Table 2 Participants’ experiences with challenges and alternative payment methods in the neonatal intensive care unit payment system
Experiences and challenges | ||
|---|---|---|
themes | subthemes | Codes |
Service accessibility | Potential unavailability | Low number of NICU beds in the country |
Shortage of NICU beds in the private sector | ||
Shortage of specialist neonatologists | ||
Failure to employ senior NICU nurses | ||
Financial barriers | The difference between public and private tariffs | |
High cost due to equipment and nursing | ||
Low economic access for parents | ||
High Out-of-pocket payments and financial risk in private hospitals | ||
Increase out-of-pocket payments with outsourcing in NICU | ||
Insurance gaps | Lack of full insurance coverage for NICU care | |
Removing some drugs from the insurance package | ||
Coverage policies Heterogeneity of health insurers | ||
Service gap | lack of NICU facilities in maternity hospitals | |
High workload of neonatologists due to faulty referral system | ||
Lack of post-discharge supports | ||
Rising cost factors | Inefficiency | Extended stay due to Payment method type |
Failure to manage the length of stay in NICU | ||
Lack of standardized guidelines and protocols for NICU admission and discharge | ||
Reducing efficiency with outsourcing of NICU care | ||
Supply factors | High autonomy of doctors | |
Overtreatment | ||
Lack of awareness of costs | ||
Induce demand | ||
Lack of responsiveness of the care team | ||
Manipulation in manual coding | ||
Financial risk for insurance | ||
Output monitoring and control | The health system sets, implements, and controls its regulations | |
Untargeted supervision | ||
Few observers | ||
Lack of regulatory infrastructure | ||
Payment under the table | ||
System organization | Lack of communication or coordination between perinatal care and delivery department | |
High frequency of visits to specialist doctors | ||
Readmission of the patient | ||
Lack of infrastructure for pregnancy care packages | ||
Defective referral system | ||
Income consideration of neonatologists | Payment delays | Payment of doctors’ wages as desired |
The hospital’s use of the doctor’s fee is the reason for the delay | ||
Delay in payment to the hospital by the insurance - time of payment | ||
Deprivation of doctors from income (non-payment of 30%) | ||
Payment mismatch | Improper payment distribution of doctors in the morning, noon and evening | |
Unfair distribution of income in the hospital | ||
Tariffs are unfair as a result of currency fluctuations | ||
Provider dissatisfaction | Lack of interest of the neonatal field among medical students | |
Dissatisfaction of the providers with the low salary | ||
Inconsistency of the current payment method with the facts | ||
Low tariff compared to other countries | ||
Unclear tariff structures | Tariff manipulation in favor of special experts | |
NICU services cost more than the tariff | ||
Conflict of interest in the professional tariff | ||
Failure to evaluate the feasibility of tariffs | ||
Variety of private and public sector tariffs | ||
Deep diversity gap between different specialties | ||
Quality of service delivery | Quality indicators and standards | Failure to pay attention to service quality indicators |
Indications are tasteful | ||
Non-examination of external control by insurance (non-supervision) | ||
Quality outcomes and risks | Threatening the health of the baby with additional services | |
Prolonged separation of mother and baby with long hospitalization due to payment method | ||
Buyer’s dissatisfaction with ungraded services | ||
Quality improvement and barriers | High work pressure of nurses | |
Dissatisfaction of nurses | ||
Reuse of equipment | ||
Lack of communication between obstetrics and gynecology department | ||
Lack of resources in the hospital | ||
The excesses of doctors | ||
Lack of pediatricians | ||
Proposed Alternative methods by respondents | ||
themes | subthemes | Codes |
Payment methods | A modified payment method based on the current one | FFS by modifying tariffs |
FFS by imposing fines | ||
Per diem + quality indicators | ||
Per diem + considering the number of procedures | ||
Per diem plus classification based on the complexity of care of care | ||
Fixed payment to physicians | The fixed payment should be made regardless of the services provided | |
Fixed salary plus a percentage of hospital profits | ||
Combining fixed salary with performance incentives | ||
Diagnosis Related Group (DRG) for a package of services | ||