Oral Trac
k
University of Indonesia, Indonesia
Backgraund: Problem of quality and satisfaction of patient relate to the health services are concerned not only to the patients but also to the family, community, provider and the government. The trend of dissatisfaction of the consumers to the health services are getting worse. Method: The design of this research is a survey.
Resource of this research is secondary data. Data were driven the Health Base Research 2007 of Center of Research and Development, Deparment of Health, Republic of Indonesia.
Results: the research find that 20% of the respondent perceive the hospitalization care is bad and 77% of respondent perceive is good. The level of unsatisfaction on the hospitalization care is alarming; that is why many the rich group people are not buying the hospitalization care from the hospitals in North Sumatera. Many of them are buying the overseas hospitalization care. Based on quantitative analyses we find there are strong correlation between factor the type of hospital, cost of health care, and the payer relate to the satisfaction of hospitalization care (P<0.05).
Conclusions: The trend of increasing the unsatisfied on the hospitalization care is alarming. It is needed the development and training in the service excellence for staff medical and administrative services of hospital in the North Sumatera Province.
OT27-7
Factors Associated to Patient and Health Care System Delays in Tuberculosis Diagnosis in Thaibinh Province, Vietnam
Huyen Thi Thanh Truong, Siripanichgon Kanokrat, Siri Sukhontha
Mahidol University, Thailand
Delay in tuberculosis diagnosis would lead to extend infectious period of tuberculosis (TB) patients, increase risk of TB transmission and mortality rate. This study aimed to assess delay in TB diagnosis among new smear positive (NSP) pulmonary TB patients in Thaibinh province and to identify risk factors of TB diagnosis delay. A cross-sectional study was conducted in Thaibinh during 1st to 20th February 2009. A total of 198 new smear positive TB patients who registered treatment under TB control program in the fourth quarter of 2008 onward were interviewed by structured
questionnaire. Median (range) patient delay was 17 days (0-251), health care system delay was 13 days (0-240) and for diagnosis delay it was 40 days (2-285). Risk factors for patient delay (>17 days) were single status, no religion and poor knowledge on cause and transmission of TB. The important factors associated with health care system delay (>13 days) were private health sector or communal health post as the first visit. Overall diagnosis delay (>40 days) were associated with middle and elderly age groups, living in rural, low education, being farmer, non-smoke, poor TB knowledge, particularly on
cause and transmission of TB. Health education strategies needed to conduct for targeted groups to raise TB awareness. For enhancing quality of health care services at peripheral level, building capacity of communal health workers were required to carry out. In addition, development of referral system between private and public health sectors could help TB program in early detection and diagnosis of TB.
OT27-8
The Relationship between Surgeon Volume and Hospitalization Costs for Patients with Oral Cancer: A Nationwide Population-Based Study in Taiwan
Ching-Chih Michael Lee
1. Buddist Dalin Tzu Chi General Hospital, Taiwan 2. National Yang-Ming University, Taiwan
3. Tzu Chi University, Taiwan
Background: Oral cancer leads to considerable health care use. Wide resection of tumor and reconstruction with pedicle flap/ free flap is widely used. This study was conducted to explore the relationship between hospitalization costs and surgeon case volume.
Methods: This study uses data for the years 2005 to 2006 obtained from the National Health Insurance Research Database published in the Taiwanese National Health Research Institute. From a population-based data covering the years 2005 to 2006, the authors selected a total of 2663 oral cancer patients who underwent resection of tumor and reconstruction from the Taiwan National Health Insurance Research Database. Case volume relationships were based on the following criteria; low-, medium-, high-, very high-volume surgeons were defined by ≦9, 10-29, 30-55, ≧56 resections with reconstruction, respectively. Hierarchical linear regression analysis was subsequently performed to explore the relationship between surgeon case volume and hospitalization costs and days.
Results: The mean hospitalization costs among the 2663 patients were $ 9528 (all costs are given in U.S. dollars). After adjusting for physician, hospital, and patient characteristics in hierarchical liner regression model, the costs per patient for were found to be $785 (p=0.008) higher than those for medium-volume surgeons, $1753 (p<0.001) higher than those for high-volume surgeons, and $1940 (p<0.001) higher than those for
very-high-volume surgeons.
Conclusions: After adjusting for physician, hospital, and patient characteristics, low-volume surgeons performing wide excision with reconstruction surgery in oral cancer patients incurred significantly higher costs per patient than others.
