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https://www.readbyqxmd.com/read/29147931/horses-for-courses-moving-india-towards-universal-health-coverage-through-targeted-policy-design
#1
Dayashankar Maurya, Altaf Virani, S Rajasulochana
The debate on how India's health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by strengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare delivery from certain states that it hopes to emulate...
November 16, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/29132634/a-model-to-determine-payments-associated-with-radiology-procedures
#2
Thusitha Mabotuwana, Christopher S Hall, Shiby Thomas, Christoph Wald
OBJECTIVE: Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29108987/insurance-related-practices-at-title-x-funded-family-planning-centers-under-the-affordable-care-act-survey-and-interview-findings
#3
Mia R Zolna, Megan L Kavanaugh, Kinsey Hasstedt
INTRODUCTION: Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid program and the private health insurance plans in their service area to provide high-quality contraceptive care to the millions of women relying on services at these sites annually...
November 3, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29056240/evaluation-of-minimum-volume-standards-for-surgery-in-the-netherlands-2003-2017-a-successful-policy
#4
Roos Mesman, Marjan J Faber, Bart J J M Berden, Gert P Westert
PURPOSE: To evaluate the introduction and implications of minimum volume standards for surgery in Dutch health care from 2003 to 2017 and formulate policy lessons for other countries. SETTING: Dutch health care. PRINCIPAL FINDINGS: Three eras were identified, representing a trust-and-control cycle in keeping with changing roles of different stakeholders in Dutch context. In the first era 'regulated trust' (2003-2009), the Dutch Inspectorate introduced national volume criteria and relied on yearly hospital reported data for information on compliance...
September 29, 2017: Health Policy
https://www.readbyqxmd.com/read/29055519/good-better-best-a-comprehensive-comparison-of-healthcare-providers-performance-an-application-to-physiotherapy-practices-in-primary-care
#5
Sander Steenhuis, Niels Groeneweg, Xander Koolman, France Portrait
Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care...
October 13, 2017: Health Policy
https://www.readbyqxmd.com/read/29051740/challenges-and-perspectives-in-bridging-in-and-outpatient-sectors-the-implementation-of-two-alternative-models-of-care-and-their-effect-on-the-average-length-of-stay
#6
Alexandre Wullschleger, Werner Wosniok, Jürgen Timm, Martin Heinze
New models of care aimed at reinforcing the outpatient sector have been introduced in Germany over the last few years. Initially, a subscription-based model ("integrated care") was introduced in 2012 in the Immanuel Klinik Rüdersdorf, wherein patients had to actively subscribe to the integrated care program. This integrated care model was replaced after 2 years by a subscription-free "model project," in which all patients insured by the contracting insurance company took part in the program. Data showed that the introduction of the integrated care program in the inpatient setting led to an increase of the average length of stay in this group...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29033595/drug-tendering-drug-supply-and-shortage-implications-for-the-uptake-of-biosimilars
#7
REVIEW
George Dranitsaris, Ira Jacobs, Carol Kirchhoff, Robert Popovian, Lesley G Shane
Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cell-transplantation-patients-toward-a-specialized-medical-home-for-complex-care-patients
#8
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 28, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28961577/predictors-of-no-show-rate-in-the-gi-endoscopy-suite-at-a-safety-net-academic-medical-center
#9
Asim Shuja, Ciel Harris, Petra Aldridge, Miguel Malespin, Silvio W de Melo
BACKGROUND/OBJECTIVES: Noncompliance with physician and procedure appointments is associated with poor disease control and worse disease outcomes. This also impacts the quality of care, decreases efficiency, and affects revenue. Studies have shown that no-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. METHODS: We performed a 17-month retrospective observational cohort study of patients scheduled for outpatient procedures in the Gastroenterology endoscopy suite at the University of Florida Health, Jacksonville...
September 28, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28944733/performance-based-risk-sharing-arrangements-for-pharmaceutical-products-in-the-united-states-a-systematic-review
#10
Justin S Yu, Lauren Chin, Jennifer Oh, Jorge Farias
BACKGROUND: Value for money is a growing necessity in today's U.S. health care system in which drug spending is expected to increase by an average rate of 6.7% yearly through 2025. In response to uncertainty about real-world clinical and economic outcomes for many drugs, health insurers and pharmacy benefit managers (PBMs) have implemented various contracts and arrangements with drug manufacturers that can collectively be described as performance-based risk-sharing arrangements (PBRSAs)...
October 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28840834/risk-of-contracting-pneumonia-among-patients-with-predialysis-chronic-kidney-disease-a-population-based-cohort-study-in-taiwan
#11
Shih-Wei Lai, Cheng-Li Lin, Kuan-Fu Liao
OBJECTIVES: The objective of the study was to investigate the association between predialysis chronic kidney disease and contracting pneumonia in Taiwan. METHODS: We employed a population-based, retrospective cohort design using the database of the Taiwan National Health Insurance (NHI) Program. There were 18807 subjects aged 20-84 years who were newly diagnosed with predialysis chronic kidney disease between 2000 to 2012 as the predialysis chronic kidney disease group and 18807 randomly selected subjects without chronic kidney disease as the non-chronic kidney disease group...
September 2017: BioMedicine
https://www.readbyqxmd.com/read/28837981/-structured-outpatient-care-in-a-new-orthopaedic-healthcare-program-patients-experiences-as-criterion-for-quality
#12
Anja Klingenberg, Petra Kaufmann-Kolle, Michel Wensing, Katja Götz, Jeanette Jahed, Burkhard Lembeck, Johannes Flechtenmacher, Tonia Kazmaier, Joachim Szecsenyi
Background In 2015 a survey was conducted in Baden-Württemberg (Germany) among patients treated by orthopaedic specialists participating in a medical specialists' contract between doctors and statutory health insurance funds, in accordance with § 73c of the German Social Code, Book V (SGB V). This contract aims to improve orthopaedic care by structured cooperation between orthopaedic specialists and general practitioners, who are the central coordinators of care, and refer patients to a specialist if necessary...
August 24, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28774725/endogenous-information-adverse-selection-and-prevention-implications-for-genetic-testing-policy
#13
Richard Peter, Andreas Richter, Paul Thistle
We examine public policy toward the use of genetic information by insurers. Individuals engage in unobservable primary prevention and have access to different prevention technologies. Thus, insurance markets are affected by moral hazard and adverse selection. Individuals can choose to take a genetic test to acquire information about their prevention technology. Information has positive decision-making value, that is, individuals may adjust their behavior based on the result of the test. However, testing also exposes individuals to uncertainty over the available insurance contract, so-called classification risk, which lowers the value of information...
July 13, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28765463/dental-group-practice-and-the-need-for-dentists
#14
David S Gesko, Howard L Bailit
This study compared the number of patients treated per year by general dentists and dental hygienists in solo practice and by those employed by a large group practice. Information on the annual number of patient visits to solo general dental practitioners comes from the 2013 American Dental Association (ADA) Survey of Dental Practice. Patient visits were divided by 2.5 to estimate the number of patients treated annually. The data on group practices come from HealthPartners (HP) of Minnesota, a large not-for-profit medical and dental Health Maintenance Organization that accepts insurance contracts based on global budgets and is financially at risk...
August 2017: Journal of Dental Education
https://www.readbyqxmd.com/read/28718496/-introduction-of-rapid-syphilis-and-hiv-testing-in-prenatal-care-in-colombia-qualitative-analysis
#15
María Teresa Ochoa-Manjarrés, Hernando Guillermo Gaitán-Duarte, Sidia Caicedo, Berta Gómez, Freddy Pérez
Objective: Interpret perceptions of Colombian health professionals concerning factors that obstruct and facilitate the introduction of rapid syphilis and HIV testing in prenatal care services. Methods: A qualitative study based on semi-structured interviews was carried out. A convenience sample was selected with 37 participants, who included health professionals involved in prenatal care services, programs for pregnant women, clinical laboratories, and directors of health care units or centers, as well as representatives from regional departments and the Ministry of Health...
December 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
https://www.readbyqxmd.com/read/28655014/association-between-health-plan-exit-from-medicaid-managed-care-and-quality-of-care-2006-2014
#16
Chima D Ndumele, William L Schpero, Mark J Schlesinger, Amal N Trivedi
Importance: State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. Objective: To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality...
June 27, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28649732/impact-of-medicaid-disenrollment-in-tennessee-on-breast-cancer-stage-at-diagnosis-and-treatment
#17
COMPARATIVE STUDY
Wafa W Tarazi, Cathy J Bradley, Harry D Bear, David W Harless, Lindsay M Sabik
BACKGROUND: States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women. METHODS: The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment...
September 1, 2017: Cancer
https://www.readbyqxmd.com/read/28621208/stem-cells-in-court-historical-trends-in-us-legal-cases-related-to-stem-cells
#18
Andreia Martins Martinho, Leigh Turner
Using two legal research platforms, we identified 193 stem-cell-related legal cases that were decided in US courts. Classifying the cases by category, we examined historical trends in the types of legal cases related to stem cells. Major types of cases involved plaintiffs seeking to overturn denial of health insurance coverage decisions, disputes related to intellectual property, false advertising, breaches of contract, exposure to hazardous agents, regulatory decisions, stem cell procedures and professional standard of care, use of stems cells in research, and public funding of embryonic stem cell research...
April 2017: Regenerative Medicine
https://www.readbyqxmd.com/read/28599329/-healthcare-research-of-cataract-surgery-analysis-of-patient-s-satisfaction-following-cataract-surgery-in-mecklenburg-vorpommern-germany
#19
Maria Seifried, Helmut Höh
Background The collection of pre-, peri- and postoperative data took place between 2005 and 2008, based on a contract between the social insurance company, AOK Mecklenburg-Vorpommern, and the outpatient cataract surgeons/centers in Mecklenburg-Vorpommern, Germany. The purpose of the contract was the monitoring of quality of cataract surgery in the outpatient healthcare system. Materials and Methods We analysed 2952 datasets of 2952 eyes, remaining after exclusion of 109 datasets because of lack of plausibility and missing data (initially 3058 eyes with surgery in our centre)...
August 2017: Klinische Monatsblätter Für Augenheilkunde
https://www.readbyqxmd.com/read/28586962/nature-of-medical-malpractice-claims-against-radiation-oncologists
#20
Deborah Marshall, Kathryn Tringale, Michael Connor, Rinaa Punglia, Abram Recht, Jona Hattangadi-Gluth
PURPOSE: To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. METHODS AND MATERIALS: Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity...
May 1, 2017: International Journal of Radiation Oncology, Biology, Physics
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