil Kelly L. Jones Julie D. Kaplan Omar A. Abdul‐Rahman Annette Uwineza Leon Mutesa Angélica Moresco María Gabriela Obregon Antonio Richieri‐Costa Vera L. Gil‐da‐Silva‐Lopes Adebowale A. Adeyemo Marshall Summar Elaine H. Zackai Donna M. McDonald‐McGinn Marius George Linguraru Maximilian Muenke 《American journal of medical genetics. Part A》2017,173(4):i-i
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Milakovic M Berg G Eggertsen R Lindstedt G Nyström E 《Journal of internal medicine》2001,250(3):208-212
OBJECTIVE: The prevalence of thyroid disease in Swedish schoolchildren is today insufficiently known. The aim of the study was therefore to determine the prevalence of abnormal thyroid function and thyroid autoimmunity in teen-age schoolchildren and to compare the findings with a healthy control group of 60-65-year-old inhabitants from the same community. SETTING: A semirural community of approximately 15,000 inhabitants. DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: Thyroid volume and serum concentrations of serum thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3'-triiodothyronine (T3), and antithyroperoxidase antibodies (TPOAb). RESULTS: Four schoolchildren (7%, 59 screened) had elevated TPOAb concentration, three of the subjects being girls (8%). One girl with a goitre was overtly hypothyroid and one girl showed borderline-high serum TSH concentration suggesting subclinical autoimmune thyroid disease. One euthyroid boy had a goitre and high concentration of TPOAb. The serum free T3 concentration was significantly higher in 15-17-year-old than 60-65-year-old (7.4 vs. 6.4 pmol L(-1), P < 0.001). The concentrations of other thyroid hormones and of TSH in 15-17-year-old did not differ from those of the 60-65-year-old. CONCLUSIONS: We found three cases of thyroid disease in need of immediate attention or later follow-up. The prevalence of autoimmune thyroid disease was high as indicated from TPOAb measurements. Thyroid tests including TPOAb measurement should be performed on wide indications when teenagers seek medical advice. The reference intervals for teen-age children for commonly used first line tests (TSH and free T4) do not differ from those for adults. 相似文献
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