National Health Insurance (NHI) is more than 13 years in Taiwan. The NHI paid medical fees to service providers on the basis of "fee-for-service" in the beginning. However, the cases numbers were increased by health providers for erned more money. Besides, it was very difficult to review the cases. The health capital expenditure was increased gradually. The Bureau of National Health Insurance took a serial measures to finance control, such as ¡§case-payment¡¨, ¡§self-management¡¨, ¡§hospital excellence program¡¨ and ¡§global budget reimubursement system¡¨. But the medical needs elevate due to the life quality and life expectancy increased, unbalance of payments is very serious¡COur government began to investigate the excellent ¡§diagnosis related group payment system¡¨ which carried out in America and other OECD countries for many years. The prospective payment system made medical costs more easily control. Though Taiwan diagnosis related groups was finished and was revised to the third edition on the basis of experts consensus during many times of discussion, the exacted time of execution is delayed again and again. Mainly in Taiwan medical league doubted and blocked the new measure. Moreover, people worried about would become medical garbage because health institute refused critical patient owing to DRG fixed payment or few percentage additional charges, especially in medical centers. It might decrease the examination items and compromised the patient rights and quality of medical care. Eeverytimes when NHI implemented new measure to control medical capital expenditure, it resulted in some degree damage to medical institute in fact. This study analysed the regional hospital income and the difference of implementation DRG by major diagnosis categories and sections in 2006 and 2007 with BCG model. The hospital begame to promote DRG payment system in 2007, compared to 2006, may simulate the difference after implementation of DRG. We also compared the medical performance and medical care quality of 2007 to 2006 to simulate the difference after implementation of DRG. The thesis reviewed the results of execution DRG in others countries and summarized some experts and scholars advisement abut the impaction of DRG carried out in Taiwan. At last, we interviewed to the department directors about the opinions and suggestions of DRG in-depth and addressed the responsive strategies and balanced scorcard implementation¡C DRG payment system was proved as an excellent measure by others countries. It could control the medical cost effectively and did not compromise medical care quality. There are several measures, including ¡§global budget reimubursement system¡¨, ¡§case- payment¡¨ and ¡§fee-for-outcome¡¨in Taiwan. Is the result of DRG implementation in Taiwan diffierent to other DRG countaries¡HOur conclusions are implementation DRG may not damage to hospital finance and medical care quality may decrease a little in the first time. For checking on medical care quality critically, it is necessary for hospitals and Bureau of NHI to set up peer review organization

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Introdução: As atividades com grupos complementando os procedimentos terapêuticos são freqüentemente utilizadas na área de saúde do trabalhador, especialmente para os pacientes com LER/DORT. Este estudo tem por objetivo avaliar os possíveis benefícios da associação do tratamento cinesioterapêutico convencional com dinâmicas de grupo e verificar se o tratamento fisioterapêutico em grupo potencializa os efeitos da cinesioterapia em pacientes com LER/DORT. Método: Participaram do estudo 24 pacientes com diagnóstico de LER/DORT que foram distribuídos aleatoriamente para os dois tipos de intervenção: individual e em grupo. O protocolo de cinesioterapia foi o mesmo para as duas intervenções e teve duração de dez sessões. Os pacientes submetidos à intervenção em grupo participaram de dinâmicas grupais com temáticas previamente estabelecidas para instigar a discussão de aspectos considerados importantes durante o tratamento. A análise das intervenções foi feita por meio da avaliação do quadro doloroso (EVA, Questionário de Dor de McGill e Questionário Nórdico de Sintomas Osteomusculares), da avaliação da funcionalidade (Questionário DASH) e da avaliação da amplitude de movimento das articulações dos membros superiores. Além disso, foi realizada uma entrevista semi-estruturada para avaliar qualitativamente o impacto dessas intervenções no quadro clínico e na qualidade de vida destes pacientes. Resultados: Na avaliação quantitativa do quadro doloroso foi observado que a intervenção em grupo não produziu efeitos para o controle da dor, especialmente para diminuição da intensidade álgica. A análise do questionário DASH revelou que o tratamento individual e o em grupo não produziram efeitos na funcionalidade das atividades de vida diária e do trabalho. O aumento da amplitude de movimento em todas as articulações de membros superiores em ambas as intervenções não foi considerado significativo. Entretanto, a análise qualitativa apontou que os pacientes que participaram da intervenção em grupo relataram uma percepção de melhora do quadro doloroso e da funcionalidade em suas vidas; houve uma reflexão gerada a partir das dinâmicas de grupo trazendo uma nova percepção de saúde e do adoecimento Conclusão: A intervenção em grupo não potencializou os efeitos da cinesioterapia no controle do quadro doloroso, na melhora da funcionalidade e no aumento das amplitudes de movimento das articulações de membros superiores, mas o tratamento cinesioterapêutico convencional associado a dinâmicas de grupo permitiu uma abordagem mais global do processo de adoecimento, recuperação e reabilitação do paciente com LER/DORT e modificou as estratégias de enfrentamento dos processos dolorosos e dos conflitos cotidianos desses indivíduos / Introduction: The group activities are often used to complement therapeutic procedures in the laborer’s health area, especially for RSI/WMSD patients. This study’s aim is to evaluate the possible benefits of associating the conventional kinesiotherapeutic treatment with group dynamics and check if the group physical therapeutic treatment potentializes the effects of kinesiotherapy in RSI/WMSD patients. Method: Twenty four RSI/WMSD patients took part in the study. They were randomly distributed for both kinds of interventions: the individual and the group treatments. The kinesiotherapy protocol was the same for both interventions and it lasted ten sessions. The patients submitted to group intervention took part in group dynamics with previously established themes to instigate the debate on aspects considered important during treatment. The interventions’ analysis was performed by the evaluation of pain conditions (VAS, McGill Pain Questionnaire, NMQ), of functionality (DASH Questionnaire), and of the upper limb joint movements. Furthermore, a semi-structured interview was performed to qualitatively evaluate the impact of these interventions in these patients’ clinical condition and quality of life. Results: In the quantitative evaluation of the pain condition it was evidenced that the group intervention was not effective for pain control, especially in the decrease in the intensity of pain. The DASH questionnaire’s analysis revealed that the individual and the group treatments were not effective in the functionality of daily life and labor activities. The increase in the movement amplitude in every upper limb joint in both interventions was not considered significant. Nonetheless, the qualitative analysis pointed out that those patients who took part in the group intervention reported the perception of improvement in the pain condition and in functionality in their lives; a reflection born within the group dynamics brought a new perception on health and illness. Conclusion: The group intervention did not potentialize the effects of kinesiotherapy in controlling pain, in improving functionality, and in increasing movement amplitudes in the upper limb joints, but the conventional kinesiotherapeutic treatment associated to group dynamics allowed a more global approach of the RSI/WMSD patient’s illness, recovering, and rehabilitation process and modified the strategies for dealing with these individuals’ pain processes and daily conflicts

Introdução: As atividades com grupos complementando os procedimentos terapêuticos são freqüentemente utilizadas na área de saúde do trabalhador, especialmente para os pacientes com LER/DORT. Este estudo tem por objetivo avaliar os possíveis benefícios da associação do tratamento cinesioterapêutico convencional com dinâmicas de grupo e verificar se o tratamento fisioterapêutico em grupo potencializa os efeitos da cinesioterapia em pacientes com LER/DORT. Método: Participaram do estudo 24 pacientes com diagnóstico de LER/DORT que foram distribuídos aleatoriamente para os dois tipos de intervenção: individual e em grupo. O protocolo de cinesioterapia foi o mesmo para as duas intervenções e teve duração de dez sessões. Os pacientes submetidos à intervenção em grupo participaram de dinâmicas grupais com temáticas previamente estabelecidas para instigar a discussão de aspectos considerados importantes durante o tratamento. A análise das intervenções foi feita por meio da avaliação do quadro doloroso (EVA, Questionário de Dor de McGill e Questionário Nórdico de Sintomas Osteomusculares), da avaliação da funcionalidade (Questionário DASH) e da avaliação da amplitude de movimento das articulações dos membros superiores. Além disso, foi realizada uma entrevista semi-estruturada para avaliar qualitativamente o impacto dessas intervenções no quadro clínico e na qualidade de vida destes pacientes. Resultados: Na avaliação quantitativa do quadro doloroso foi observado que a intervenção em grupo não produziu efeitos para o controle da dor, especialmente para diminuição da intensidade álgica. A análise do questionário DASH revelou que o tratamento individual e o em grupo não produziram efeitos na funcionalidade das atividades de vida diária e do trabalho. O aumento da amplitude de movimento em todas as articulações de membros superiores em ambas as intervenções não foi considerado significativo. Entretanto, a análise qualitativa apontou que os pacientes que participaram da intervenção em grupo relataram uma percepção de melhora do quadro doloroso e da funcionalidade em suas vidas; houve uma reflexão gerada a partir das dinâmicas de grupo trazendo uma nova percepção de saúde e do adoecimento Conclusão: A intervenção em grupo não potencializou os efeitos da cinesioterapia no controle do quadro doloroso, na melhora da funcionalidade e no aumento das amplitudes de movimento das articulações de membros superiores, mas o tratamento cinesioterapêutico convencional associado a dinâmicas de grupo permitiu uma abordagem mais global do processo de adoecimento, recuperação e reabilitação do paciente com LER/DORT e modificou as estratégias de enfrentamento dos processos dolorosos e dos conflitos cotidianos desses indivíduos / Introduction: The group activities are often used to complement therapeutic procedures in the laborer’s health area, especially for RSI/WMSD patients. This study’s aim is to evaluate the possible benefits of associating the conventional kinesiotherapeutic treatment with group dynamics and check if the group physical therapeutic treatment potentializes the effects of kinesiotherapy in RSI/WMSD patients. Method: Twenty four RSI/WMSD patients took part in the study. They were randomly distributed for both kinds of interventions: the individual and the group treatments. The kinesiotherapy protocol was the same for both interventions and it lasted ten sessions. The patients submitted to group intervention took part in group dynamics with previously established themes to instigate the debate on aspects considered important during treatment. The interventions’ analysis was performed by the evaluation of pain conditions (VAS, McGill Pain Questionnaire, NMQ), of functionality (DASH Questionnaire), and of the upper limb joint movements. Furthermore, a semi-structured interview was performed to qualitatively evaluate the impact of these interventions in these patients’ clinical condition and quality of life. Results: In the quantitative evaluation of the pain condition it was evidenced that the group intervention was not effective for pain control, especially in the decrease in the intensity of pain. The DASH questionnaire’s analysis revealed that the individual and the group treatments were not effective in the functionality of daily life and labor activities. The increase in the movement amplitude in every upper limb joint in both interventions was not considered significant. Nonetheless, the qualitative analysis pointed out that those patients who took part in the group intervention reported the perception of improvement in the pain condition and in functionality in their lives; a reflection born within the group dynamics brought a new perception on health and illness. Conclusion: The group intervention did not potentialize the effects of kinesiotherapy in controlling pain, in improving functionality, and in increasing movement amplitudes in the upper limb joints, but the conventional kinesiotherapeutic treatment associated to group dynamics allowed a more global approach of the RSI/WMSD patient’s illness, recovering, and rehabilitation process and modified the strategies for dealing with these individuals’ pain processes and daily conflicts

The thesis, Survey of the methods of costing of hospitalization, deals with the characteristics of the classification system DRG used for costing of hospitalization. The first half of the theoretical part of this work describes the Czech health care in general and specific ways of financing it. We focus on the costs related to the emergency care in hospitals which are classified by the DRG system. The second half of the theoretical part studies the actual principles of costing of hospitalization. The method chosen for this is called Activity Based Costing (ABC). It defines the procedures of costing which are being used in hospitals. At the end, we provide a description of the current and suggested procedures of costing of hospitalization and how they are utilized to set up parameters of the reimbursing mechanism. The practical part of this thesis maps the situation of hospitalization financing in Klatovska nemocnice, a. s. We suggest a new way of financing based on the methodology DRG Restart. Base on the data obtained in Klatovska nemocnice, a. s. we summarize and compare the results of the new method to the current one.

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