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Results for “Insurance, Health, Reimbursement”

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At least 235 records · Page 13Linked to original sources
PubMed2004

Medical errors: the perspective of the insurer.

Errors in medicine have a significant impact upon the cost of health insurance in the United States. These errors may reflect a range of errors ranging from ineffective or futile care to inappropriate medical judgments to coding errors. These may be unintentional, but underlying all of these error-types is a failure of process stemming back to physician training. The commercial industries that pay for health insurance may be demanding a process approach and accountability structures in return for continued funding of health care services.

Delivery of Health Care↗
PubMed2002

Health insurer monopsony power: the all-or-none model.

The textbook model of monopsony that is typically employed in analyzing health insurer monopsony power does not adequately describe the supply decision of physicians confronting a dominant health insurer. Rather than restricting purchases in order to extract a lower price for provider services, monopsonistic insurers are able to obtain discounts from providers without experiencing a decrease in quantity when physicians are forced to operate along their "all-or-none" supply curve. The welfare effects of the all-or-none model of monopsony are compared to those implied by the traditional model.

Antitrust Laws↗
PubMed1988

Payor mix of trauma patients at a rural-metropolitan regional trauma center: a three-year experience.

The development of a statewide trauma system will depend on designation of community hospitals as trauma centers. The financial impact of such designation will be a prime concern. The payor mix of trauma patients will be one of the deciding factors as to whether hospitals will agree to accept designation. A three-year review of payor class on discharge for 2,605 trauma and 55,041 nontrauma admissions to a nonuniversity teaching hospital is presented. Sixty-four percent of all trauma admissions had third-party payor insurance coverage, compared with 72% of all nontrauma admissions (P less than .00001). Twenty-seven percent of trauma admissions were for penetrating injury. Sixty-eight percent of patients admitted for blunt trauma had third-party coverage, while 50% of those admitted for penetrating trauma had third-party coverage. Total commercial insurance coverage was higher for trauma patients than for nontrauma admissions. The payor class mix for trauma patients presented may be representative of similar institutions in a similar geographic setting and may offer assistance to hospitals considering the financial impact of trauma center designation.

Adolescent↗
PubMed1997

Basic insurance concepts for dentists.

Dentists cannot afford to be ignorant about insurance. Insurance is an important risk-management tool, minimizing the exposure for catastrophic claims and losses. Patient insurance is also a major source of revenue for most dental practices.

Insurance↗
PubMed2004

New evidence on hospital profitability by payer group and the effects of payer generosity.

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. The data are taken from hospital accounting reports in four states in FY2000, and detailed discharge summaries from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. The profitability of inpatient care for privately insured patients was found to be about 4% less than for Medicare, but 14% higher than for Medicaid and only 9% higher than for self-pay patients. We found significant direct associations but not external effects of payer generosity on the intensity of care.

Facility Regulation and Control↗