Amrizal Muhammad Nur

The impact of Casemix system on quality of patient care in a Class B hospital in west Sumatera Province, Indonesia

Background Health spending in Indonesia is on the increase every year due to a number of factors including change in pattern of diseases towards chronic and non-communicable conditions, priority on curative care rather than preventive services, use of new technology in health services and use of fee-for-service for provider payment. Raise in health care cost can have negative impact on accessibility of health service by the poor communities. In Indonesia, the Ministry of Health has launched a special program to ensure that the poor have access to health care services. One of the most important programs is JAMKESMAS, which is a special health financing scheme for the poor funded by taxation. The implementation of Casemix in Indonesia is based on a special law (Undang-undang No.40) and Minister of Health decree (SK Menkes No. 1663/MENKES/SK/XII/2005). Casemix was implemented as a pilot project involving 14 hospitals in 2005. However in 2008, the use of Casemix was extended to cover all hospitals in Indonesia. Hospitals are reimbursed on locally customized Casemix system called INA-CBG, which is based on UNU-CBG case-mix grouper. In the first phase of Casemix implementation, the system was used to develop hospital tariff for prospective payment with the objective of enhancing service efficiency. However it is widely known that Casemix system is also a powerful tool to enhance quality of care. A number of challenges were identified in the early part of case-mix implementation in Indonesia. These include lack of basic data for Casemix, poor documentation of diagnosis and procedures, and ineligible handwriting of doctors in the medical records. Presently, there is no study carried out in Indonesia to assess the impact of case-mix system implementation on quality of patient care.

Turkish health system reform from the people's perspective: a cross sectional study

BackgroundSince 2003, Turkey has implemented major health care reforms to develop easily accessible, high-quality, efficient, and effective healthcare services for the population. The purpose of this study was to bring out opinions of the Turkish people on health system reform process, focusing on several aspects of health system and assessing whether the public prefer the current health system or that provided a decade ago.MethodsA cross sectional survey study was carried out in Turkey to collect data on people’s opinions on the healthcare reforms. Data was collected via self administered household’s structured questionnaire. A five-point Likert-type scale was used to score the closed comparative statements. Each statement had response categories ranging from (1) “strongly agree” to (5) “strongly disagree.” A total of 482 heads of households (response rate: 71.7%) with the mean age of (46.60 years) were selected using a multi stage sampling technique from seven geographical regions in Turkey from October 2011 to January 2012. Multiple logistic regressions were performed to identify significant contributing factors in this study.ResultsEmploying descriptive statistics it is observed that among the respondents, more than two third of the population believes that the changes have had positive effects on the health system. A vast majority of respondents (82.0%) believed that there was an increase in accessibility, 73.7% thought more availability of health resources, 72.6% alleged improved quality of care, and 72.6% believed better attitude of politician/mass media due to the changes in the last 10 years. Indeed, the majority of respondents (77.6%) prefer the current health care system than the past. In multivariate analysis, there was a statistically significant relationship between characteristics and opinions of the respondents. The elderly, married females, perceived themselves healthy and those who believe that people are happier now than 10 years ago have a more positive opinion of the changes. While, the single unemployed from rural region who perceived themselves as unhealthy and believe that people are unhappy now compare to ten years ago showed less positive opinions.ConclusionsHence, we conclude that from the people’s perspective overall the health system reforms were most likely successful.

Hair arsenic levels and prevalence of arsenicosis in three Cambodian provinces

Natural, inorganic arsenic contamination of groundwater threatens the health of more than 100 million people worldwide, including residents of the densely populated river deltas of South and Southeast Asia. Contaminated groundwater from tube wells in Cambodia was discovered in 2001 leading to the detection of the first cases of arsenicosis in 2006. The most affected area was the Kandal Province. The main objective of this study was to determine the prevalence of arsenicosis in Cambodia based on acceptable criteria, and to investigate the use of hair arsenic as a biomarker not only for arsenicosis-related signs but also for associated symptoms. A cross-sectional epidemiological study of 616 respondents from 3 purposely selected provinces within the Mekong River basin of Cambodia was conducted. The Kandal Province was chosen as a high arsenic-contaminated area, while the Kratie Province and Kampong Cham Province were chosen as moderate and low arsenic-contaminated areas, respectively. The most prevalent sign of arsenicosis was hypomelanosis with a prevalence of 14.5% among all respondents and 32.4% among respondents with a hair arsenic level of ≥1 μg/g. This was followed by hyperkeratosis, hyperpigmentation and mees lines. Results also suggest a 1.0 μg/g hair arsenic level to be a practical cut off point for an indication of an arsenic contaminated individual. This hair arsenic level, together with the presence of one or more of the classical signs of arsenicosis, seems to be a practical criteria for a confirmed diagnosis. Based on these criteria, the overall prevalence of arsenicosis for all provinces was found to be 16.1%, with Kandal Province recording the highest prevalence of 35.5%. This prevalence is comparatively high when compared to that of other affected countries. The association between arsenicosis and the use of Chinese traditional medicine also needs further investigation.

Economic Impact of Pneumococcal Protein-D Conjugate Vaccine (PHiD-CV) on the Malaysian National Immunization Programme

OBJECTIVE To assess the cost-effectiveness of introducing pneumococcal polysaccharide and nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in the National Immunization Programme of Malaysia. This study compared introducing PHiD-CV (10 valent vaccine) with current no vaccination, as well as against the alternative 13-valent pneumococcal conjugate vaccine (PCV13). METHODS A lifetime Markov cohort model was adapted using national estimates of disease burden, outcomes of pneumococcal disease, and treatment costs of disease manifestations including pneumonia, acute otitis media, septicemia, and meningitis for a hypothetical birth cohort of 550,000 infants. Clinical information was obtained by review of medical records from four public hospitals in Malaysia from the year 2008 to 2009. Inpatient cost from the four study hospitals was obtained from a diagnostic-related group-based costing system. Outpatient cost was estimated using clinical pathways developed by an expert panel. The perspective assessed was that of the Ministry of Health, Malaysia. RESULTS The estimated disease incidence was 1.2, 3.7, 70, and 6.9 per 100,000 population for meningitis, bacteremia, pneumonia, and acute otitis media, respectively. The Markov model predicted medical costs of Malaysian ringgit (RM) 4.86 billion (US

The cost of radiological procedures at Universiti Kebangsaan Malaysia Medical Centre: applying activity based costing methodology

1.51 billion) in the absence of vaccination. Vaccination with PHiD-CV would be highly cost-effective against no vaccination at RM30,290 (US

Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines

7,407) per quality-adjusted life-year gained. On comparing PHiD-CV with PCV13, it was found that PHiD-CV dominates PCV13, with 179 quality-adjusted life-years gained while saving RM35 million (US

Development of package payment based on UNU-CBGs Casemix system for provider payment in Aceh Health Insurance, Indonesia

10.87 million). CONCLUSIONS It is cost-effective to incorporate pneumococcal vaccination in the National Immunization Programme of Malaysia. Our model suggests that PHiD-CV would be more cost saving than PCV13 from the perspective of the Ministry of Health of Malaysia.

Cloud computing: Feasibility of developing web-based UNU Casemix Grouper

Background Department of Radiology is one of the intermediate cost centres for supporting patient treatment in wards and clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 121,221 procedures were performed in 2011. Unfortunately, since UKMMC began its operations, the actual cost of each procedure in this particular department has never been studied. Hence, it is important to determine the actual cost of each procedure in preparation for future autonomous university governance, particularly budgeting.

Cost- effectiveness of HPV vaccination regime: comparing twice versus thrice vaccinations dose regime among adolescent girls in Malaysia

OBJECTIVES To describe the incidence, mortality, cost, and length of stay (LOS) of hospitalized community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in three Southeast Asian countries: Malaysia, Indonesia, and the Philippines. METHODS Using Casemix system data from contributing hospitals, patients with International Classification of Diseases 10(th) revision (ICD-10) codes identifying pneumonia were categorized into CAP or HAP using a logical algorithm. The incidence among hospitalized patients, case fatality rates (CFR), mean LOS, and cost of admission were calculated. The population incidence was calculated based on Malaysian data. RESULTS For every 100000 discharges, CAP and HAP incidences were 14245 and 5615 cases, respectively, in the Philippines, 4205 and 2187, respectively, in Malaysia, and 988 and 538, respectively, in Indonesia. The impact was greatest in the young and the elderly. The CFR varied from 1.4% to 4.2% for CAP and from 9.1% and 25.5% for HAP. The mean LOS was 6.1-8.6 days for CAP and 6.9-10.2 days for HAP. The cost of hospitalization was between USD 254 and USD 1208 for CAP and between USD 275 and USD 1482 for HAP. CONCLUSIONS The burden of CAP and HAP is high. Results varied between the three countries, likely due to differences in socio-economic conditions, health system differences, and ICD-coding practices.

HEALTH SYSTEM REFORM FROM THE PEOPLE'S POINT OF VIEW: DEVELOPMENT OF RELIABLE AND VALID QUESTIONNAIRE

Background The Aceh Health Insurance (JKA) has been established since June 1, 2010. Presently, the provincial Government of Aceh faces difficulty in getting adequate budget to fund JKA program that tends to increase every year. In the year 2010, the second year of JKA implementation, the government was only able to allocate Rp. 382 billion from the total requirement of Rp. 482 billion. The figure will possibly continue to increase next year because of the increase in the overall hospital tariff of adjustments where there was an increase over 50%. In addition, there were complaints that quality of care is not optimum. The fee for service reimbursement system in JKA is one of the reasons for increase in cost of JKA. The main purposes of this study are to develop and implement the Casemix system as a provider payment mechanism and to assess its feasibilities to improve the performance of JKA program.