2,159 results match your criteria reimbursement inpatient

Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy.

Matern Child Health J 2021 Jun 9. Epub 2021 Jun 9.

Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, 46 Armstrong Street SE, Atlanta, GA, 30303, USA.

Objectives: The postpartum period is a time of high unmet contraception need. Providing long-acting reversible contraception (LARC), particularly in the immediate postpartum period, is one strategy to meet contraceptive needs. This practice may also prevent unintended and short interpregnancy interval pregnancies. Read More

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Temporal Patterns of High-Spend Subgroups Can Inform Service Strategy for Medicare Advantage Enrollees.

J Gen Intern Med 2021 Jun 7. Epub 2021 Jun 7.

OptumLabs at UnitedHealth Group, Minneapolis, MN, USA.

Background: Most healthcare costs are concentrated in a small proportion of individuals with complex social, medical, behavioral, and clinical needs that are poorly met by a fee-for-service healthcare system. Efforts to reduce cost in the top decile have shown limited effectiveness. Understanding patient subgroups within the top decile is a first step toward designing more effective and targeted interventions. Read More

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Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis.

J Pharm Pract 2021 Jun 3:8971900211021258. Epub 2021 Jun 3.

Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA.

Background: Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy.

Methods: This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Read More

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Benefit of China's Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform.

Int J Environ Res Public Health 2021 May 25;18(11). Epub 2021 May 25.

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.

With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. Read More

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Funding Innovative Dialysis Technology in the United States: Home Dialysis and the ESRD Transitional Add-on Payment for New and Innovative Equipment and Supplies (TPNIES).

Am J Kidney Dis 2021 May 26. Epub 2021 May 26.

Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota.

Innovative, patient-centered, and pragmatic dialysis technologies are urgently needed to accommodate the growing national interest in home dialysis use. To help achieve this goal, the Centers for Medicare and Medicaid Services are expanding reimbursement for eligible home dialysis machines through an existing payment mechanism, the transitional add-on payment for new and innovative equipment and supplies (TPNIES). This mechanism incentivizes the early adoption of innovative equipment into practice by reimbursing dialysis providers up to 26% of the total cost of approved home dialysis machines. Read More

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Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam.

JAC Antimicrob Resist 2021 Jun 17;3(2):dlab040. Epub 2021 May 17.

Essex Partnership University NHS Trust, Wickford, UK.

Objectives: To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice.

Methods: An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Read More

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Economic Study of 2-Stage Exchange in Patients With Knee or Hip Prosthetic Joint Infection Managed in a Referral Center in France: Time to Use Innovative(s) Intervention(s) at the Time of Reimplantation to Reduce the Risk of Superinfection.

Front Med (Lausanne) 2021 10;8:552669. Epub 2021 May 10.

Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.

Chronic prosthetic joint infections (PJI) are serious complications in arthroplasty leading to prosthesis exchange and potential significant costs for health systems, especially if a subsequent new infection occurs. This study assessed the cost of chronic PJI managed with 2-stage exchange at the Lyon University Hospital, CRIOAc Lyon reference center, France. A threshold analysis was then undertaken to determine the reimbursement tariff of a hypothetical preventive device usable at the time of reimplantation, which possibly enables health insurance to save money according to the risk reduction of subsequent new infection. Read More

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Left behind again: Rural home health services in a Medicaid pediatric accountable care organization.

J Rural Health 2021 May 12. Epub 2021 May 12.

Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA.

Purpose: To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees.

Methods: Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10-year period between 2010 and 2019. Read More

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[Cost coverage for complex paediatric spinal deformities with preoperative halo traction-an economic problem?]

Orthopade 2021 May 12. Epub 2021 May 12.

Klinik u. Poliklinik für Orthopädie, Unfallchirurgie u. Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.

Background: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered.

Materials And Methods: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. Read More

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Direct medical costs of interprosthetic femoral fracture treatment: A cohort analysis.

Injury 2021 Apr 23. Epub 2021 Apr 23.

Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, UK; Academic Department of Trauma and Orthopaedics, University of Leeds, UK. Electronic address:

Introduction: Periprosthetic femoral fractures (PPFs) represent a challenging clinical problem with a fast-rising incidence. Interprosthetic fractures (IPFs) represent one of its most difficult variants. There is a paucity of data regarding the financial burden of PPFs, and none for IPFs. Read More

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An equity evaluation in stroke inpatients in regard to medical costs in China: a nationwide study.

BMC Health Serv Res 2021 May 5;21(1):425. Epub 2021 May 5.

School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, People's Republic of China.

Background: Stroke has always been a severe disease and imposed heavy financial burden on the health system. Equity in patients in regard to healthcare utilization and medical costs are recognized as a significant factor influencing medical quality and health system responsiveness. The aim of this study is to understand the equity in stroke patients concerning medical costs and healthcare utilization, as well as identify potential factors contributing to geographic variation in stroke patients' healthcare utilization and costs. Read More

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Improving Arthroplasty Efficiency and Quality Through Concentrating Service Volume by Complexity: Surviving the Medicare Policy Changes.

J Arthroplasty 2021 Apr 20. Epub 2021 Apr 20.

Department of Orthopaedic Surgery, Brigham and Women's Health, Boston, MA.

We have an academic medical center (AMC), an associated community-based hospital (CBH) and several ambulatory care centers which are being prepared to provide same day discharge (SDD) total joint arthroplasty (TJA) and unicompartmental knee arthroplasty (UKA). The near-capacity AMC cared for medically and technically complicated TJA patients. The CBH wanted to increase volume, improve margins, and become a center of excellence with an efficient hospital outpatient department and SDD TJA experience. Read More

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Detailed analysis of in-hospital costs for adult patients with type III intestinal failure: A single-center study with global implications.

JPEN J Parenter Enteral Nutr 2021 Apr 30. Epub 2021 Apr 30.

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.

Background: Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, owing to IF's rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing costs. Read More

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Best Practices for Using Telehealth in Hospice and Palliative Care.

J Hosp Palliat Nurs 2021 06;23(3):277-285

Hospice and palliative care providers throughout the United States have continued to provide compassionate patient- and family-centered care during the COVID-19 (coronavirus disease 2019) pandemic while adapting to the need for scrupulous infection control measures and the accelerated use of telehealth. Prior to the pandemic, hospice and palliative care adopted telehealth slowly compared with other specialties, but its rapidly increasing utilization during the COVID-19 pandemic has long-term implications for access to primary and specialty palliative care, particularly for patients in rural communities and populations experiencing inequitable access to services. Telehealth also shows great promise for leveraging technology to provide care more effectively and efficiently. Read More

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Assessment of the introduction of DRG-based reimbursement in Switzerland: Evidence on the short-term effects on length of stay compliance in university hospitals.

Health Policy 2021 Jun 4;125(6):739-750. Epub 2021 Mar 4.

University of Lucerne, Department of Health Sciences and Health Policy and Center for Health, Policy and Economics, Frohburgstrasse 3, PO Box 4466, CH-6002 Lucerne, Switzerland. Electronic address:

The implementation of a nationwide diagnosis-related groups (DRG) reimbursement system in 2012 marked an important step in increasing the transparency and efficiency of hospital services in Switzerland. However, no clear evidence exists to date on the response of hospitals to the introduction of SwissDRG. Using administrative data on inpatient stays in Swiss university hospitals and the length of stay compliance (LOSC) as a measure of hospital performance, we find a significant short-term reduction in LOSC for hospitals that experienced a change from retrospective per diem to prospective DRG reimbursement, compared to hospitals with a prospective payment system already before 2012. Read More

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The Economic Impact of COVID-19 Treatment at a Hospital-level: Investment and Financial Registers of Brazilian Hospitals.

J Health Econ Outcomes Res 2021 Apr 16;8(1):36-41. Epub 2021 Apr 16.

Grupo Hospital Nossa Senhora da Conceição, Brazil.

The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. This research covers the initial findings of "COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system," which includes 10 hospitals. Read More

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Understanding value and patient complexity among common inpatient vascular surgery procedures.

J Vasc Surg 2021 Apr 19. Epub 2021 Apr 19.

Department of Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address:

Objective: Vascular surgery patients are highly complex, second only to patients undergoing cardiac procedures. However, unlike cardiac surgery, work relative value units (wRVU) for vascular surgery were undervalued based on an overall patient complexity score. This study assesses the correlation of patient complexity with wRVUs for the most commonly performed inpatient vascular surgery procedures. Read More

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[How Often is Rare Really Rare? A Survey on the Frequency of Rare Diseases at a University Hospital].

Gesundheitswesen 2021 Apr 15. Epub 2021 Apr 15.

Klinik und Poliklinik für Kinder- und Jugendmedizin, Dresden University Hospital, Dresden, Deutschland.

Aim Of Study: The prevalence of rare diseases in hospitals and in university hospitals is unknown. As the ICD-10 coding system does not adequately represent rare diagnoses, the prevalence of rare diseases cannot be estimated based on ICD-10 coded discharge diagnoses. The current hospital reimbursement system does not seem to be designed to capture performance-related higher expenditures in the treatment of rare diseases. Read More

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Perspectives on outpatient administration of CAR-T cell therapy in aggressive B-cell lymphoma and acute lymphoblastic leukemia.

J Immunother Cancer 2021 Apr;9(4)

BMT & Cell Therapy Program, Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.

Chimeric antigen receptor (CAR) T-cell therapies that specifically target the CD19 antigen have emerged as a highly effective treatment option in patients with refractory B-cell hematological malignancies. Safety and efficacy outcomes from the pivotal prospective clinical trials of axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel and the retrospective, postmarketing, real-world analyses have confirmed high response rates and durable remissions in patients who had failed multiple lines of therapy and had no meaningful treatment options. Although initially administered in the inpatient setting, there has been a growing interest in delivering CAR-T cell therapy in the outpatient setting; however, this has not been adopted as standard clinical practice for multiple reasons, including logistic and reimbursement issues. Read More

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Is the routine health information system ready to support the planned national health insurance scheme in South Africa?

Health Policy Plan 2021 Jun;36(5):639-650

Burden of Disease Research Unit, South African Medical Research Council. South Africa.

Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional health-records review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Read More

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Clinical Benefits and Cost-Effectiveness of Moxifloxacin as Initial Treatment for Community-Acquired Pneumonia: A Meta-Analysis and Economic Evaluation.

Clin Ther 2021 Apr 1. Epub 2021 Apr 1.

School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China. Electronic address:

Purpose: Moxifloxacin and levofloxacin are currently recommended as empirical initial treatment options for community-acquired pneumonia (CAP) in China according to guidelines. Most studies that evaluated the efficacy and safety of moxifloxacin and levofloxacin in treating CAP as initial empirical treatment were single-centered trials assessing different clinical end points. In addition, there is limited research investigating moxifloxacin's clinical benefits in the context of health care resource utilization and reimbursement from the payer's perspective in China. Read More

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Patient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement.

J Am Acad Orthop Surg Glob Res Rev 2021 04 1;5(4). Epub 2021 Apr 1.

From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.

Introduction: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a federally mandated survey that assesses patient satisfaction after hospitalization. It has been noted that a minority of patients actually return the survey. Potential bias in who does and does not respond to the survey (nonresponse bias) after total hip arthroplasty (THA) may affect the survey results. Read More

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Hospital at Home services: An inventory of fee-for-service payments to inform Medicare reimbursement.

J Am Geriatr Soc 2021 Apr 2. Epub 2021 Apr 2.

Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Hospital at Home (HaH) is a growing model of care with proven patient benefits. However, for the types of services required to provide an episode of HaH, full Medicare reimbursement is traditionally paid only if care is provided in inpatient facilities.

Design: This project identifies HaH services that could be reimbursable under Medicare to inform episodic care within fee-for-service (FFS) Medicare. Read More

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Annual epidemiological and health insurance disease burden of pertrochanteric fractures in Hungary

Orv Hetil 2021 03;162(162 Suppl 1):46-53

1 Pécsi Tudományegyetem, Egészségtudományi Kar, Egészségbiztosítási Intézet, Pécs, Vörösmarty u. 3., 7621.

Összefoglaló. Bevezetés: A pertrochanter töréssel kapcsolatos szolgáltatások igénybevétele jelentős terhet jelent a társadalom és az egészségügyi rendszerek számára. Célkitűzés: Elemzésünk célja volt a pertrochanter törés okozta éves epidemiológiai és egészségbiztosítási betegségteher meghatározása Magyarországon. Read More

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Nationwide epidemiological and health insurance disease burden of rheumatoid arthritis in Hungary

Orv Hetil 2021 03;162(162 Suppl 1):30-37

1 Pécsi Tudományegyetem, Egészségtudományi Kar, Egészségbiztosítási Intézet, Pécs, Vörösmarty u. 3., 7621.

Összefoglaló. Bevezetés: A rheumatoid arthritisszel kapcsolatos szolgáltatások igénybevétele nagy teher az egészségügyi rendszerek számára. Célkitűzés: Elemzésünk célja volt a rheumatoid arthritis okozta éves epidemiológiai és egészségbiztosítási betegségteher meghatározása Magyarországon. Read More

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Characterizing managing physicians by claims sequences in episodes of care.

J Biomed Inform 2021 May 22;117:103759. Epub 2021 Mar 22.

Analytics and Data Science Institute, Kennesaw State University, GA, USA.

Value-based healthcare in the US is a payment structure that ties reimbursement to quality rather than volume alone. One model of value-based care is the Tennessee Division of TennCare's Episodes of Care program, which groups common health conditions into episodes using specified time windows, medical code sets and quality metrics as defined in each episode's Detailed Business Requirements [1,2]. Tennessee's program assigns responsibility for an episode to a managing physician, presenting a unique opportunity to study physician variability in cost and quality within these structured episodes. Read More

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Reimbursement for Orthopaedic Surgeries in Commercial and Public Payors: A Race to the Bottom.

J Am Acad Orthop Surg 2021 Mar 22. Epub 2021 Mar 22.

From the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.

Introduction: The purpose of this study was to compare surgeon professional fee reimbursement and trends from Medicare versus commercial payors for inpatient orthopaedic surgeries: total knee arthroplasty (TKA), total hip arthroplasty (THA), total shoulder arthroplasty (TSA), anterior cervical diskectomy and fusion (ACDF), and posterior lumbar fusion (PLF).

Methods: Patients undergoing TKA, THA, TSA, single-level ACDF, and single-level PLF from 2010 to 2018 were queried in a commercially insured claims database. Medicare reimbursements and the work relative value unit (wRVU) of each procedure were obtained from the Medicare Physician Fee Schedule. Read More

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Comparison of 1-Year Health Care Costs and Use Associated With Open vs Robotic-Assisted Radical Prostatectomy.

JAMA Netw Open 2021 03 1;4(3):e212265. Epub 2021 Mar 1.

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York.

Importance: With the current patterns of adoption and use of robotic surgery and improvement in the overall survival of patients with prostate cancer, it is important to evaluate the immediate and long-term cost implications of treatments for patients with prostate cancer.

Objective: To compare health care costs and use 1 year after open radical prostatectomy (ORP) vs robotic-assisted radical prostatectomy (RARP).

Design, Setting, And Participants: This retrospective cohort study used a US commercial claims database from January 1, 2013, to December 31, 2018. Read More

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Association between Medicare's Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share.

BMC Health Serv Res 2021 Mar 19;21(1):248. Epub 2021 Mar 19.

Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1063, USA.

Background: Medicare's Hospital Readmissions Reduction Program (HRRP), implemented beginning in 2013, seeks to incentivize Inpatient Prospective Payment System (IPPS) hospitals to reduce 30-day readmissions for selected inpatient cohorts including acute myocardial infarction, heart failure, and pneumonia. Performance-based penalties, which take the form of a percentage reduction in Medicare reimbursement for all inpatient care services, have a risk of unintended financial burden on hospitals that care for a larger proportion of Medicare patients. To examine the role of this unintended risk on 30-day readmissions, we estimated the association between the extent of their Medicare share of total hospital bed days and changes in 30-day readmissions. Read More

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[Outsourcing of nursing staff costs in psychiatry? : A secondary data analysis of possible effects on the remuneration system in psychiatry].

Nervenarzt 2021 Mar 19. Epub 2021 Mar 19.

Peter L. Reichertz Institut für Medizinische Informatik der TU Braunschweig und der Medizinischen Hochschule Hannover, Mühlenpfordtstraße 23, 38106, Braunschweig, Deutschland.

Background: Nursing staff were excluded from the German DRG system for somatic hospital treatment and will be funded separately in the future. In psychiatry and psychosomatic medicine, binding personnel requirements have been defined but there has been no regulation of how these personnel requirements are adequately financed.

Objective: The objective of this study was to analyze the costs of inpatient psychiatry and psychosomatic medicine and to evaluate possible effects of funding nursing staff separately. Read More

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