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Employer healthcare plans and cost sharing

I A A Perfors, C W Helsper, E A Noteboom, E van der Wall, N J de Wit, A M May
BACKGROUND: Due to the ageing population and improving diagnostics and treatments, the number of cancer patients and cancer survivors is increasing. Policymakers, patients and professionals advocate a transfer of (part of) cancer care from the hospital environment to the primary care setting, as this could stimulate personalized and integrated care, increase cost-effectiveness and would better meet the patients' needs and expectations. The effects of structured active follow-up from primary care after cancer diagnosis have not been studied yet...
February 5, 2018: BMC Cancer
Claire Harris, Kelly Allen, Vanessa Brooke, Tim Dyer, Cara Waller, Richard King, Wayne Ramsey, Duncan Mortimer
BACKGROUND: This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment...
May 25, 2017: BMC Health Services Research
Deborah S Keller, Anthony J Senagore, Kathryn Fitch, Andrew Bochner, Eric M Haas
BACKGROUND: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery. METHODS: A Truven MarketScan® claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs)...
July 2017: Surgical Endoscopy
Julia Thornton Snider, Seth Seabury, Janice Lopez, Scott McKenzie, Dana P Goldman
OBJECTIVES: To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk. STUDY DESIGN: A retrospective claims analysis of data from 35 large, private, self-insured employers (2004 to 2012). METHODS: We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out-of-pocket cost to purchase a pre-specified bundle of T2D prescriptions...
June 2016: American Journal of Managed Care
K L Mattick, K Kaufhold, N Kelly, J A Cole, G Scheffler, C E Rees, A Bullock, G J Gormley, L V Monrouxe
OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis. SETTING: Four UK study sites, one in each country. PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25)...
February 23, 2016: BMJ Open
Christopher T Robertson
In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums...
2014: Yale Journal of Health Policy, Law, and Ethics
Albert Tzeel, Jack Brown
BACKGROUND: AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics...
July 2010: American Health & Drug Benefits
Melinda C Haren, Kirk McConnell, Arthur F Shinn
Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal...
April 2009: American Health & Drug Benefits
Melinda C Haren, Kirk McConnell
OBJECTIVE: The relationship between healthcare insurers and employers plays a critical role today in decisions about benefit design, cost-sharing, and even the coverage of individual products and services. To better understand how these 2 stakeholders interact in the creation of healthcare benefit design, the Zitter Group conducted a large national study of insurer-employer relationship. METHODS: This study is based on a primary web-based survey with 100 top decision makers in large national and important regional commercial managed care plans, and a similar survey of 100 employers and employer benefit consultants, including medical directors and benefit decision makers...
February 2009: American Health & Drug Benefits
Julia Philippou
AIM: To examine nurse employees' and employers' views about responsibilities for managing nurses' careers. BACKGROUND: Career management policies are associated with cost savings, in terms of workforce recruitment and retention and an increase in job and career satisfaction. In nursing, responsibility for career management remains relatively unexplored. DESIGN: A multicenter, cross-sectional questionnaire survey. METHODS: Data were collected from 871 nurse employees and employers in the British National Health Service...
January 2015: Journal of Advanced Nursing
Corinne Marie Karuppan
Outbound medical travel (MT) involves U.S. patients going abroad to seek medical care. Over the past decade, there has been much discussion about MT's broadening appeal to several segments of U.S. healthcare consumers, but little is known about its penetration in the employer-based coverage (EBC) marketplace. The objectives of this article are to fill this gap and identify (1) the current status of MT options in EBC, (2) the differences between adopters and nonadopters of MT options, and (3) the factors that impede adoption...
May 2014: Journal of Healthcare Management / American College of Healthcare Executives
Stephane A Régnier
OBJECTIVES: To quantify how access to on-patent drugs by tier placement varies by insurance type and therapeutic area. STUDY DESIGN: Retrospective analysis of insurance plan drug coverage data. METHODS: Drug coverage information was collected from the Fingertip Formulary database in May 2011 for 3 drug classes (statins, angiotensin II receptor blockers, and protein-tyrosine kinase inhibitors) across 3 therapeutic areas with varying levels of generic drug availability...
April 2014: American Journal of Managed Care
Matthew Limb
No abstract text is available yet for this article.
2014: BMJ: British Medical Journal
Bikaramjit S Mann, Lianne Barnieh, Karen Tang, David J T Campbell, Fiona Clement, Brenda Hemmelgarn, Marcello Tonelli, Diane Lorenzetti, Braden J Manns
BACKGROUND: Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. OBJECTIVE: To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease)...
2014: PloS One
Mohammad-Pooyan Jadidfard, Shahram Yazdani, Mohammad-Hossein Khoshnevisan
AIMS: This study aimed to describe the current situation with regard to dental care provided under social insurance in Iran in qualitative terms and to assess it critically with regard to equity and efficiency. METHODS: After a thorough review of the relevant literature, a template of topics, which included population coverage, range of treatment provided, contracting mechanisms, fees, level of co-payments and dental share of total health expenditures, was developed by a panel of Iranian health finance experts...
December 2012: Oral Health and Dental Management
Julie Gazmararian, Rita Carreón, Nicole Olson, Barbara Lardy
OBJECTIVES: To explore why health plans collect or forgo data collection efforts on race, ethnicity, and language (REL), and the challenges encountered in collecting and using data for quality improvement. STUDY DESIGN: In-depth interviews with 15 health plans were conducted between June and August 2009. METHODS: Fifteen health plans participated and were divided into 2 groups: Plans that collect and use REL data (n = 10), and plans that do not collect REL data (n = 5)...
July 2012: American Journal of Managed Care
Gail Tomblin Murphy, Rob Alder, Adrian MacKenzie, Amanda Cook, Victor Maddalena
The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) methodology (Earl et al. 2001) with a mixed-methods, repeat survey (before/after) study design. This design uses concurrent measurement of process and outcome indicators at baseline and follow-up. The RTA project proved effective at improving work environments and thereby promoting the retention and recruitment of nurses. Nurses involved in the RTA initiatives had a higher perception of leadership and support in their units, improved job satisfaction, increased empowerment and occupational commitment, and a greater intention to stay on the job...
March 2012: Nursing Leadership
Albert L Tzeel
Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities...
November 2011: American Journal of Managed Care
Tsipi Heart, Efrat Kalderon
BACKGROUND: The proportion of older adults in the population is steadily increasing, causing healthcare costs to rise dramatically. This situation calls for the implementation of health-related information and communication technologies (ICT) to assist in providing more cost-effective healthcare to the elderly. In order for such a measure to succeed, older adults must be prepared to adopt these technologies. Prior research shows, however, that this population lags behind in ICT adoption, although some believe that this is a temporary phenomenon that will soon change...
November 2013: International Journal of Medical Informatics
Nancy A Hardie, Anthony T Lo Sasso, Mona Shah, Regina A Levin
BACKGROUND: Numerous studies have examined behavioral health services via employer-sponsored health insurance cost-sharing measures. Their results clearly indicate that health plan design matters a great deal with respect to behavioral health utilization. It is also clear that there remain a number of unresolved issues, particularly with respect to the effects of a switch from traditional plan designs to high deductible, consumer-driven policies. Health Savings Accounts (HSA) have been well described in the literature with some comparisons to traditional healthcare plans, however no reports have been made about their use for behavioral health treatment...
December 2010: Journal of Mental Health Policy and Economics
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