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https://www.readbyqxmd.com/read/29470774/multi-indication-and-combination-pricing-and-reimbursement-of-pharmaceuticals-opportunities-for-improved-health-care-through-faster-uptake-of-new-innovations
#1
Ulf Persson, J M Norlin
Many pharmaceuticals are effective in multiple indications and the degree of effectiveness may differ. A product-based pricing and reimbursement system with a single price per product is insufficient to reflect the variable values between different indications. The objective of this article is to present examples of actual pricing and reimbursement decisions using current value-based pricing in Sweden and to discuss their implications and possible solutions. The value of several cancer drugs was estimated for various indications based on a willingness-to-pay threshold of 1 million SEK (EUR 104,000) per QALY gained...
February 22, 2018: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/29470731/sacral-neuromodulation-versus-personalized-conservative-treatment-in-patients-with-idiopathic-slow-transit-constipation-study-protocol-of-the-no-2-trial-a-multicenter-open-label-randomized-controlled-trial-and-cost-effectiveness-analysis
#2
S C M Heemskerk, A H Rotteveel, M A Benninga, C I M Baeten, A A M Masclee, J Melenhorst, S M J van Kuijk, C D Dirksen, S O Breukink
PURPOSE: The evidence regarding the (cost-)effectiveness of sacral neuromodulation (SNM) in patients with therapy-resistant idiopathic slow-transit constipation is of suboptimal quality. The Dutch Ministry of Health, Welfare and Sports has granted conditional reimbursement for SNM treatment. The objective is to assess the effectiveness, cost-effectiveness, and budget impact of SNM compared to personalized conservative treatment (PCT) in patients with idiopathic slow-transit constipation refractory to conservative treatment...
February 22, 2018: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29470545/private-healthcare-provider-experiences-with-social-health-insurance-schemes-findings-from-a-qualitative-study-in-ghana-and-kenya
#3
Maia Sieverding, Cynthia Onyango, Lauren Suchman
BACKGROUND: Incorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers' perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa-the National Health Insurance Scheme (NHIS) in Ghana and the National Hospital Insurance Fund (NHIF) in Kenya...
2018: PloS One
https://www.readbyqxmd.com/read/29469209/the-impact-of-aging-on-different-types-of-health-care-the-example-of-the-polish-health-insurance-system
#4
Ewa Kocot
The aging phenomenon, which is being observed all over the world, can strongly affect health policy and a planning in the health care sector. However, the impact of demographic changes on different parts of it can be varied. The main objective of this study was to check the possible impact of aging on health expenditure (HE) regarding different types of health care and to evaluate whether this impact is significant for all analyzed areas. To show a relationship between age and HE a special indicator (old-age sensitivity) was defined, showing a difference between the standardized value of HE per capita in the age group 65+ and in the group 20 to 64 (defined as the reference group)...
February 22, 2018: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/29468627/terrorism-reports-the-tip-of-the-iceberg
#5
Eytan Ellenberg, Mark Taragin, Zvia Bar-On, Osnat Cohen, Ishay Ostfeld
IMPORTANCE: Medical impact of terror is a public health issue as the threat is growing all over the world. OBJECTIVE: Our objective was to compare the number of injured and incidents in the three different databases and reports [Global Terrorism Database (GTD), Israeli Security Agency (ISA) and National Insurance Institute (NII)] in Israel. DESIGN: Retrospective study. SETTING: Analyses of three different databases (GTD, ISA and NII) and basic comparison...
October 2017: American Journal of Disaster Medicine
https://www.readbyqxmd.com/read/29467120/medicaid-becomes-the-first-third-party-payer-to-cover-passive-remote-monitoring-for-home-care-policy-analysis
#6
Clara Berridge
BACKGROUND: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS)...
February 21, 2018: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/29466887/access-to-anti-cancer-drugs-in-india-is-there-a-need-to-revise-reimbursement-policies
#7
Gertruud Haitsma, Himanshu Patel, Parthasarathi Gurumurthy, Maarten J Postma
BACKGROUND: The aim of this study was to examine the access of Indian cancer patients to optimum cancer care under selected government schemes by reviewing reimbursement schemes for cancer care in India. METHODS: All cancer care reimbursement schemes in India were identified and three highly utilized schemes (VAS, RAS, CMCHS) were selected. Quality of breast, colorectal, lung, head & neck, and gastric cancer care was reviewed with respect to NCCN guidelines...
February 22, 2018: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/29465658/pathways-to-congenital-syphilis-prevention-a-rapid-qualitative-assessment-of-barriers-and-the-public-health-response-in-caddo-parish-louisiana
#8
Karen Kroeger, Thurka Sangaramoorthy, Penny S Loosier, Rebecca Schmidt, DeAnn Gruber
BACKGROUND: Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. While CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and congenital syphilis, with the highest number of CS cases in northwest Louisiana, where Shreveport is located...
January 10, 2018: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/29465644/state-laws-related-to-billing-third-parties-for-healthcare-services-at-public-std-clinics-in-the-united-states
#9
Ryan Cramer, Penny S Loosier, Andee Krasner, Jennifer Kawatu
BACKGROUND: Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. METHODS: Two surveys (1) clinic managers [N=246], 2) STD program managers [N=63]) conducted via a multi-regional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third party billing for STD services...
February 7, 2018: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/29463665/assessing-health-related-quality-of-life-in-patients-with-diabetic-foot-disease-why-is-it-important-and-how-can-we-improve-the-2017-roger-e-pecoraro-award-lecture
#10
Dane K Wukich, Katherine M Raspovic
Patient-reported outcomes (PROs) have become an important subject in the area of diabetes-related foot complications. Self-reported health-related quality of life (HRQOL) surveys can provide a generic measure of overall health (global) and can be disease specific (i.e., diabetes) or even region specific (i.e., lower-extremity function). Analysis of PRO measures utilizing validated instruments allows health care providers to determine whether medical and surgical treatments are providing patients with the highest level of outcome possible and are actually improving HRQOL...
March 2018: Diabetes Care
https://www.readbyqxmd.com/read/29463163/staff-perceptions-of-adult-day-centers-providing-post-acute-care-for-persons-with-dementia
#11
Holly Dabelko-Schoeny, Ji Won Shin, Emily Kowal, Janine Overcash, Jeffrey M Caterino, Mary Beth Happ
The purpose of this study was to examine the perception of adult day services (ADS) staff and hospital discharge planners regarding the feasibility of ADS to provide post-acute care (PAC) for persons with dementia. We conducted key informant interviews with emergency department (ED) and inpatient hospital discharge planners ( n = 9), and two focus groups with ADS staff ( n = 15) representing five ADS programs. Four thematic categories were identified from the discharge planners, including concerns for patients, factors influencing discharge, experience with ADS, and conditions for ADS referrals...
February 1, 2018: Journal of Applied Gerontology: the Official Journal of the Southern Gerontological Society
https://www.readbyqxmd.com/read/29462048/where-are-all-the-women-commentary-on-an-article-by-emma-b-holliday-md-et-al-equal-pay-for-equal-work-medicare-procedure-volume-and-reimbursement-for-male-and-female-surgeons-performing-total-knee-and-total-hip-arthroplasty
#12
https://www.readbyqxmd.com/read/29462043/equal-pay-for-equal-work-medicare-procedure-volume-and-reimbursement-for-male-and-female-surgeons-performing-total-knee-and-total-hip-arthroplasty
#13
Emma B Holliday, Christina Brady, William C Pipkin, Jeremy S Somerson
BACKGROUND: The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons. METHODS: The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29462030/refining-risk-adjustment-for-the-proposed-cms-surgical-hip-and-femur-fracture-treatment-bundled-payment-program
#14
Mark A Cairns, Robert F Ostrum, R Carter Clement
BACKGROUND: The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29461852/variation-in-markups-on-outpatient-oncology-services-in-the-united-states
#15
Angela Park, Tim Xu, Michael Poku, James Taylor, Martin A Makary
OBJECTIVES: Price markups are a major cause of healthcare inflation and financial harm to patients, especially those who are self-paying or covered by commercial insurance. STUDY DESIGN: Retrospective analysis of publicly-available information on Medicare physician payments, representing 100% of Part B services provided to fee-for-service beneficiaries during calendar year 2014. METHODS: Outcomes were markup ratios for oncology services, defined as the ratio of submitted charges to the amount reimbursed by Medicare...
February 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29460679/amcp-partnership-forum-improving-quality-value-and-outcomes-with-patient-reported-outcomes
#16
(no author information available yet)
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions...
February 20, 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29458428/a-review-of-promoting-access-to-medicines-in-china-problems-and-recommendations
#17
Jing Sun, Cecile Jia Hu, Mark Stuntz, Hans Hogerzeil, Yuanli Liu
BACKGROUND: Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China...
February 20, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29458368/report-from-the-3rd-cardiovascular-outcome-trial-cvot-summit-of-the-diabetes-cardiovascular-disease-d-cvd-easd-study-group
#18
EDITORIAL
Oliver Schnell, Eberhard Standl, Doina Catrinoiu, Stefano Genovese, Nebojsa Lalic, Katarina Lalic, Jan Skrha, Paul Valensi, Antonio Ceriello
The 3rd Cardiovascular Outcome Trial Summit of the Diabetes & Cardiovascular Disease EASD Study Group was held on the 26-27 October 2017 in Munich. As in 2015 and 2016, this summit was organised in light of recently completed and published CVOTs on diabetes, aiming to serve as a reference meeting for in-depth discussions on the topic. Amongst others, the CVOTs EXSCEL, DEVOTE, the CANVAS program and the ACE-trial, which released primary outcome results in 2017, were discussed. Trial implications for diabetes management and recent perspectives of diabetologists, cardiologists, endocrinologists, nephrologists and general practitioners were highlighted...
February 19, 2018: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29458282/cost-effectiveness-of-hydrophilic-coated-intermittent-catheters-compared-with-uncoated-catheters-in-canada-a-public-payer-perspective
#19
Blayne Welk, Wanrudee Isaranuwatchai, Andrei Krassioukov, Louise Husted Torp, Dean Elterman
STUDY DESIGN: A Markov model was used to analyze cost-effectiveness over a lifetime horizon. OBJECTIVE: To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI). SETTING: A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective...
February 20, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29457626/-transesophageal-echocardiography-in-adults-guidelines-of-the-working-group-on-echocardiography-of-the-polish-cardiac-society
#20
Piotr Lipiec, Janusz Bąk, Wojciech Braksator, Marcin Fijałkowski, Andrzej Gackowski, Zbigniew Gąsior, Jarosław D Kasprzak, Anna Klisiewicz, Mirosław Kowalski, Tomasz Kukulski, Katarzyna Mizia-Stec, Edyta Płońska-Gościniak, Piotr Pruszczyk, Bożena Sobkowicz, Piotr Szymański, Andrzej Szyszka, Olga Trojnarska, Andrzej Wysokiński, Piotr Hoffman
This document presents current Polish guidelines on the clinical use of transesophageal echocardiography, including guidance of percutaneous procedures and intraoperative echocardiography, in adult patients. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.
2018: Kardiologia Polska
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