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Removing anonymity protection and utilization review decisions: a real-world case under a single-payer health system

Authors :
Chih-Kuang Wang
Shih-Jung Chien
Po-Chang Lee
Shou-Hsia Cheng
Source :
Scientific Reports, Vol 12, Iss 1, Pp 1-8 (2022)
Publication Year :
2022
Publisher :
Nature Portfolio, 2022.

Abstract

Abstract The effects of anonymity on utilization review has never been examined in the real world. This study aimed to evaluate the impact of removing anonymity protection for claims reviewers on their review decisions. Using a single-blinded repeated measures design, we randomly selected 1457 claims cases (with 12,237 orders) that had been anonymously reviewed and reimbursed in 2016 and had them re-reviewed in a signed review program in 2017 under the Taiwanese National Health Insurance scheme. The signed review policy significantly decreased the likelihood of a deduction decision at the case and the order level (P

Subjects

Subjects :
Medicine
Science

Details

Language :
English
ISSN :
20452322
Volume :
12
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Scientific Reports
Publication Type :
Academic Journal
Accession number :
edsdoj.068ddb458a743ff9e5a98b8b255e55b
Document Type :
article
Full Text :
https://doi.org/10.1038/s41598-022-16536-1