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Transformation of health care and the new model of care in Saudi Arabia: Kingdom's Vision 2030.医疗保健的转型与沙特阿拉伯的新型医疗模式:王国的 2030 愿景。
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Hospital revenue cycle management and payer mix: do Medicare and Medicaid undermine hospitals' ability to generate and collect patient care revenue?医院收入周期管理与支付方组合:医疗保险和医疗补助是否会削弱医院产生和收取患者护理收入的能力?
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沙特政府医院收入周期管理的未来之路与挑战

The Road Ahead and Challenges of Revenue Cycle Management in Saudi Governmental Hospitals.

作者信息

Alradhi Zainab, Alanazi Abdullah

机构信息

Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia.

King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia.

出版信息

Healthcare (Basel). 2023 Oct 12;11(20):2716. doi: 10.3390/healthcare11202716.

DOI:10.3390/healthcare11202716
PMID:37893790
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10606396/
Abstract

Healthcare providers use revenue cycle management (RCM) to track patient billing and revenue. The revenue cycle collects data from various systems and compiles it into a single RCM system connected to payers. Effective system integration improves revenue and financial stability. The aim is to assess RCM feasibility in Saudi Arabia's governmental hospitals, examine financial management, and recommend practical implementation. In this study, healthcare leaders were interviewed face-to-face and via audio recording to collect qualitative data in response to semi-structured questions. Key informants from seven main hospitals were interviewed. Respondents understood RCM and identified internal and external challenges in hospital financial management. Government hospitals face accountability obstacles. Two of the seven surveyed hospitals operate business clinics using a fee-for-service model. The billing system is not integrated with the information system. The RCM system faces challenges such as unclear vision, lack of accountability, staff resistance, process redesign, and importance of project management. Despite these challenges, respondents still value RCM and recognize its importance in improving hospital revenue management. Effective implementation of RCM requires significant transformational processes, including vision, governance, accountability, proper training, and effective monitoring and evaluation processes. Communication should also be emphasized, and the patient's perspective must be brought into focus. Involving all stakeholders can create direct and holistic patient benefits; therefore, bringing them on board is crucial. New approaches are required to enhance healthcare in Saudi Arabia, addressing gaps in revenue optimization and RCM. Future research should evaluate the move from government-funded to self-operated hospitals, providing a better understanding of the challenges and opportunities.

摘要

医疗服务提供者使用收入周期管理(RCM)来跟踪患者计费和收入。收入周期从各种系统收集数据,并将其汇编到一个与付款人相连的单一RCM系统中。有效的系统集成可提高收入和财务稳定性。目的是评估沙特阿拉伯政府医院中RCM的可行性,检查财务管理,并推荐实际的实施方法。在本研究中,通过面对面访谈和录音采访医疗保健领导者,以收集针对半结构化问题的定性数据。采访了来自七家主要医院的关键信息提供者。受访者了解RCM,并确定了医院财务管理中的内部和外部挑战。政府医院面临问责障碍。七家接受调查的医院中有两家使用按服务收费模式经营商业诊所。计费系统未与信息系统集成。RCM系统面临着诸如愿景不清晰、缺乏问责制、员工抵制、流程重新设计以及项目管理的重要性等挑战。尽管存在这些挑战,受访者仍然重视RCM,并认识到其在改善医院收入管理方面的重要性。RCM的有效实施需要重大的变革过程,包括愿景、治理、问责制、适当的培训以及有效的监测和评估过程。还应强调沟通,并且必须关注患者的观点。让所有利益相关者参与可以为患者带来直接和全面的好处;因此,让他们参与进来至关重要。需要新的方法来改善沙特阿拉伯的医疗保健,解决收入优化和RCM方面的差距。未来的研究应该评估从政府资助医院向自营医院的转变,以便更好地理解其中的挑战和机遇。