The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration
“…Among the 19 studies selected for the review, nine studies discuss the role of rewards, six publications report on reimbursement mechanisms and three focused on penalties. Two studies do not report on any specific type of financial mechanism but instead stress, in general, the importance of appropriate financing mechanisms to improve care for older adults [ 30 , 34 ].…”
Section: Resultsmentioning
confidence: 99%
“…Two of those studies do not specify the setting but rather argue that the financial incentives target all (health) care providers [ 28 , 37 ]. Two studies do not mention any setting [ 30 , 34 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Some studies focus on the role of financial incentives in the United States ( n = 5), Taiwan ( n = 4), United Kingdom ( n = 3), Sweden [ 26 ], Japan [ 41 ], Germany [ 29 ], Canada [ 36 ], Norway [ 40 ] and Ireland [ 42 ]. Two studies do not focus on any particular intervention country but rather discuss the importance of appropriate financial incentives [ 30 , 34 ].…”
Section: Resultsmentioning
confidence: 99%
“…As shown in Table 4 , majority of studies ( n = 16) investigate the impact of the financial incentives on care coordination that is measured with the use of process and/or outcome indicators. Three studies do not measure the effect of financial incentives [ 26 , 30 , 34 ]. Overall, from included studies, seven studies report on the positive effect of financial incentives on care coordination, six studies demonstrate to have unclear or have no effect, and three studies show a negative effect of financial incentives.…”
Background
Suboptimal care transitions of older adults may ultimately lead to worse quality of care and increased costs for the health and social care systems. Currently, policies and financing often focus on care in specific settings only, and neglect quality of care during transitions between these settings. Therefore, appropriate financing mechanisms and improved care coordination are necessary for effective care transitions. This study aims to review all available evidence on financial aspects that may have an impact on care transitions in LTC among older adults.
Methods
This systematic review was performed as part of the European TRANS-SENIOR project. The databases Medline, EMBASE (Excerpta Medica Database) and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they reported on organizational and financial aspects that affect care transitions in long-term care systems.
Results
All publications included in this review (19 studies) focused specifically on financial incentives. We identified three types of financial incentives that may play a significant role in care transition, namely: reimbursement mechanism, reward, and penalty. The majority of the studies discussed the role of rewards, specifically pay for performance programs and their impact on care coordination. Furthermore, we found that the highest interest in financial incentives was in primary care settings.
Conclusions
Overall, our results suggest that financial incentives are potentially powerful tools to improve care transition among older adults in long-term care systems and should be taken into consideration by policy-makers.
Trial registration
A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42020162566.
“…Among the 19 studies selected for the review, nine studies discuss the role of rewards, six publications report on reimbursement mechanisms and three focused on penalties. Two studies do not report on any specific type of financial mechanism but instead stress, in general, the importance of appropriate financing mechanisms to improve care for older adults [ 30 , 34 ].…”
Section: Resultsmentioning
confidence: 99%
“…Two of those studies do not specify the setting but rather argue that the financial incentives target all (health) care providers [ 28 , 37 ]. Two studies do not mention any setting [ 30 , 34 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Some studies focus on the role of financial incentives in the United States ( n = 5), Taiwan ( n = 4), United Kingdom ( n = 3), Sweden [ 26 ], Japan [ 41 ], Germany [ 29 ], Canada [ 36 ], Norway [ 40 ] and Ireland [ 42 ]. Two studies do not focus on any particular intervention country but rather discuss the importance of appropriate financial incentives [ 30 , 34 ].…”
Section: Resultsmentioning
confidence: 99%
“…As shown in Table 4 , majority of studies ( n = 16) investigate the impact of the financial incentives on care coordination that is measured with the use of process and/or outcome indicators. Three studies do not measure the effect of financial incentives [ 26 , 30 , 34 ]. Overall, from included studies, seven studies report on the positive effect of financial incentives on care coordination, six studies demonstrate to have unclear or have no effect, and three studies show a negative effect of financial incentives.…”
Background
Suboptimal care transitions of older adults may ultimately lead to worse quality of care and increased costs for the health and social care systems. Currently, policies and financing often focus on care in specific settings only, and neglect quality of care during transitions between these settings. Therefore, appropriate financing mechanisms and improved care coordination are necessary for effective care transitions. This study aims to review all available evidence on financial aspects that may have an impact on care transitions in LTC among older adults.
Methods
This systematic review was performed as part of the European TRANS-SENIOR project. The databases Medline, EMBASE (Excerpta Medica Database) and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they reported on organizational and financial aspects that affect care transitions in long-term care systems.
Results
All publications included in this review (19 studies) focused specifically on financial incentives. We identified three types of financial incentives that may play a significant role in care transition, namely: reimbursement mechanism, reward, and penalty. The majority of the studies discussed the role of rewards, specifically pay for performance programs and their impact on care coordination. Furthermore, we found that the highest interest in financial incentives was in primary care settings.
Conclusions
Overall, our results suggest that financial incentives are potentially powerful tools to improve care transition among older adults in long-term care systems and should be taken into consideration by policy-makers.
Trial registration
A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42020162566.
“…In improving performance, restitution should be commensurate, fair, and appropriate according to the hospital's financial capacity. Buchan et al stated that remuneration takes a strategic portion in the hospital as a performance boost and evaluates efficient and effective health services (Ekdahl 2014).…”
The compensation system is very critical and sensitive in the company. So that not a few companies are experiencing difficulties due to compensation that appears not implemented properly. The primary purpose of this study was to determine the remuneration system at PKU Aisyiyah Hospital Jepara. This study uses observation and in-depth interviews with selected respondents to collect data and analyzes with a qualitative approach using an action research design. The qualitative case study used purposive sampling involving nine people directly involved in the compensation process: three directors, three heads of general and finance divisions, and three finance staff. Some hospitals have not implemented the 2017 Permendiknas, but they have generally implemented several remuneration principles. This research has implications for the process of providing remuneration to hospital employees and recommendations for hospital managers to improve the application of remuneration according to PERMEN 2017.
A MMSE-score < 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.
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