Evidence map›Paper›PMID 35842541›Full record

ArticleScientific reports2022

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

Chih-Kuang Wang, Shih-Jung Chien, Po-Chang Lee, Shou-Hsia Cheng

Open access · goldAbstract read
In one paragraph

Article in Scientific reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact, top 84% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 0 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Chih-Kuang WangDepartment of Planning, National Health Insurance Administration, Taipei, Taiwan.
Shih-Jung ChienDepartment of Medical Affairs, National Health Insurance Administration, Taipei, Taiwan.
Po-Chang LeeNational Health Insurance Administration, Taipei, Taiwan.
Shou-Hsia ChengInstitute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Road, Room 618, Taipei, 10055, Taiwan. shcheng@ntu.edu.tw.
National Taiwan University · TW

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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 < 0.001). Furthermore, signed reviewers tended to make more "too lenient" decisions, and were less likely to make "too harsh" decisions. Removing anonymity protection dramatically reduced the deduction rate and overturned the tendency of decisions from "too harsh" to "too lenient". However, whether to maintain the anonymity of utilization reviews is a challenge for health authorities around the globe.

Indexed as

Research DesignUtilization Review

Identifiers

PMID35842541
PMCPMC9288443
OpenAlexW4285588803

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.