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Cost sharing in healthcare

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https://www.readbyqxmd.com/read/28222905/implementation-of-the-2013-amended-patients%C3%AC-rights-act-in-norway-clinical-priority-guidelines-and-access-to-specialised-health-care
#1
Kjell Arne Johansson, Elizabeth Nygaard, Berit Herlofsen, Frode Lindemark
In 2013, the Norwegian Patient Rights' Act was amended in order to simplify the priority setting process for specialized elective health care and to improve access to care. As a result of the amendment, priority for treatment is now determined by only two criteria: 1) clinical effectiveness; and 2) cost-effectiveness of the intervention. There are 33 clinical priority-setting guidelines organised by medical specialty, which help hospitals evaluate whether individual patients have a right to access care. Following the amendment of the Patient Rights' Act, these guidelines had to be revised in order to assure coherence with the new legislation...
February 17, 2017: Health Policy
https://www.readbyqxmd.com/read/28220485/epidemiology-of-basal-cell-carcinoma-scholarly-review
#2
REVIEW
J A C Verkouteren, K H R Ramdas, M Wakkee, T Nijsten
Basal cell carcinoma (BCC) is the most common cancer in white-skinned individuals with increasing incidence rates worldwide. Patients with BCC place a large burden on healthcare systems, because of the high incidence and the increased risk of synchronous and metachronous BCCs and other ultraviolet radiation (UVR) related skin cancers (i.e. field cancerization). As a result, the disability-adjusted life years and healthcare costs have risen significantly in recent decades. BCC is a complex disease, in which the interplay between UVR, phenotype (UVR-sensitive) and genotype (somatic mutations and germline mutations/polymorphisms) fulfils a key role in the aetiopathogenesis...
February 20, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28219377/the-effect-of-increasing-the-coinsurance-rate-on-outpatient-utilization-of-healthcare-services-in-south-korea
#3
Hyo Jung Lee, Sung-In Jang, Eun-Cheol Park
BACKGROUND: The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization...
February 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28216118/systematic-review-of-patient-education-practices-in-weight-loss-surgery
#4
Karen D Groller
BACKGROUND: Education plays a key role in adherence to lifestyle modifications after weight loss surgery (WLS). Education given before and after surgery may decrease weight recidivism rates and improve outcomes. OBJECTIVE: The purpose of this systematic review was to analyze educational practices in bariatric centers. METHODS: The Cumulative Index to Nursing and Allied Health and PubMed databases were searched in May 2016 for English-language, peer-reviewed studies about WLS patient education practices from 1999 to 2016...
January 11, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28212159/liver-allocation-and-distribution-time-for-a-change
#5
Ranjit Deshpande, Ryutaro Hirose, David Mulligan
PURPOSE OF REVIEW: Liver allograft allocation has been a topic of hot debate for over a decade. New redistricting changes have been proposed by the Liver and Intestinal Transplant Committee to the existing United Network for Organ Sharing (UNOS) liver allocation policy. The basis of this new proposal is similar to the old one with an aim to distribute organs in a fair, efficient and equitable fashion. In this review, we plan to look in depth at the redistribution proposals thus far, their merits and how they may help patients who do not have adequate access to livers...
February 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28210864/pharmacy-benefit-management-companies-do-they-create-value-in-the-us-healthcare-system
#6
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...
February 16, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28202052/primary-care-focus-and-utilization-in-the-medicare-shared-savings-program-accountable-care-organizations
#7
Lindsey A Herrel, John Z Ayanian, Scott R Hawken, David C Miller
BACKGROUND: Although Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs)...
February 15, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28178729/re-examining-physical-findings-with-point-of-care-ultrasound-a-narrative-review
#8
William Diprose, Francois Verster, Cameron Schauer
The art of physical examination has continued to be practised by physicians largely unchanged for over 200 years. Ultrasound, once the domain of the radiologist, is now being increasingly used by emergency physicians and intensivists to make rapid, accurate diagnoses at the point-of-care. We review the growing body of evidence supporting point-of-care ultrasound (PoCUS) as the preferred alternative to many aspects of the cardiovascular, respiratory, abdominal and neurological examinations in internal medicine...
January 27, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28169925/hospital-teaching-status-and-medicare-expenditures-for-complex-surgery
#9
Jason C Pradarelli, Christopher P Scally, Hari Nathan, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: To evaluate the relationship between hospital teaching intensity, Medicare payments, and perioperative outcomes. BACKGROUND: Several emerging payment policies penalize hospitals for low-value healthcare. Teaching hospitals may be at a disadvantage given the perception that they deliver care less efficiently. METHODS: Using Medicare Provider and Analysis Review files, we studied patients from age 65 to 100 years who underwent abdominal aortic aneurysm (AAA) repair (n = 71,422), pulmonary resection (n = 93,056), or colectomy (n = 277,619) from 2009 to 2012...
March 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28166804/addressing-the-gaps-in-diabetes-care-in-first-nations-communities-with-the-reorganizing-the-approach-to-diabetes-through-the-application-of-registries-radar-the-project-protocol
#10
Dean T Eurich, Sumit R Majumdar, Lisa A Wozniak, Allison Soprovich, Kari Meneen, Jeffrey A Johnson, Salim Samanani
BACKGROUND: Type-2 diabetes rates in First Nations communities are 3-5 times higher than the general Canadian population, resulting in a high burden of disease, complications and comorbidity. Limited community nursing capacity, isolated environments and a lack of electronic health records (EHR)/registries lead to a reactive, disorganized approach to diabetes care for many First Nations people. The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) project was developed in alignments with federal calls for innovative, culturally relevant, community-specific programs for people with type-2 diabetes developed and delivered in partnership with target communities...
February 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28162966/over-the-counter-antibiotics-in-saudi-arabia-an-urgent-call-for-policy-makers
#11
Sharafaldeen Bin Nafisah, Salahaldin Bin Nafesa, Aliyah H Alamery, Mazen A Alhumaid, Haitham M AlMuhaidib, Fahad A Al-Eidan
Antibiotics over-consumption is a pandemic that has a tremendous cost on the overwhelmed healthcare system. The accessibility of antibiotics coupled with the misconception of public toward those drugs both of which implicated in the use and misuse of antibiotics. The aim of this study was to investigate the perception of the community toward antibiotics, its purpose and harmfulness, in addition to the accessibility of those drugs as over the counter and without prescriptions. We also investigated the behavior toward antibiotic prescriptions when perceived unnecessary...
February 2, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28160771/a-realist-review-of-shared-medical-appointments-how-for-whom-and-under-what-circumstances-do-they-work
#12
Susan R Kirsh, David C Aron, Kimberly D Johnson, Laura E Santurri, Lauren D Stevenson, Katherine R Jones, Justin Jagosh
BACKGROUND: Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances...
February 4, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28152910/choosing-wisely-in-oncology-are-we-ready-for-value-based-care
#13
Doug Blayney, Mohammad Jahanzeb, Pamela Kadlubek, August Knape, Merry Jennifer Markham, Trang Pham, Tracey L Evans
: 275 Background: The Choosing Wisely (CW) Campaign challenges patients, healthcare providers, and specialty disease societies to make better decisions about healthcare delivery. In 2012, Schnipper et al. published ASCO's Top Five List targeting overuse of medications, tests, and procedures that are costly and lack evidence. 1.) Do not use cancer-directed therapy for patients with low performance status (undocumented, 3 or 4). 2.) Do not use PET, CT and radionuclide bone scans in the staging of early prostate cancer...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152794/using-technology-to-improve-patient-provider-communication-and-delivery-of-quality-care
#14
Amanda Hathaway, Karina I Halilova, Michele Gaguski, Kathryn A Thomas, Carrie Tompkins Stricker, Karen Hammelef, SarahLena Panzer, Paul B Jacobsen, Joanne S Buzaglo, Douglas W Blayney
: 76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients' understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. METHODS: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152789/does-oncology-patient-reported-healthcare-experience-vary-by-site-of-care-soc
#15
Adrianne Waldman Casebeer, Sari Hopson, Joseph Dye, Zhuliang Tao, Andrew M Howe, Stephen Stemkowski, Jeffrey Patton, Art Small, Anthony Masaquel
: 71 Background: Patients with cancer are increasingly receiving chemotherapy infusions in a hospital outpatient (HO) as compared to the physician practice setting (PO). Previous research has focused on SOC differences in economic measures, such as healthcare costs, in commercially insured populations. This study investigates SOC differences in patients' reported healthcare experience for a mostly Medicare population. METHODS: A convenience sample of 2,604 Humana members with cancer of the breast, lung, colon/rectum or NHL/CLL and treated in 2014 received a survey by mail to capture patient reported healthcare experiences...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152738/designing-and-implementing-a-payment-system-to-support-cancer-care-coordination-a-literature-review
#16
Chloe Gerves-Pinquie, Etienne Minvielle
: 40 Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. METHODS: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152735/early-impact-of-the-affordable-care-act-aca-on-financial-worry
#17
Xin Hu, Helen M Parsons, Zhiyuan Zheng
: 44 Background: We examined changes in financial worry for working-aged cancer survivors compared to individuals without a cancer history (controls) after ACA-mandated health insurance enrollment and caps on cost-sharing were implemented in 2014. We hypothesized that cancer survivors would be more likely to report financial worry, and that ACA implementation would reduce financial worry. METHODS: We pooled data from the 2013-2014 National Health Interview Survey for adults aged 21-64 years...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28132168/delivery-and-payment-redesign-to-reduce-disparities-in-high-risk-postpartum-care
#18
Elizabeth A Howell, Norma A Padrón, Susan J Beane, Joanne Stone, Virginia Walther, Amy Balbierz, Rashi Kumar, José A Pagán
Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk...
January 28, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28130949/how-appropriate-is-all-this-data-sharing-building-consensus-around-what-we-need-to-know-about-shared-electronic-health-records-in-extended-circles-of-care
#19
Josephine McMurray, Kelly A Grindrod, Catherine Burns
BACKGROUND: The bulk of healthcare spending is on individuals who have complex needs related to age, income, chronic disease and mental illness. Care involves many different professions, and interoperable electronic health records (EHRs) are increasingly essential. OBJECTIVES: The objective of this paper is to describe the use of a nominal group technique (NGT) to develop a stakeholder-centred research agenda for clinical interoperability in extended circles of care that include social supports...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28122623/criteria-to-assess-potential-reverse-innovations-opportunities-for-shared-learning-between-high-and-low-income-countries
#20
Onil Bhattacharyya, Diane Wu, Kathryn Mossman, Leigh Hayden, Pavan Gill, Yu-Ling Cheng, Abdallah Daar, Dilip Soman, Christina Synowiec, Andrea Taylor, Joseph Wong, Max von Zedtwitz, Stanley Zlotkin, William Mitchell, Anita McGahan
BACKGROUND: Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings...
January 25, 2017: Globalization and Health
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