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https://www.readbyqxmd.com/read/28381338/selective-contracting-and-channelling-patients-to-preferred-providers-a-scoping-review
#1
REVIEW
Romy E Bes, Emile C Curfs, Peter P Groenewegen, Judith D de Jong
Selective contracting by health insurers and channelling patients to contracted providers is crucial in a health care system based on managed competition, as this should lead to better value for money delivery of healthcare. However, an important consequence for enrolees is that health insurers interfere with their choice of care provider. This scoping review aims to find out what is known about selective contracting from the enrolee's perspective. Is it being done and how do enrolees feel about the role of their health insurer in their care provider choice? A literature search was conducted, and, in addition, experts were consulted for extra information and documents...
March 24, 2017: Health Policy
https://www.readbyqxmd.com/read/28375593/va-dental-insurance-program-final-rule
#2
(no author information available yet)
This document revises Department of Veterans Affairs (VA) medical regulations to reflect the codification of the authority for the VA Dental Insurance Program (VADIP), a program through which VA contracts with private dental insurers to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. The VA Dental Insurance Reauthorization Act of 2016 codified the authority of the VADIP, and this final rulemaking accordingly revises the authority citation in the VA medical regulations that implement VADIP...
April 4, 2017: Federal Register
https://www.readbyqxmd.com/read/28371945/-linkage-between-promotion-of-employment-and-promotion-of-health-in-the-community-setting-results-of-the-pilot-project-of-the-federal-employment-agency-and-the-statutory-health-insurance
#3
Michael Bellwinkel, Karin Schreiner-Kürten, Kathrin Melzer
The Federal Employment Agency and the Statutory Health Insurance (GKV) have put the link between the promotion of employment and of health to the test by making a joint approach aiming to reach unemployed persons with preventive health services and to maintain or improve their employability. Specialist case workers (Integrationsfachkräfte) of the job centres conducted health consultations, motivating unemployed persons and raising their awareness of their own health as well as enabling them to access health promotion services of health insurance funds on a voluntary basis...
April 3, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28359982/bidirectional-association-between-bell-s-palsy-and-anxiety-disorders-a-nationwide-population-based-retrospective-cohort-study
#4
Chih-Chieh Tseng, Li-Yu Hu, Mu-En Liu, Albert C Yang, Cheng-Che Shen, Shih-Jen Tsai
OBJECTIVE: Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life...
March 27, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28353670/demand-and-signing-of-general-practitioner-contract-service-among-the-urban-elderly-a-population-based-analysis-in-zhejiang-province-china
#5
Yanrong Zhao, Junfen Lin, Yinwei Qiu, Qing Yang, Xinyi Wang, Xiaopeng Shang, Xiaoping Xu
This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables...
March 29, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28332206/contract-care-in-dentistry-sense-making-of-the-concept-and-in-practice-when-multiple-institutional-logics-are-at-play
#6
Ylva Ulfsdotter Eriksson, Karin Berg, Ulla Wide Boman, Magnus Hakeberg
In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of 'selling contracts'. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH...
March 23, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28316544/a-review-on-methods-of-risk-adjustment-and-their-use-in-integrated-healthcare-systems
#7
Christin Juhnke, Susanne Bethge, Axel C Mühlbacher
INTRODUCTION: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. THEORY AND METHODS: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines...
October 26, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28290918/health-plan-choice-in-the-netherlands-restrictive-health-plans-preferred-by-young-and-healthy-individuals
#8
Romy E Bes, Emile C Curfs, Peter P Groenewegen, Judith D de Jong
In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees' choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417)...
March 14, 2017: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/28284363/-evaluation-of-family-doctor-centred-health-care-in-germany-based-on-aok-rheinland-hamburg-claims-data
#9
Mike Klora, Jan Zeidler, Melanie May, Nils Raabe, J-Matthias Graf von der Schulenburg
BACKGROUND: Health insurance funds in Germany are obliged to offer family doctor-centred health care models (Hausarztzentrierte Versorgung, "HzV"). The participation is voluntary for the insured persons. Participants agree to utilise outpatient specialist care only if their family doctor or general practitioner ("gatekeeper") refers them to a specialist. The aim of this programme is to both strengthen the role of general practitioners and to avoid unnecessary specialist visits and double examinations...
February 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28274386/willingness-to-pay-for-other-individuals-healthcare-expenditures
#10
A P Borges, A Reis, J Anjos
OBJECTIVES: The need to improve the sustainability of public health expenditure, in a climate of growing pressure on national budgets, inevitably leads to a discussion about resource rationing, and the extent of society's responsibility for those expenditures. To contribute to this discussion empirically, this study evaluated the willingness of Portuguese respondents to pay for other individuals' healthcare expenditures through out-of-pocket payments. STUDY DESIGN: A questionnaire addressed to the general public was developed, with 296 respondents...
March 2017: Public Health
https://www.readbyqxmd.com/read/28264957/provider-offered-medicare-advantage-plans-recent-growth-and-care-quality
#11
Garret Johnson, Zoe M Lyon, Austin Frakt
Hospitals and health systems are increasingly offering their own insurance products, a type of consolidation known as "vertical integration." The relationship between plan-provider vertical integration and quality of care has not been examined extensively or over time. We created a new data set of all vertically integrated Medicare Advantage contracts operating in the period 2011-15 and tracked their characteristics and quality over time. While the percentage of vertically integrated contracts increased slightly between 2011 and 2015, the percentage of all Medicare Advantage enrollees in them declined from 24...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28226336/educational-outreach-to-opioid-prescribers-the-case-for-academic-detailing
#12
Margot Trotter Davis, Brian Bateman, Jerry Avorn
Nonmedical use of opioid medications constitutes a serious health threat as the rates of addiction, overdoses, and deaths have risen in recent years. Increasingly, inappropriate and excessively liberal prescribing of opioids by physicians is understood to be a central part of the crisis. Public health officials, hospital systems, and legislators are developing programs and regulations to address the problem in sustained and systematic ways that both insures effective treatment of pain and appropriate limits on the availability of opioids...
February 2017: Pain Physician
https://www.readbyqxmd.com/read/28210864/pharmacy-benefit-management-companies-do-they-create-value-in-the-us-healthcare-system
#13
Alan Lyles
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing...
May 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28161669/impact-of-health-financing-policies-in-cambodia-a-20-year-experience
#14
Tim Ensor, Chhim Chhun, Ton Kimsun, Barbara McPake, Ijeoma Edoka
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting...
January 26, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28155766/-contribution-of-the-bruche-valley-district-planning-authority
#15
Eric Muziotti
<ce:para>The Bruche Valley (composed of 26 municipalities and 22,000 inhabitants) is a medium-altitude, rural territory situated in Alsace, France. For more than 40 years, this territory has developed a intercommunal cooperation and local development approach. The district planning authority is a recognised coordinator of public health actions in the region. All of these actions are defined by a special contract called “Contrat local de santé” (CLS), signed by the State, the district planning authority and numerous collaborators including health care insurance funds and local health facility group managers...
December 19, 2016: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
https://www.readbyqxmd.com/read/28152999/a-participatory-supportive-return-to-work-program-for-workers-without-an-employment-contract-sick-listed-due-to-a-common-mental-disorder-an-economic-evaluation-alongside-a-randomized-controlled-trial
#16
Lieke Lammerts, Johanna M van Dongen, Frederieke G Schaafsma, Willem van Mechelen, Johannes R Anema
BACKGROUND: Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care...
February 2, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28139461/slovakia-health-system-review
#17
Martin Smatana, Peter Pazitny, Daniela Kandilaki, Michaela Laktisova, Darina Sedlakova, Monika Paluskova, Ewout van Ginneken, Anne Spranger
This analysis of the Slovak health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting of health care providers. Containment of health spending became a major policy goal after the 2008 financial crisis. Health spending stabilized after 2010 but remains well below European averages...
November 2016: Health Systems in Transition
https://www.readbyqxmd.com/read/28135899/insulin-use-increases-risk-of-asthma-but-metformin-use-reduces-the-risk-in-patients-with-diabetes-in-a-taiwanese-population-cohort
#18
Chiung-Zuei Chen, Chih-Hui Hsu, Chung-Yi Li, Tzuen-Ren Hsiue
objective -Recent reports have suggested that insulin promotes airway smooth muscle contraction and enhances airway hyperresponsiveness, which are cardinal features of asthma. In contrast, metformin can reduce both airway inflammatory and remodeling properties. However, these results are all from in vitro and animal studies. This study investigated whether diabetes and various antidiabetic agents associate with the risk of asthma. methods -We used a retrospective population-based cohort study using Taiwan's National Health Insurance claim database from 2000 to 2010 and a Cox proportional hazards regression model to compare the incidence of asthma between patients with diabetes (n = 19,428) and a matched non-diabetic group (n = 38,856)...
January 31, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28086976/impact-of-a-tailored-program-on-the-implementation-of-evidence-based-recommendations-for-multimorbid-patients-with-polypharmacy-in-primary-care-practices-results-of-a-cluster-randomized-controlled-trial
#19
Cornelia Jäger, Tobias Freund, Jost Steinhäuser, Christian Stock, Johannes Krisam, Petra Kaufmann-Kolle, Michel Wensing, Joachim Szecsenyi
BACKGROUND: Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group: (a) structured medication counseling including brown bag reviews, (b) the use of medication lists, and (c) structured medication reviews to reduce potentially inappropriate medication...
January 13, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28072896/the-medical-home-machine
#20
Joey Berlin
Practices that achieve patient-centered medical home (PCMH) status could realize reduced costs and incentive payments from insurance payers if they see the value in contracting with a PCMH.
January 1, 2017: Texas Medicine
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