Insurance, Health, Reimbursement

Publication Title: 
Alternative Therapies in Health and Medicine

OBJECTIVE: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into managed care. DATA SOURCES: A literature review and information search were conducted to determine which new insurers had special policies for CAM from 1999 to 2000.

Author(s): 
Pelletier, Kenneth R.
Astin, John A.
Publication Title: 
Home Healthcare Nurse Manager

The prospective payment system will require agencies to become more creative and network with community resources. This article describes a health needs assessment survey that provided the foundation for a parish nurse ministry. The survey revealed that parish nurses could complement home health nurses by filling some of the gaps in healthcare not provided by third-party payers.

Author(s): 
Thomas, D. J.
King, M. A.
Publication Title: 
Modern Healthcare

Some observers may say the timing was preordained. Against the backdrop of Tenet Healthcare Corp.'s mounting woes, the Catholic Health Association, headed by the Rev. Michael Place (left), is expected this week to release a report arguing that Roman Catholic hospitals deserve special and distinct financial concessions from the federal government because of the role they play.

Author(s): 
Reilly, Patrick
Publication Title: 
Social Science & Medicine (1982)

In 1980, drug consumption per capita was 455 Swedish crowns (SEK) in Sweden, SEK 452 in Denmark, SEK 384 in Finland and SEK 382 in Norway; actual figures for Denmark, Finland and Norway being converted into Swedish crowns using the mean 1980 exchange rates. To what extent can these differences be explained by differences in the drug reimbursement programmes of these four Nordic countries?

Author(s): 
Lindgren, B.
Silverberg, R.
Publication Title: 
Journal of Aging & Social Policy

The prospect of budget cuts in Medicare is likely to result in less generous reimbursements from Medicare and thus affects physicians' willingness to accept Medicare patients with the reduced payments. This study examines physicians' decisions about case-by-case assignment and participation in Medicare in relation to Medicare reimbursement generosity. A two-part model is applied to a database from a national survey of physicians.

Author(s): 
Zhang, M.
Publication Title: 
International Journal of Health Care Finance and Economics

This study provides (a) new estimates of U.S. hospital profitability by payer group, controlling for hospital characteristics, and (b) evidence about the intensity of care for particular diseases associated with the generosity of the patient's payer and other payers at the same hospital. The conceptual framework is a variant of the well-known model of a local monopolist selling in a segmented market. Effects of two kinds of regulation are considered.

Author(s): 
Friedman, Bernard
Sood, Neeraj
Engstrom, Kelly
McKenzie, Diane
Publication Title: 
Health Services Research

OBJECTIVE: This study examines the effects of Medicaid payment generosity on access and care for adult and child Medicaid beneficiaries. DATA SOURCE: Three years of the National Surveys of America's Families (1997, 1999, 2002) are linked to the Urban Institute Medicaid capitation rate surveys, the Area Resource File, and the American Hospital Association survey files.

Author(s): 
Shen, Yu-Chu
Zuckerman, Stephen
Publication Title: 
Medical Care

BACKGROUND: Previous studies have documented that hospitals decrease costs in response to reimbursement cutbacks. However, research concerning how this may affect quality of care has produced mixed results. Until recently, the ability to study changes in patient safety and payment has been limited. OBJECTIVE: The objective of the study was to determine whether changes in 4 hospital patient safety indicator (PSI) rates are related to changes in the generosity of payers over time.

Author(s): 
Clement, Jan P.
Lindrooth, Richard C.
Chukmaitov, Askar S.
Chen, Hsueh-Fen
Publication Title: 
Inquiry: A Journal of Medical Care Organization, Provision and Financing

Controlling for state fixed effects and other factors, this paper estimates the effect of the generosity of Medicaid physician payment levels on the volume and site of ambulatory care received by Medicaid patients compared to privately insured patients. Results indicate that cuts in Medicaid physician fees lead to statistically significant reductions in the number of visits for Medicaid patients compared to privately insured patients.

Author(s): 
Decker, Sandra L.
Publication Title: 
Health Services Research

OBJECTIVES: To examine the effects of changes in payment and risk adjustment on (1) the annual enrollment and switching behavior of Medicare Advantage (MA) beneficiaries, and (2) the relative costliness of MA enrollees and disenrollees. DATA: From 1999 through 2008 national Medicare claims data from the 5 percent longitudinal sample of Parts A and B expenditures. STUDY DESIGN: Retrospective, fixed effects regression analysis of July enrollment and year-long switching into and out of MA.

Author(s): 
Morrisey, Michael A.
Kilgore, Meredith L.
Becker, David J.
Smith, Wilson
Delzell, Elizabeth

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