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At least 235 records · Page 13Linked to original sources
PubMed2003

The next stage in the health care economy: aligning the interests of patients, providers, and third-party payers through consumer-driven health care plans.

This article reviews employers' attempts over the past 25 years to address the cost and accessibility of health care services for their employees and the effect these efforts have had on U.S. health care delivery. The difficulties in aligning the interests of all parties in a third-party health beneficiary contract are examined. Many employers are considering consumer-driven health care plans as an alternative to managed care plans to both control health care costs and improve employee satisfaction. Such plans differ from fee-for-service and managed care models in terms of the economic alignment of the parties. Consumer-driven plans align the employer's economic interest with the employee/patient, and reduce health benefit costs by providing information, tools, and direct economic incentives to employees for self-management of health care dollars. Because these incentives are designed to reduce the consumption of services, providers are the party left out of economic alignment under the consumer-driven model.

Consumer Advocacy↗
PubMed2003

Health-related quality of life and cost of ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers?

The objective was to quantify the outcome of osteoporosis (OP) in terms of health-related quality of life (HR-QOL) and cost of ambulatory care and to look at the association between these two outcomes variables. A cross-sectional health survey of 4800 Belgian individuals over the age of 45 years was used. Individuals having reported OP were retrieved and for each of them, at least two matched individuals for age, sex, residency location, and health insurance status were identified. All individuals were assessed with the SF-36. The two major health insurance providers furnished cost value for ambulatory care. HR-QOL and cost data were compared between the OP group and control group. Beta-coefficients from linear regression were calculated to give information on the relative importance of the association between each SF-36 dimensions and cost of ambulatory care. Of 4796 individuals appropriately surveyed, 221 (4.8%) reported OP. The control group included 651 individuals. The OP group experienced impaired HR-QOL compared to their matched counterparts, all the difference in mean or median SF-36 scores being significant at the level of P < 0.001. Osteoporotic respondents averaged 816 in cost of ambulatory care whereas controls averaged 579 (P < 0.001). When looking at detailed comparisons between categories of cost, costs in the OP group far exceeded those in the control group, all the differences being significant at the level of P < 0.001 except for home health nurse (P = 0.012). In the OP group, vitality dimensions played the most important role in the determination of cost (beta = -0.28, P < 0.001), followed by physical functioning (beta = -0.26, P < 0.01), general health, and social functioning (beta = -0.23, P < 0.01). This study evidences the burden of OP in terms of HR-QOL and cost of ambulatory care. Exploring the association between HR-QOL and cost show that mental dimension such as vitality can play an important role in the determination of cost. Conclusively, they should not be neglected in future management of OP.

Aged↗
PubMed1993

Health-care reform. Single-payer models.

Health-care reform is one of the most urgent issues facing the United States today. The current system is marked by enormous disparities between services available to those with virtually unlimited resources and those who must pay for services directly. Among the options being considered is that of a single-collector, state-based system with universal access, effective cost control, administrative simplicity, re-allocation of services toward primary and preventive care, and a reduction in unnecessary services. A key element in such a plan is a politically independent Federal Health Board, which would be responsible for making decisions about the definition of a standard benefit plan to be provided to each American.

Delivery of Health Care↗
PubMed2000

Financing the treatment of chronic pain: models for risk-sharing among pain medicine physicians, health care payers, and consumers.

Chronic pain patients are among a growing group of medically underserved Americans. Despite increasing public awareness about pain and widespread legislative activity that is focusing on the needs of pain patients, there remain significant roadblocks in bringing the expertise of Pain Medicine specialists to these unfortunate people. This paper explores how the managed care revolution has impacted the practice of Pain Medicine in the United States. The dissolution of many prominent multi-disciplinary pain treatment centers has been paralleled by the evolution of pain management as an area of interest by several competing medical specialty societies. Despite this fragmentation, the American Academy of Pain Medicine continues to grow and to promote the needs of Pain Medicine specialists and their patients. The advantages and disadvantages of various practice patterns for Pain Medicine specialists is explored against a backdrop of discussions about: (1) the problems currently faced by chronic pain patients; (2) the role of organized Pain Medicine in helping patients to access and finance care; and (3) the future of American health care and the new responsibilities that will bring to physicians. Finally, we have some specific recommendations for pain medicine specialists about: (1) sharing risk; (2) exerting individual leadership; and (3) simplifying one's professional life in the new health care environment, that we hope will enable them to continue caring for as many chronic pain patients as possible. It is opined that the development of sophisticated regional specialty networks is the best model to accomplish this task in the future.

Journal Article↗
PubMed2006

[Expenditures for members of a health insurance company suffering from alcoholism - a payer's view].

AIM: In this study, expenditures of a health insurance company for alcoholics are calculated and analysed. METHOD: Data are derived from the company's records. To participate in this study, subjects had to have a clearly alcohol-related diagnosis during a stay in hospital or a time-off work in 2001 (index-year). 127 Persons were identified according to these criteria. The sample was divided into two groups, those with an alcohol-related diagnosis only in 2001 (Group 1) and those with an alcohol-related diagnosis in at least one other year (Group 2, chronic condition). Expenditures are calculated, cost figures are compared with the health insurance company's average means. For Group 1, the course of costs is examined. Also, cost-predictors are identified. RESULTS: The results show increased costs for alcoholics for all sectors included. Further analyses revealed higher expenditures for persons with a chronic condition (Group 2) and older age. The course of costs for Group 1 shows that expenditures here are clearly increased in the index-year, but not in the other years. CONCLUSIONS: A recurrent diagnosis of alcoholism leads to high costs for health insurance companies. Investments in effective prevention and treatment strategies are recommended to reduce the financial burden.

Adolescent↗
PubMed2001

When the payer says "no!": ethical considerations in patient advocacy.

Spinal cord injury is a relatively infrequent but often catastrophic injury. As such, it presents special challenges for the individuals affected and the clinicians who care for them. Claims for reimbursement of acute care, rehabilitation, and long-term care are often denied, requiring patients and clinicians to exhaust every effort to ensure coverage for therapeutic interventions, preventive care, and durable medical equipment. Ethical dilemmas are presented within the framework of the US healthcare system, and practical strategies are discussed.

Ethics, Medical↗