Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

This paper examines primary care performance in three types of community health facilities in five provinces in northern Thailand. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were hampered by shortages of trained doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. While the plan is to move over time to doctor-staffed THPHs, many rural areas rely on facilities staffed by public health officers or nurses. The study used structured interviews to measure patient views on performance, defined in terms of accessibility, continuity, comprehensiveness, co-ordination and community orientation, in 23 THPHs divided across the three types. Counter-intuitively it was the THPHs staffed by public health officers which achieved the highest scores, followed by nurse-staffed facilities and then doctor-staffed facilities. The sharpest differences found were in the scores for accessibility, continuity, and comprehensiveness of care. The authors argue that these are associated with local services, which rural patients in particular value more than services offered by doctors on rotation in larger outpatient department-like centres. Patients value these aspects of care more than professional skill-mix per se. This is not an argument for delaying an increase in use of qualified staff, but an indication of the need to do this in a way that preserves the features of local services that patients value

Perceived, Actual, and Desired Knowledge Regarding Medicare Billing and Reimbursement: A National Needs Assessment Survey of Internal Medicine Residents

BACKGROUND: Economics and reimbursement have become a daily part of practicing physicians' lives. Yet, few internal medicine (IM) programs have offered formal curricula during residency about practice management or economics. OBJECTIVE: To determine perceived, desired, and actual knowledge of Medicare billing and reimbursement among residents compared with community-based General Internists. DESIGN AND PARTICIPANTS: Cross-sectional needs assessment survey of community and university-based second-year IM residents from 4 geographic regions of the United States. RESULTS: One hundred and thirty-three second-year IM residents completed the questionnaire. Residents rated their level of knowledge about Medicare as a 2.0 (SD = 0.9) on a Likert scale (1 = “very low,” 5 = “very high”). Residents agreed that Medicare reimbursement should be taught in residency with a score of 4.0 (SD = 1.1; 1 = “strongly disagree,” 5 = “strongly agree” SD = 1.1). On the knowledge assessment portion of the questionnaire, residents scored significantly lower than a group of general IM physicians who completed the same questions (percent correct = 41.8% vs 59.0%, P<.001). Residents' scores correlated with their self-assessed level of knowledge (P = .007). CONCLUSIONS: Our study demonstrates that second year IM residents feel they have a low level of knowledge regarding outpatient Medicare billing, and have a lower test score than practicing Internists to back up their feelings. The residents also strongly agree that they do not receive enough education about Medicare reimbursement, and believe it should be a requirement in residency training