Read by QxMD icon Read

Insurance contracts

Kenneth Munge, Stephen Mulupi, Edwine W Barasa, Jane Chuma
BACKGROUND: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. METHODS: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing...
July 18, 2017: International Journal of Health Policy and Management
Meghan A Piccinin, Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, Todd Frush
In an effort to rein in expenditures and improve quality of care, the Centers for Medicare and Medicaid Services (CMS) has initiated bundled reimbursement programs for total joint arthroplasty (TJA) procedures. The success of CMS's bundled payment models has prompted some private insurers to collaborate with provider organizations to institute similar bundled contracts for TJA. The authors review the experiences of orthopedic groups in the implementation of bundled payments for primary and revision TJA through both public and private payers...
April 2018: Orthopedic Clinics of North America
Thomas Wiseman
I study the interplay among competition, contractual commitment, income risk, and saving and borrowing in insuring consumers against both short-term healthcare expenses and longer-term changes in health status. Examining different combinations of firms' ability to commit to long-term contracts, consumers' access to credit markets, and the availability of termination fees helps to highlight sources of inefficiency.
February 16, 2018: Journal of Health Economics
Danielle Martin, Ashley P Miller, Amélie Quesnel-Vallée, Nadine R Caron, Bilkis Vissandjée, Gregory P Marchildon
Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care...
February 22, 2018: Lancet
Bronwyn McGill, Blythe J O'Hara, Anne C Grunseit, Adrian Bauman, Dale Osborne, Luke Lawler, Philayrath Phongsavan
BACKGROUND: Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. METHODS: We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance...
February 13, 2018: BMC Public Health
Svetlana V Doubova, Víctor Hugo Borja-Aburto, Germán Guerra-Y-Guerra, V Nelly Salgado-de-Snyder, Miguel Ángel González-Block
Objectives: The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM)...
February 8, 2018: International Journal for Quality in Health Care
Kenny Oh, Goda Savulionyte, Satish Muluk
OBJECTIVE: The standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the "endovascular era." This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs)...
February 3, 2018: Journal of Vascular Surgery
Jamie Koerner, Alicia B Forinash, Abigail M Yancey, Jessica Brinkmeyer, Spencer Dingman, Collin Miller, Judy Thompson, Laura Bergin, Julia D López, Amy Ravin
BACKGROUND: Infants younger than 6 months of age are at high risk for contracting pertussis because of not being fully vaccinated. The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating all pregnant women with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) between 27 and 36 weeks to offer passive immunity to the infant to help protect them until they are able to receive the full pertussis series. OBJECTIVE: To assess and compare compliance with the 2013 ACIP recommendation of vaccinating pregnant women with Tdap at 27 to 36 weeks' gestation in 2 obstetric clinics...
February 1, 2018: Annals of Pharmacotherapy
Roni S Moran, Daniel S Moran, Gil Fire
The World Health Organization (WHO) has declared obesity a global epidemic. WHO sheds much light on this matter in its publications on health promotion and preventative medicine. Lack of physical activity, an unbalanced diet and an unhealthy lifestyle are the leading causes of developing obesity and chronic diseases. In Israel, the growing rate of obesity is a reason for concern. About 500,000 diabetics, mainly as a result of obesity, live in Israel today and by 2030 the number is expected to rise to 2,000,000...
January 2018: Harefuah
Johanna Gregor-Haack
A reimbursement category for "apps" does not exist in German statutory health insurance. Nevertheless different ways for reimbursement of digital health care products or processes exist. This article provides an overview and a description of the most relevant finance and reimbursement categories for apps in German statutory health insurance. The legal qualifications and preconditions of reimbursement in the context of single contracts with one health insurance fund will be discussed as well as collective contracts with national statutory health insurance funds...
January 26, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Natasha Azzopardi-Muscat, Rita Baeten, Timo Clemens, Triin Habicht, Ilmo Keskimäki, Iwona Kowalska-Bobko, Anna Sagan, Ewout van Ginneken
Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings...
January 4, 2018: Health Policy
Barb Jacobs, Anne M Ryan, Katherine S Henrichs, Barry D Weiss
This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs...
January 2018: Annals of Family Medicine
Francesco Decarolis, Andrea Guglielmo
Evidence on insurers' behavior in environments with both risk selection and market power is largely missing. We fill this gap by providing one of the first empirical accounts of how insurers adjust plan features when faced with potential changes in selection. Our strategy exploits a 2012 reform allowing Medicare enrollees to switch to 5-star contracts at anytime. This policy increased enrollment into 5-star contracts, but without risk selection worsening. Our findings show that this is due to 5-star plans lowering both premiums and generosity, thus becoming more appealing for most beneficiaries, but less so for those in worse health conditions...
December 2017: Journal of Health Economics
Heini Salo, Terhi Kilpi
The savings in treatment costs generated by disease cases prevented by the national vaccination program exceed the costs of the vaccination program by at least 60 million euros. In addition, other costs due to contracting the illness are avoided. Vaccinations serve the purpose of both increasing well-being and releasing resources for other uses. Financial support of vaccinations through the health insurance system would be costly and targetted to those with the ability to pay. Public funds should be directed to the development of a vaccination program...
2017: Duodecim; Lääketieteellinen Aikakauskirja
Brystana G Kaufman, B Steven Spivack, Sally C Stearns, Paula H Song, Emily C O'Brien
Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2)...
December 1, 2017: Medical Care Research and Review: MCRR
Julie M Donohue, Colleen L Barry, Elizabeth A Stuart, Shelly F Greenfield, Zirui Song, Michael E Chernew, Haiden A Huskamp
OBJECTIVES: The Alternative Quality Contract (AQC) implemented in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) is intended to improve quality and control costs by putting providers at risk for total medical spending and tying payment to performance on specified quality measures. We examined the AQC's early effects on use of and spending on medication treatment (MT) for addiction among individuals with alcohol use disorders (AUDs) and opioid use disorders (OUDs), conditions not subject to any performance measurement in the AQC...
January 2018: Journal of Addiction Medicine
Joseph Burns
The company has more than 15,000 employees - or about a third of the eligible employees in those four locations - enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
November 2017: Managed Care
Joseph Menzin, Jyoti Aggarwal, Brian Boatman, Jeffrey Yu, Kevin Stern, David J Harrison, Jeetvan G Patel
BACKGROUND: Ezetimibe is recommended by clinical practice guidelines as a second-line therapy for lowering low-density lipoprotein cholesterol (LDL-C) levels, but little is known about its use and effectiveness in real-world populations. OBJECTIVE: To understand the real-world impact of adding or switching to ezetimibe on LDL-C goal achievement in patients with clinical atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH)...
December 2017: Journal of Managed Care & Specialty Pharmacy
Soo Kyung Park, Chung Kwon Lee
PURPOSE: This study examined the effect of pre-injury job characteristics on the odds of RTW outcomes for specific socio-demographic and injury-related characteristics among injured workers in South Korea. METHODS: This study employed first-wave data for 1993 participants from the Panel Study of Workers' Compensation Insurance. A two-step cluster analysis was conducted to profile pre-injury job characteristics, including monthly wages, length of service, company size, contract type, and working hours...
November 24, 2017: Disability and Rehabilitation
Victoria Perez
States choose to provide Medicaid coverage via managed care or traditional fee-for-service. Managed care provided by private insurers poses higher contracting costs and information asymmetry than traditional fee-for-service but potentially improves efficiency and reduces spending. Evaluating the effect of managed care on Medicaid spending is challenging because adoption of managed care is nonrandom and may be driven by local economic shocks that simultaneously affect Medicaid spending. This study implements a dynamic panel framework to estimate the effect of managed care enrollment on spending levels and program design...
November 23, 2017: Health Economics
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"