According to the empirical study, it is confirmed that physician satisfaction has great influence on patient satisfaction, and the physician¡Vpatient relationship could also affect health quality. The agreeableness and satisfaction of the healthcare providers (especially the physicians) to reimbursement system therefore should be emphasized especially with the intervention of health insurance. The objective of the study is to investigate the agreeableness and satisfaction of dentists to global budgets and their contributing factors. We survey dentists practiced within the Southern Branch and the Kao-Ping Branch regions of the National health insurance bureau with questionnaire. The primary result is as following: 1. The satisfaction of dentists to global budget after implementation: Male dentists are more satisfied than female detests. Dentists over 40 years old or with more than 15 years of practice experience are more satisfied. Solo practitioners are more satisfied than those who are employed or in partnership. Dentists practiced at Kaohsiung city have better stultification within the Kao-Ping Branch region; while the dentists, work in Jia-yi county are more satisfied than those at Tainan city within the Southern Branch region. Dentists with greater patient volume per day or longer business hours per week are less satisfied. Lastly, dentists whose service points claimed per month didn¡¦t decrease after the implementation of global budget are more satisfied with the system. 2. The agreeableness of dentists to global budget after implementation: Male, older dentists agree more with the reimbursement system. Dentists with more or equal service points claimed per month after implementation agree more with the global budget system. But those increase service hours per week are less agreeable to the system. Within the Kao-Ping Branch region, the dentists practice in Pun-hu county, are more agreeable than those at Kaohsiung city; those work in Jia-yi are more in agreement than those at Tainan within the Southern Branch region. Opened questionnaire indicated that surveyed dentists showed negative feedback on t the appropriateness, equity, and standardization of peer review. They further suggested the operation of dental association should be transparent, and the names of the dental clinics should be made known to the public if there¡¦s fraud. Besides, they also made some constructive suggestions such as the establishment of the public record of the oral cavity examination, periodic oral examination, and improvement of professional medical technology. Theses suggestions should be useful to the dental association for professional and quality improvement, standard protocol development and to the Bureau of the National Health Insurance for policy evaluation.

Study on Service Quality of and Users¡¦ Satisfaction with Nursing Homes for the Aged ¡V Old People¡¦s Apartments in Kaohsiung County Abstract Raising children as insurance against the insecurity of old age has been a deep-rooted concept of the Chinese people. Traditionally, care and nursing of the aged are mostly done in families. However, with the change of social and life styles, as well as the reduction of fertility rate, such kind of concept has been put to a severe test now. In the early stage, a nursing home was mainly the shelter for homeless, solitary and poor old people. The concept of social welfare still remains in the stage of providing relief. Therefore, the old people who lived in the nursing homes were labeled as poor. Besides, ¡§the standard, contents and methods of service provided by the nursing homes also make the general people to halt in hesitation.¡¨ In fact, in addition to physiological satisfaction, the aged will also pursue the psychological satisfaction, i.e., a living worthy of human dignity, at their old age. This is right the ultimate goal to promote the business of nursing homes. Owing to the increasing demand for care and nursing of the aged, the government also encourages the establishment of private nursing organizations for the aged. Hence, the fee-for-service private nursing organizations of ¡§service¡¨ nature emerge gradually, apart from the government-supported nursing organizations of ¡§relief¡¨ nature. The old people who live in such an organization become ¡§welfare consumers¡¨. In Kaohsiung County, the old people¡¦s apartments are run in a fee-for-service mode under the sponsorship of the government, but they have to be responsible for the profit and loss of the apartments by themselves. The purpose of this study is to know the service quality of nursing homes at present and the old people¡¦s satisfaction with the service they received. (1) To understand the service quality of the nursing homes in order to provide a basis of their management for the government. (2) To understand the users¡¦ satisfaction with nursing homes in order to meet the demands of the aged. (3) To discuss the relationship between service quality of the nursing homes and the user¡¦s satisfaction.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (p. [55]-60).

Objectives: Managed care organizations reduce healthcare costs and may improve patient health outcomes by encouraging better control of prevalent chronic diseases. The purpose of this study was to determine whether changing from a fee-for-service program to a capitated managed care program improved medication adherence for Medicaid patients in Kentucky with hypertension, hypercholesterolemia, or type 2 diabetes. Methods: We conducted a quasi-experimental study of patients enrolled in Kentucky Medicaid to evaluate the impact of transitioning to capitated managed care in November 2011. Medication adherence was measured using the proportion of days covered (PDC) method. Multivariable analyses measured the adjusted differences in adherence as a result of the implementation of capitated managed care. Results: Adjusted analyses indicate an average decrease in PDC by about 17-22 days of therapy coverage in the post-policy time period. However, no significant difference in adherence rate changes between the treatment and control populations were observed. Conclusions: Results indicate clinically inconclusive evidence regarding the immediate effect of the implementation of Medicaid managed care in Kentucky on medication adherence rates in patients with prevalent chronic diseases. There is a need to address the decline in average adherence rates, and the efficacy of Medicaid managed care based on medication adherence.

Thesis (Ph. D.)--RAND Graduate School, 2002. / Includes bibliographical references (p. 96-101).

Thesis (Ph.D.)--RAND Graduate School, 2002. / Includes bibliographical references (p. 96-101).

<p>The purpose of this qualitative study was to learn more about the experiences of social work practitioners who are employed in the for-profit sector. Data were collected through individual interviews with four registered social workers. Findings showed that social worker’s experiences of practice within for-profit or private practice settings falls into six main categories. ‘Social work identity’, which includes a comparison of social work and other professions, professional values and ethics, and professional practice issues. ‘Valued characteristics’, which includes past and current work experience, goals for practice, service provision, and job flexibility. The category of ‘fee for service’ examines charging fees in exchange for social work services, salary and compensation, funding, and advertising. ‘Challenges’ of social work practice in the for-profit sector includes experiencing financial pressure, client no-shows, and navigating the “balancing act” of providing services while earning an income. ‘Supervision’, which addresses issues of debriefing. The final category, ‘social work education’, explores the current post-secondary social work program and includes recommendations from participants on improving the curriculum and preparing graduates for working within the field. A central issue for social workers within the for-profit sector is the misconceptions that exist regarding their work. The conclusion is that unlike private practice, social work practice within non-profit and for-profit agencies has a number of similarities. The social work profession offers a multitude of career options for practitioners; different social workers fill different roles, according to their proficiencies, experience, and expertise.</p> / Master of Social Work (MSW)

The way physicians are paid for the provision of care is a relevant aspect of health care systems. Fee-for-service (FFS) payment system has been criticized for affecting quality of care, contributing to the fragmentation of health care, and for rising costs of health care systems. Alternative payment plans (APP) have been introduced as options to the traditional FFS payment scheme. Despite the link between payment methods and behavior of physicians that has been established; there is a lack of evidence about the impact of payment systems on wellness of physicians, specifically on their perception of professional equity and daily distress of physicians. The purpose of this study was to explore the effects of APP on physicians’ perceptions of professional equity and daily distress. The following questions guided this dissertation: 1) Does professional equity perceived by physicians vary among practitioners paid by FFS, APP, or blended alternatives? 2) Is the payment method associated with daily distress of medical practitioners? and 3) Are levels of professional equity, daily distress, and career satisfaction of physicians different by gender and payment methods? In 2011, a cross-sectional study was conducted with physicians practicing in the Saskatoon Health Region (SHR), the largest health authority of Saskatchewan, Canada. Physicians completed a questionnaire evaluating their perceptions of professional equity and daily distress. Analyses of variances (ANOVA) were performed to assess differences in professional equity (overall and by its fulfillment, financial, and recognition dimensions) and daily distress among physicians paid by FFS, APP, and blended schemes. As multivariable analyses, a linear regression was used to test the interaction between specialty and payment methods on the perception of professional equity, controlling for the number of patients, gender, and age group. A mixed linear regression model was built to predict daily distress, testing demographics, workload, complexity of patients, payment method, career satisfaction, and practice profile; the random component of the model considered the influence of geographic area of practice. Also, a multivariate analysis of variance (MANOVA) was conducted to evaluate differences among professional equity, daily distress, and career satisfaction by payment method and gender. In total, 382 (48.1%) physicians participated in the study. Response bias was tested and found to be negligible (Appendix F). The ANOVA identified that physicians paid by APP perceived higher professional equity than those paid by FFS (p=0.005), as well as higher levels of income (p=0.03) and recognition (p=0.001) equity than those with FFS. In the multivariable analyses, a higher level of professional equity was predicted among family practitioners (FPs) paid by APP and blended schemes in comparison to those paid by FFS. Additionally, the payment method was a predictor of daily distress when adjusted by other factors. Lower levels of distress were found among physicians who had more than 75% of patients with complex conditions and were paid by APP compared to those paid by FFS and blended methods. The MANOVA identified that female physicians had poorer wellness indicators than male practitioners. Multiple comparisons identified higher levels of equity among male physicians paid by APP than those with FFS, although this benefit was not observed among female ones. In conclusion, physicians paid by APP perceived higher professional equity (fair economic rewards and appropriate recognition) in comparison to those paid by FFS. Particularly, FPs paid by APP perceived higher professional equity than those FPs paid by FFS. Additionally, the payment method was identified as an associated factor with distress; lower levels of daily distress were predicted among physicians paid by APP who see high proportions of patients with complex conditions. Notwithstanding, female physicians had poorer wellness indicators and the impact of APP on professional equity was only distinguished among males. A potential unequal impact of APP must be recognized between female and male physicians.

Thesis (D.P.H.)--University of Michigan.

Dissertation (D.P.H.)--University of Michigan.