Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach
Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospita...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2018/9298024 |
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| author | Paibul Suriyawongpaisal Samrit Srithamrongsawad Pongsakorn Atiksawedparit Khanisthar Phooseemungkun Krongkan Bunchaiyai Thanita Thongtan |
| author_facet | Paibul Suriyawongpaisal Samrit Srithamrongsawad Pongsakorn Atiksawedparit Khanisthar Phooseemungkun Krongkan Bunchaiyai Thanita Thongtan |
| author_sort | Paibul Suriyawongpaisal |
| collection | DOAJ |
| description | Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries. |
| format | Article |
| id | doaj-art-438f5b00d5364411a9b7959bdf4e2c69 |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-438f5b00d5364411a9b7959bdf4e2c692025-02-03T01:06:41ZengWileyEmergency Medicine International2090-28402090-28592018-01-01201810.1155/2018/92980249298024Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods ApproachPaibul Suriyawongpaisal0Samrit Srithamrongsawad1Pongsakorn Atiksawedparit2Khanisthar Phooseemungkun3Krongkan Bunchaiyai4Thanita Thongtan5Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Ratchatewi, Bangkok, ThailandDepartment of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Ratchatewi, Bangkok, ThailandDepartment of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Ratchatewi, Bangkok, ThailandNational Institute of Emergency Medicine, Ministry of Public Health, Tiwanond, Muang, Nonthaburi, ThailandNational Institute of Emergency Medicine, Ministry of Public Health, Tiwanond, Muang, Nonthaburi, ThailandDepartment of Physiology, Faculty of Science, Mahidol University, 272 Rama 6 Rd, Rajathevi, Bangkok 10400, ThailandIntroduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.http://dx.doi.org/10.1155/2018/9298024 |
| spellingShingle | Paibul Suriyawongpaisal Samrit Srithamrongsawad Pongsakorn Atiksawedparit Khanisthar Phooseemungkun Krongkan Bunchaiyai Thanita Thongtan Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach Emergency Medicine International |
| title | Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach |
| title_full | Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach |
| title_fullStr | Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach |
| title_full_unstemmed | Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach |
| title_short | Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach |
| title_sort | payment reforms for prehospital care services in a middle income country assessing implementation and patient outcomes using a mixed methods approach |
| url | http://dx.doi.org/10.1155/2018/9298024 |
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