Reimbursement Mechanisms

Publication Title: 
Journal of Neurosurgery

The decade of the 1990's has provided neurosurgery with multiple challenges and opportunities. Numerous developments hold a promise for making the 1990's the most rewarding decade of the 20th century for neurosurgery. The "Decade of the Brain" resolution, adopted by the United States House and Senate and signed into law by President Bush in 1989, has provided the specialty with staggering opportunities.

Author(s): 
Rhoton, A. L.
Publication Title: 
Journal of Neurosurgery

The decade of the 1990's has provided neurosurgery with multiple challenges and opportunities. Numerous developments hold a promise for making the 1990's the most rewarding decade of the 20th century for neurosurgery. The "Decade of the Brain" resolution, adopted by the United States House and Senate and signed into law by President Bush in 1989, has provided the specialty with staggering opportunities.

Author(s): 
Rhoton, A. L.
Publication Title: 
Health Services Research

Health care for the indigent is a major problem in the United States. This review of the literature on health care for the indigent was undertaken to determine which major questions remain unresolved. Overall, this article finds that a very large pool of individuals under age 65 are at risk of being medically indigent.

Author(s): 
Bazzoli, G. J.
Publication Title: 
Journal of Health Economics

Several recent studies have shown that physician participation in state Medicaid programs is directly related to the generosity of their reimbursement levels. The implication is that when states reduce fees, Medicaid eligibles suffer because their access to physicians' services is thereby limited. The results presented in this paper do not support this implication.

Author(s): 
Long, S. H.
Settle, R. F.
Stuart, B. C.
Publication Title: 
Archives of General Psychiatry

Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods.

Author(s): 
Wells, K. B.
Manning, W. G.
Valdez, R. B.
Publication Title: 
Journal of Health Economics

This study investigates the capacity of hospitals to vary the intensity of their services based on patients' expected sources of payment. While the concept of price discrimination by hospitals based on payer generosity ("cost-shifting") has been discussed extensively, the notion that hospitals can adjust payer-specific marginal costs to reflect differences in reimbursement policies has not been studied in depth. To examine this issue.

Author(s): 
Dor, A.
Farley, D. E.
Publication Title: 
The Canadian Journal of Clinical Pharmacology = Journal Canadien De Pharmacologie Clinique

INTRODUCTION: Federal legislation outlined in the Medical Care Act of 1966 and the Canada Health Act of 1984 stipulates that Canadian provincial governments are to administer insurance programs for "medically necessary" services provided by hospitals and physicians. The legislation did not mandate provincial government coverage for prescription drugs taken outside of the hospital. Each province has, however, provided coverage to senior citizens and social assistance recipients; some provinces have introduced drug coverage for the general public.

Author(s): 
Grootendorst, Paul
Publication Title: 
The Journal of Mental Health Policy and Economics

BACKGROUND: Insurance benefits can have a large effect on whether one is able to access health care services. Mental health and substance abuse (MHSA) insurance coverage has typically been less generous than that of general health services. AIMS OF THE STUDY: This paper examines trends in the generosity of private insurance benefits for mental health (MH) services in the United States from 1987 to 1996.

Author(s): 
McKusick, David R.
Mark, Tami L.
King, Edward C.
Coffey, Rosanna M.
Genuardi, James
Publication Title: 
Journal of Health Economics

Nursing home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for nursing home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals.

Author(s): 
Grabowski, David C.
Gruber, Jonathan
Publication Title: 
Medical Care

BACKGROUND: As information is disseminated about best practices, variations in patterns of care should diminish over time. OBJECTIVE: To test the hypotheses that differences in rates of a surgical procedure are associated with type of insurance in an era of evolving practice guidelines and that insurance and site differences diminish with time as consensus guidelines disseminate among the medical community. METHODS: We use lymph node dissection among women with ductal carcinoma in situ (DCIS) as an example of a procedure with uncertain benefit.

Author(s): 
Griggs, Jennifer J.
Sorbero, Melony E. S.
Ahrendt, Gretchen M.
Stark, Azadeh
Heininger, Susanne
Gold, Heather T.
Schiffhauer, Linda M.
Dick, Andrew W.

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