PAY PER CASE PAYMENT MODEL IN HOSPITALS: COMPARISON OF P Yazar / Author: i Abstract Today, the fact that the prices of health care services are not determined according to the financial situation affects the financial sustainability of the hospitals. In Turkey, there has not been a significant increase in tpatient wages for approximately nine years. However, the hospital's labor, material and operating costs are increasing every year. The purpose of this study is to compare the remuneration costs of a university hospital with inpatient examinations. At the end of the research, the total income of the hospital from the inpatient was 1.753.953TL and inpatient costs was determined as 2.156.439TL. Social Security Institution (SSI) has an average repayment of 66.3TL for one patient. However, the cost of a polyclinic patient of the hospital is 81.6TL. For this reason, it is thought that the perincident price should be increased by at least about 15% in future periods. Keywords: Pay per case, reimbursement, cost, hospital TL gider ise 2.156.439TL TL geri TL olarak Anahtar Kelimeler: 1. 2014). Ancak ayaktan ge i yigitv@hotmail.com. 752
2016:254) (Ersoy, 2014:i) (Tatar, 2011:103). Geri (Waters and Hussey, 2004:175). veril 2.. Bu. Bire hizmetlerini sunanlar 2011:104;. Hangi finansman 2011:103). (Tatar, (Tatar, 753
1. Bismarck Modeli 1883 Otto Van Bismarck ve daha sonra hale. Bir veya birden fazla kar olmayan kamu mevcut. Herkes, gelirinin belirli bir sigortaya. miktar gelire. Hizmetler bir fiyat listesi hekim ve hastanelere sigorta. Gerekli her ve tedavi faaliyetleri. hastaneler hizmeti sunan kurumlar aittir. Almanya, Avusturya, Fransa, Hollanda ve gibi. 2. Semashko Modeli Eski Sovyetler ilk (Nikolai Semashko) ile bilinir. Hastane ve hekimler de dahil sistemi devlet kontrol edilir. hizmetleri herkes. Rusya ve Avrupa sistemdir. 3. Beveridge Modeli ekonomist ve sosyal reformcu William Beveridge ile bilinir. Beveridge modelinin ortaya bu model genellikle Ulusal Hizmeti (National Health ServiceNHS) ile. Danimarka, Finlandiya, Portekiz, Yunanistan gibi modelin temel hizmetlerinin vergilere olarak finanse edilmesidir. 4. Pazar Bu sistem daha Amerika Devletlerinde. Borowitz and Atun, 2007;Tatar, 2011; den 2002:256) (Jegers et al. 754
2.1 niversite 2.2. (Normand and Weber; 2009:89). Bu dikkate Gazete, 2006). (Resmi 755
Tablo1. 1 43 2 44 3 Beyin ve Sinir Cerrahisi 55 4 49 5 45 6 49 7 41 8 55 9 50 10 Genel Cerrahi 55 11 49 12 49 13 43 14 56 15 61 16 Kalp ve Damar Cerrahisi 56 17 Kardiyoloji 68 18 KulakBurun 43 19 51 20 Ortopedi ve Travmatoloji 49 21 e Estetik Cerrahi 55 22 49 23 50 24 50 25 55 Kaynak: (SUT, 2013) ilave edilmektedir. 2.3. her 756
3. yetleri 4. Bulgular B TL gelir elde Tablo 1. Grup Adedi Toplam Tutar (TL) % Yatarak 24 2.151 4.695.202,45 57,29 Ayakta 29 26.425 1.753.953,32 21,40 20 1.542 1.126.339,97 13,74 9 968 620.177,25 7,57 TOPLAM: 82 31.086 8.195.672,99 100,00 (39 757
Tablo 2. Gelir S. Ortalama No Toplam Ayaktan Vaka % % Tutar(TL) Birim Fiyat 1 Acil 2.394 9,06 181.430 10,34 76 2 400 1,51 19.983 1,14 50 4 Beyin ve Sinir Cerrahisi 586 2,22 47.428 2,70 81 5 128 0,48 5.545 0,32 43 6 353 1,34 16.697 0,95 47 7 1.449 5,48 85.259 4,86 59 8 Dermatoloji 1.587 6,01 62.025 3,54 39 10 352 1,33 27.186 1,55 77 11 650 2,46 54.101 3,08 83 12 Genel Cerrahi 1.167 4,42 90.610 5,17 78 13 98 0,37 14.003 0,80 143 14 913 3,46 84.195 4,80 92 15 1.337 5,06 55.943 3,19 42 16 6.055 22,91 471.321 26,87 78 17 1.593 6,03 99.060 5,65 62 18 Kalp ve Damar Cerrahisi 476 1,80 25.666 1,46 54 19 Kardiyoloji 861 3,26 58.887 3,36 68 20 KulakBurun 1.353 5,12 66.788 3,81 49 21 861 3,26 67.956 3,87 79 22 Ortopedi ve Travmatoloji 1.024 3,88 55.125 3,14 54 23 Plastik Cerrahi 527 1,99 27.305 1,56 52 24 Psikiyatri 749 2,83 36.168 2,06 48 27 143 0,54 8.021 0,46 56 29 1.031 3,90 68.520 3,91 66 338 1,28 24.733 1,41 73 TOPLAM: 26.425 100,00 1.753.953 100,00 66 10.178.435,60 TL ola 758
Tablo 3. Gid. Personel Giderleri Laborat 662.231 6,51 % 418.145 4,11 1.834.318 18,02 Memurlar 653.035 6,42 29.500 0,29 6.846 0,07 17.815 0,18 956.221 9,39 1.370.460 13,46 235.964 2,32 37.560 0,37 33.502 0,33 En 350.049 3,44 104.914 1,03 11.111 0,11 12.107 0,12 1.506.735 14,80 meti Giderleri 28.869 0,28 676.695 6,65 802 0,01 126.361 1,24 25.085 0,25 89.115 0,88 42.838 0,42 Giderleri 63.493 0,62 7.431 0,07 19.315 0,19 19.016 0,19 59.723 0,59 169.499 1,67 427.949 4,20 Hazine Hissesi 112.332 1,10 69.398 0,68 28,64 32,13 39,24 Genel Toplam 10.178.435,60 100,00 0,00 759
Tablo 4 aplama Tablosu 1.853.942,61 2.156.439 26.425 81,61 66,37 Kar/Zarar 15,23 (Mathauer and Wittenbecher, 2013:753) benzer k (Ayano 1.753.953TL gider ise 2.156.439 760
ak hastanenin 153. 5 50. 975590521 2014. ss:111114 a (DRG) Bilimler Dergisi, 13(51), 273 290. 53. Borowitz, M. ve Atun, R. (2007). The unfinished journey from Semashko to Bismarck: health reform in Central Asia from 1991 to 2006. Central Asian Survey, 25(4), 419 440. doi:10.1080/02634930701210633 6055782795 Ankara2013. ss: 169 226 lmesi. Gazi hospitals under a capitation payment scheme. Health Economics, Policy, and Law, 8, 1 30. doi:10.1017/s1744133112000345 Practical Health Guide No:8, Ireland. 1993 http://books.google.com.tr, (02.01.2012) Hospital Payment Mechanisms: Theory And Practice In Transition Countries, McKee, M. and Healy, J. (eds.) In: Hospital in a Changing Europe, Open University Press, 2002BuchinghamPhiladelphia, pp: 150176. Jegers, M., Kesteloot, K., De Graeve, D. ve Gilles, W. (2002). A typology for provider payment systems in health care. Health Policy, 60, 255 273. Asia and the Pasific : Best Practices and Remaining Challen Washington, D.C. (The International Bank For Reconstruction and Development), 2011Washington. pp:70 Mathauer, I. ve Wittenbecher, F. (2013). Hospital payment systems based on diagnosisrelated groups: experiences in low and middleincome countries. Bulletin of the World Health Organization, 91(10), 746 756A. doi:10.2471/blt.12.115931 Normand, C.,Weber A (2009).. Social Health Insurance: A Guidebook For Planning. ADB / ILO/ WHO / GTZ. 2009Eschborn. pp: 89 761
Resmi Gazete (2006 Resmi Ga 133. Tengi 26. 133. 159. Waters, H. R. ve Hussey, P. (2004). Pricing health services for purchasersa review of methods and experiences. Health Policy, 70(2), 175 184. 98. 8(16), 253. doi:10.20875/sb.84868 762