دانلود رایگان مقاله لاتین اثر اصلاحات بیمارستان دولتی بر هزینه پزشکی از سایت الزویر
عنوان فارسی مقاله:
اندازه گیری تاثیر اصلاحات بیمارستان دولتی محلی ژاپن بر هزینه های پزشکی ملی از طریق رگرسیون داده های پانل
عنوان انگلیسی مقاله:
Measuring the impact of Japanese local public hospital reform on national medical expenditure via panel data regression
سال انتشار : 2016
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بخشی از مقاله انگلیسی:
2. The LPH system and national medical expenditure in Japan
2.1. The LPH system LPHs, a type of Local Public Enterprise (LPE) owned by local governments or Local Independent Administrative Corporations (LIAC) (Tanaka, 2010), are established to secure necessary and adequate health care for all residents across the nation. The LIAC was established by local governments to carry out projects related to public benefits based on the Local Independent Administrative Corporations Law. Legal status of the LIAC makes it more independent of local governments. According to the 2011 data from the Ministry of Health, Labour and Welfare (MHLW), only 11% of all hospitals and 13% of all beds nationwide were operated by LPHs that year. The LPHs, however, engaged intensively in different types of PBMS. For example, LPHs accounted for 67.8% of designated hospitals serving remote areas, 40.9% of emergency centers, and 39.6% of regional perinatal medical centers. These PBMSs are usually subsidized by central and local governments. Local governments faced both a huge deficit from LPHs and a problem persisting for a number of years and worsening since 2000. In 2008, local governments were required to publicize their financial indicators based on consolidated accounting statements with LPEs including LPHs. Some local governments with large deficit from LPHs would face the risk of financial failure, which would necessitate direct control by the MIC. In late 2007, the MIC launched the LPH reform as a measure to deal with problems in LPH management and with increasing regional disparities in health care resources. To improve the management of LPHs, the guideline of the reform required first, all local governments should monitor and publicize key performance indicators of their LPHs; second, local governments should initiate the organizational reform for LPHs. The daily management of LPHs was outsourced, a designated manager system was introduced and corporatization given by a transfer from LPE-owned to LIACowned or privatization of LPHs was performed by some local governments. To secure equal accessibility while retaining the balance of financial burden on local governments, the guideline stipulated that local health care systems should be reorganized by concentrating beds in well-functioned “magnet hospitals” and building “satellite clinics” to improve the quality of care and to secure health care for remote regions. The guideline also stipulated that LPHs whose occupancy rate was b70% in the three most recent years should reduce the number of beds or be downsized to clinics (MIC, 2007). The number of total beds decreased from about 1,631,000 to 1,593,000 during the period from 2005 to 2010. The percentage of LPH beds is defined to be the percentage of LPH beds to total number of beds in Japanese hospitals and also it can be a quantitative indicator of LPH burden of local governments. The average percentage of LPH beds for all prefectures in Japan decreased from 18.09% to 17.53% during the above period. The percentage of LPHs operating with a surplus increased from 25.5% in 2006 to 52.3% in 2010, and annual deficits sharply decreased from N190 billion yen to minus 5.6 billion yen (surplus) during the same period (MIC, 2010). Though financial performance and efficiency of LPHs improved after the reform, some scholars argue that the effect of the reform might have been driven by significant government subsidies and that those effects disappeared with the subsequent decrease in government subsidies (Kawaguchi et al., 2014). Concerns also arose about compromised accessibility of health care system after the reform (Matsuda, 2008).
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کلمات کلیدی:
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