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https://www.readbyqxmd.com/read/29903000/assessing-out-of-pocket-expenditures-for-primary-health-care-how-responsive-is-the-democratic-republic-of-congo-health-system-to-providing-financial-risk-protection
#1
Samia Laokri, Rieza Soelaeman, David R Hotchkiss
BACKGROUND: The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage...
June 15, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29894233/value-based-surgical-care-a-view-from-the-surgeon-s-knife
#2
Alice Ca Murray
NHS trusts across the country are facing unprecedented financial pressures, along with rising levels of demand and widespread variation in surgical quality and cost. There is a moral and financial imperative to provide the most efficient use of resources in order to ensure sustainability of a system that is free at the point of use, and provide consistently high-value care for patients across the country. Delivering 'value' does not mean any reduction in the quality of care - it means achieving the same or higher quality at the same or lower cost...
June 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29891194/association-of-medicare-s-bundled-payment-reform-with-changes-in-use-of-vitamin-d-among-patients-receiving-maintenance-hemodialysis-an-interrupted-time-series-analysis
#3
Julia Spoendlin, Sebastian Schneeweiss, Theodore Tsacogianis, Julie M Paik, Michael A Fischer, Seoyoung C Kim, Rishi J Desai
BACKGROUND & RATIONALE: Medicare's 2011 prospective payment system (PPS) was introduced to curb overuse of separately billable injectable drugs. After epoietin, intravenous (IV) vitamin D analogues are the biggest drug cost drivers in hemodialysis (HD) patients, but the association between PPS introduction and vitamin D therapy has been scarcely investigated. STUDY DESIGN: Interrupted time-series analyses. SETTING & PARTICIPANTS: Adult US HD patients represented in the US Renal Data System between 2008 and 2013...
June 8, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29870111/-pay-for-success-financing-and-home-based-multicomponent-childhood-asthma-interventions-modeling-results-from-the-detroit-medicaid-population
#4
Paula M Lantz, George Miller, Corwin N Rhyan, Sara Rosenbaum, Leighton Ku, Samantha Iovan
Policy Points: The Pay for Success (PFS) financing approach has potential for scaling the implementation of evidence-based prevention interventions in Medicaid populations, including a range of multicomponent interventions for childhood asthma that combine home environment risk mitigation with medical case management. Even though this type of intervention is efficacious and cost-saving among high-risk children with asthma, the main challenges for implementation in a PFS context include legal and regulatory barriers to capturing federal Medicaid savings and using them as a source of private investor repayment...
June 2018: Milbank Quarterly
https://www.readbyqxmd.com/read/29794522/medicaid-innovations-and-the-role-of-academic-health-centers
#5
Sheldon M Retchin, Wendy Yi Xu
Although they represent less than 8% of all U.S. hospitals, academic health centers (AHCs) deliver almost 40% of the inpatient care for Medicaid beneficiaries. However, because of low Medicaid reimbursement rates, AHCs have had to rely on supplemental funding sources, such as disproportionate share hospital (DSH) payments and upper payment limit (UPL) payments. Recent legislative efforts and changes to payment structures have made these sources vulnerable to severe reductions. For instance, DSH payments are scheduled to be cut by $8 billion by 2021, and UPL payments are a diminishing resource for many states because the program is based on a fee-for-service model and most states are moving to managed care...
May 22, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29793470/universal-health-coverage-in-the-context-of-population-ageing-what-determines-health-insurance-enrolment-in-rural-ghana
#6
Nele Van der Wielen, Andrew Amos Channon, Jane Falkingham
BACKGROUND: Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC...
May 24, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29762274/decomposing-medicaid-spending-during-health-system-reform-and-aca-expansion-evidence-from-oregon
#7
Stephanie Renfro, Stephan Lindner, K John McConnell
BACKGROUND: Expansion of the Medicaid program is likely to create new budgetary pressures at the state and federal levels, creating a need for greater understanding of how program dollars are allocated and what drives spending growth. OBJECTIVE: To characterize Oregon Medicaid expenditures across diseases and medical conditions, during periods of payment reform and coverage expansion. RESEARCH DESIGN: Decomposition of changes in Medicaid expenditures using a person-based allocation of spending across 50 diseases/medical conditions...
July 2018: Medical Care
https://www.readbyqxmd.com/read/29754969/pathways-to-drg-based-hospital-payment-systems-in-japan-korea-and-thailand
#8
Peter Leslie Annear, Soonman Kwon, Luca Lorenzoni, Stephen Duckett, Dale Huntington, John C Langenbrunner, Yuki Murakami, Changwoo Shon, Ke Xu
Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand...
May 7, 2018: Health Policy
https://www.readbyqxmd.com/read/29734968/impacts-of-the-type-of-social-health-insurance-on-health-service-utilisation-and-expenditures-implications-for-a-unified-system-in-china
#9
Si Ying Tan, Xun Wu, Wei Yang
While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model...
May 8, 2018: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/29734874/the-merit-based-incentive-payment-system-mips-a-primer-for-otolaryngologists
#10
Vinay K Rathi, Matthew R Naunheim, Mark A Varvares, Kenneth Holmes, Nancy Gagliano, Christopher J Hartnick
Following passage of the 2015 Medicare Access and CHIP Reauthorization Act, most clinicians caring for Medicare Part B patients were required to participate in a new value-based reimbursement system known as the Merit-based Incentive Payment System (MIPS) beginning in 2017. The MIPS adjusts payment rates to providers based on a composite score of performance across 4 categories: quality, advancing care information, clinical practice improvement activities, and resource use. However, factors such as practice size, setting, informational capabilities, and patient population may pose challenges as otolaryngologists endeavor to adapt to this broad-reaching payment reform...
May 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29727978/production-phase-greenhouse-gas-emissions-arising-from-deliberate-withdrawal-and-destruction-of-fresh-fruit-and-vegetables-under-the-eu-s-common-agricultural-policy
#11
Stephen D Porter, David S Reay, Elizabeth Bomberg, Peter Higgins
Since 1962 the Common Agriculture Policy (CAP) of the European Union (EU) has enabled payment of subsidy to some food producers for withdrawal of specific commodities - including fresh fruit and vegetables (FFV) - where market prices have fallen below a pre-set level. These deliberate withdrawals have led to large amounts of usable food (~60% of withdrawals) being destroyed on farms across the EU. Such wasted food incurs a significant climate change cost through its production-phase greenhouse gas (GHG) emissions...
August 1, 2018: Science of the Total Environment
https://www.readbyqxmd.com/read/29719177/reform-at-risk-mandating-participation-in-alternative-payment-plans
#12
Scott Levy, Nicholas Bagley, Rahul Rajkumar
In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was..
May 3, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29710238/insights-into-oropharyngeal-dysphagia-from-administrative-data-and-clinical-registries-a-literature-review
#13
Rebecca S Bartlett, Susan L Thibeault
Purpose: The call for data-driven health care has been bolstered by the digitization of medical records, quality initiatives, and payment reform. Administrative databases and clinical registries are increasingly being used to study oropharyngeal dysphagia and to facilitate data-driven decision making. The objective of this work was to summarize key findings, etiologies studied, data sources used, study objectives, and quality of evidence of all original research articles that have investigated oropharyngeal dysphagia or aspiration pneumonia using administrative or clinical registry data to date...
May 3, 2018: American Journal of Speech-language Pathology
https://www.readbyqxmd.com/read/29704683/rates-of-hospital-readmission-among-medicare-beneficiaries-with-gastrointestinal-bleeding-vary-based-on-etiology-and-comorbidities
#14
Shazia Mehmood Siddique, Shivan J Mehta, James Lewis, Mark D Neuman, Rachel M Werner
BACKGROUND & AIMS: Gastrointestinal bleeding results in significant morbidity, mortality, and healthcare costs in the United States. The Center for Medicare and Medicaid Services' payment reform programs assess quality and value based on rates of hospital readmission for patients with gastrointestinal bleeding, but they identify these patients using Medicare Severity Diagnosis Related Groups (MS-DRGs), which include many types of gastrointestinal bleeding and do not account for the clinical heterogeneity among these patients...
April 25, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29697433/ensuring-access-to-quality-health-care-in-vulnerable-communities
#15
Jay Bhatt, Priya Bathija
For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed...
April 24, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29679224/payment-reform-to-transform-primary-care-what-more-is-needed
#16
EDITORIAL
Eugene C Rich
No abstract text is available yet for this article.
April 20, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29673803/paying-hospital-specialists-experiences-and-lessons-from-eight-high-income-countries
#17
Wilm Quentin, Alexander Geissler, Friedrich Wittenbecher, Geoff Ballinger, Robert Berenson, Karen Bloor, Dana A Forgione, Peer Köpf, Madelon Kroneman, Lisbeth Serden, Raúl Suarez, Johan W van Manen, Reinhard Busse
Payment systems for specialists in hospitals can have far reaching consequences for the efficiency and quality of care. This article presents a comparative analysis of payment systems for specialists in hospitals of eight high-income countries (Canada, England, France, Germany, Sweden, Switzerland, the Netherlands, and the USA/Medicare system). A theoretical framework highlighting the incentives of different payment systems is used to identify potentially interesting reform approaches. In five countries,most specialists work as employees - but in Canada, the Netherlands and the USA, a majority of specialists are self-employed...
May 2018: Health Policy
https://www.readbyqxmd.com/read/29671716/payment-models-in-the-era-of-health-care-reform-and-population-health
#18
Rachel Nash, David B Nash
No abstract text is available yet for this article.
April 2018: Surgical Innovation
https://www.readbyqxmd.com/read/29657242/diagnosis-related-group-drg-based-case-mix-funding-system-a-promising-alternative-for-fee-for-service-payment-in-china
#19
Cuirong Zhao, Chao Wang, Chengwu Shen, Qian Wang
Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative...
May 13, 2018: Bioscience Trends
https://www.readbyqxmd.com/read/29618391/provider-payment-to-primary-care-physicians-in-china-background-challenges-and-a-reform-framework
#20
Xiaoying Pu, Yaming Gu, Xiaohe Wang
AIM: To provide a framework for provider payment reform for primary care physicians in China. BACKGROUND: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. METHODS: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians...
April 5, 2018: Primary Health Care Research & Development
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