Optimization of Medical Supervision, Management, and Reimbursement of contemporary Home Care

Optimization of Medical Supervision, Management, and Reimbursement of contemporary Home Care

B. Spyropoulos (Technological Education Institute of Athens, Greece), M. Botsivaly (Technological Education Institute of Athens, Greece), A. Tzavaras (Technological Education Institute of Athens, Greece) and K. Koutsourakis (Technological Education Institute of Athens, Greece)
DOI: 10.4018/978-1-60960-561-2.ch605

Abstract

Adapting medical and managerial decision-making (Spyropoulos, 2006a) in the modern home care environment is a cardinal prerequisite, in order to ensure, first, an economically sustainable development of the aging population healthcare (Scarcelli, 2001); second, the rehabilitation services required for impaired persons; and finally, the psychosomatic support necessary in the developed countries, during the next decades. Thus, a strategic question emerges that is how home care will be medically supervised and financially reimbursed. The present study attempts to describe the present situation and the contemporary technological trends in home care; more specific, it is focused on a system developed by our team that intends first, to enable the optimal documentation of the provided home care, and second, to facilitate the acquisition of all relevant financial data, leading to a fair remuneration of the services offered.
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Introduction

The concepts of health, sickness, and illness are subject to the specific sociocultural conditions under which they are considered, and, on the basis of which medical care is provided (Spyropoulos & Papagounos, 1995). The concepts and the methods involved in diagnosis and treatment are subject to the prevalent at the time theoretical model of disease. Hospitals, as a social institution, emerged as a response to particular needs and corresponded to the specific level of the understanding of health and disease. About 2,500 years ago, the temples of Asklepeios, the god of medicine, were probably the first well organized houses of refuge for the sick and training schools for physicians. Hospitals also existed in India under Buddhist auspices as early as the 3rd century BCE. The number of hospitals grew in the first centuries of the Christian era. In the 4th century AD, hospitals were founded in Caesarea and in Rome. Throughout the Byzantine time, the Middle Ages, the Arab and Ottoman dominance periods, the Renaissance, and even later, hospitals were almost entirely run by religious Christian or Islamic groups. During all these centuries, home care remains the main and usually the unique mode of treatment for the majority of the people world-wide. Only during the 18th century, hospitals ceased to be purely philanthropic institutions and they started to assume the character of a social institution where a systematic and theory-infused approach to disease prevailed. From the middle of the 19th century on, the number of hospitals, particularly in Europe and in the USA, increased, principally because of the discovery of anesthesia, aseptic surgical techniques, and, by the end of the century, the introduction of the x-rays. The demand for hospital services expanded further with the spread of prosperity, and with the introduction of various forms of hospitalization insurance, especially in England and in Germany, where the first obligatory and generalized social insurance system is introduced. It is the first time in the human history that home care ceased to be the main way of providing healthcare, and hospital treatment became gradually an important social right.

The modern hospital emerged gradually and successively, during a very long historical development, from a religious philanthropy institution to the contemporary managed care Establishment. The civil structure, the social demands, and the individual performance were always and are still reflected, on the hospital, throughout the centuries. Therefore, the 21st century hospital will provide a radically different professional activity environment, and a quite different professional-patient interaction modus; it will increasingly encourage telemedicine (De Leo, 2002) supported home care because of the increase of mean life expectancy, and the hospital care cost avalanche (Wipf & Langner, 2006; Woolhandler, Campbell, & Himmelstein, 2003). Its mission will be completed by a network of various associated Institutions, providing care rather closer to home care, than to that of the traditional hospital-care (Brazil, Bolton, Ulrichsen, & Knott, 1998).

Adapting medical and managerial decision-making (Spyropoulos, 2006a) in the modern home care environment is a cardinal prerequisite, in order to ensure, first, an economically sustainable development of the aging population healthcare (Scarcelli, 2001); second, the rehabilitation services required for impaired persons; and finally, the psychosomatic support necessary in the developed countries, during the next decades. Thus, a strategic question emerges that is how home care will be medically supervised and financially reimbursed. The present study attempts to describe the present situation and the contemporary technological trends in home care; more specific, it is focused on a system developed by our team that intends first, to enable the optimal documentation of the provided home care, and second, to facilitate the acquisition of all relevant financial data, leading to a fair remuneration of the services offered.

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