Assessment of reimbursement mechanisms in terms of patient safety (A proposal of a system)

At the present time, studies aimed at preventing medical errors and adverse events and patient injuries resulting from these are increasingly drawing interest. In the meantime, it is observed that a number of strategies have been put in the place aimed at establishing practices in healthcare organizations about the notion of "patient safety" which can be described as a discipline and embraced by the studies mentioned above. Some reasons come along with especially developed countries such as unpreventable increase in healthcare expenditures, on the other hand not this increase to reflect on the patient outcomes are triggering a paradigm shift in healthcare. This shift is being realized in the direction of the focal point of discussion about the quality of healthcare, changing from healthcare organizations to the public or private health insurance organizations purchasing healthcare services. Patient safety studies are also observed to be influenced from this paradigm shift. A set of steps have been taken towards improving the existed potentials of insurance organizations in direction of incentivizing providers to deliver safe healthcare and removing barriers in achieving this. Thus the main objective of the present thesis is to present a proposal of a system which is peculiar to our country, prioritizing patient safety and can be helpful in achieving financial sustainability, by means of examining the steps taken especially in terms of reimbursement mechanisms. Accordingly, approaches of dealing with the notion of patient safety globally and locally examined in the first chapter of the present thesis. As for second chapter, reimbursement mechanisms used to make payments to the providers are discussed in the aspect of quality and patient safety for the purpose of to propose a model. In following third chapter, "Hospital Acquired Conditions" approach, which is both a comprehensible approach with regard to reimbursement practices and considers patient safety within the scope of value based purchasing, was addressed in the sense of research methodology. A research design was developed based on 14 hospital acquired conditions within cited approach and conducted in a research hospital. Kruskal-Wallis H, Mann-Whitney U and Chi-square tests were employed in the analysis of data gathered via the research process. According to the findings, there is statistically significant difference between patients with and without an HAC for HAC Categories of Catheter-Associated Urinary Tract Infection and Vascular Catheter-Associated Bloodstream Infection in terms of all three variables which is length of stay, cost and mortality. On the other hand, there is statistically significant difference for Surgical Site Infection Following Cardiac Implantable Electronic Device HAC category in terms of both length of stay and cost, and for Surgical Site Infection Following Coronary Artery Bypass Graft and Surgical Site Infection Following Certain Orthopedic Procedures HAC categories in terms of only length of stay. All in all, a proposal of a system based on patient safety and financial sustainability was presented in the light of findings obtained from analysis and the knowledge obtained from literature research in the last chapter of the present study.