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PubMed2000

Medicare's new home health prospective payment system explained.

The new Medicare home health prospective payment system pays fixed, predetermined rates for services provided during episodes of home health care. This article details the construction and principal components of the new payment system and shows how episode payment rates and other amounts that Medicare now pays for home health care are calculated. Suggestions are made for steps that home health agencies can take to respond most effectively to the new system's operational requirements and align themselves with the plan's financial incentives.

Aged↗
PubMed2005

Medicaid managed care program provides fiscal rewards for performance.

Commercial insurers across the country are paying bonuses to physicians and hospitals that meet or exceed quality and performance goals. But now a Medicaid managed care program is using pay-for-performance incentives to prompt hospitals to take better care of its members.

California↗
PubMed1987

Rules and incentives for hospitals: the Belgian financing system.

The purpose of the paper is to analyze the set of rules and mechanisms that control the financing of Belgian hospitals. It emphasizes their effects on economic incentives for hospital managers and physicians. For this purpose, it is first necessary to understand how the social security system and the health care sector are organized in Belgium. The paper first describes their main features. The paper then gives an historical overview of recent developments in the financing of Belgian hospitals. It emphasizes the double source of hospital revenues, i.e., patient per-diam prices and medical practice fees, although its main concern is with the evolution of the rate-setting process for the per-diem prices. Since the 1981 decision to freeze the per-diem prices and patient-day quotas for individual hospitals, proposals for changes in the financing system have been under study. Implementation of some of these changes began in 1986. The major modification involved is to correct historical per-diem prices by means of interhospital cost comparisons. The paper ends with a critical appraisal of these latest developments. It focuses on the advantages and shortcomings of the pre-1986 system and of the recent changes. The accent is put on the economic incentives and their effects on the behavior of hospitals.

Belgium↗
PubMed2006

Quality councils as change agents and drivers of quality improvement in healthcare.

This commentary addresses four key questions raised in the lead paper. We recognize that health quality councils have a delimited range of tools available to bring about needed change. They have neither funding and regulatory powers nor day-to-day operational authority. Nevertheless, based on the Health Quality Council of Alberta's (HQCA) successes to date using a multidimensional change strategy, we are confident that quality councils can play a vital role in driving and sustaining quality improvement in provincial healthcare systems. The provisos are that the councils need to be sufficiently empowered, establish themselves as trusted partners and independent advisors, use effective change strategies, focus on strategic priorities and gain strong stakeholder support for needed changes. We are also convinced that multilevel measurement is an essential tool for learning, priority setting, establishing the imperative for action and assessing progress. Finally, in terms of the value proposition - the relationship between resource inputs and healthcare outcomes - we strongly suggest that health quality councils work collaboratively with service providers to obtain better value for money by improving quality rather than aligning themselves with funders and rely on "pay for quality" incentives to "compel" quality improvement.

Alberta↗
PubMed2004

Professional and public attitudes toward incentives for organ donation.

The U.S. faces a widening gap between the need for, and the supply of, transplantable organs. The waiting list for transplants increased 150% in the past decade; last year, about 6,000 people died awaiting a transplant. This need has rekindled debate about the morality and feasibility of using incentives to encourage posthumous organ donation. This Issue Brief explores attitudes of the public and health professionals in the transplant community about using financial and nonfinancial incentives to increase the supply of cadaver organs for transplant.

Attitude of Health Personnel↗
PubMed1990

An analysis of financial incentives in the performance contract of Montana.

In an effort to contain costs and provide appropriate services, a growing number of states are experimenting with the terms of their fiscal transfers to localities. This paper contains an analysis of the economic incentives present in one such effort, the performance contract of the state of Montana. This contract contains incentives which do not fully support the attainment of a number of possible social goals, but these incentives could be strengthened by some simple amendments to the existing structure.

Community Mental Health Centers↗
PubMed2006

Making sense of medical technology.

In seeking to explain contradictory reports that increased medical spending is both valuable and wasteful, Jonathan Skinner and colleagues rightly emphasize differences in regional practice patterns in response to constraints. However, it is more accurate to view the situation not as a choice between valuable but inexpensive care and more costly care with worse outcomes-as Skinner and colleagues theorize-but as a choice between responses to regional inefficiencies. Given that we do not know what will best improve the efficiency of medical care in a given area, experiments with financial incentives to both providers and individual patients should receive high priority.

Biomedical Technology↗
PubMed2004

Factors influencing the willingness to donate body parts for transplantation.

Three hundred and thirty-six people representing three ethnic groups (White, Asian, and Afro-Caribbean) were asked to rank their preferences concerning various incentives that might induce them to agree to the posthumous donation of their body parts. A conjoint analysis of the responses suggested that 'self centred' options (notably upfront cash payments and priority on waiting lists) were generally more popular than 'altruistic' alternatives. Members of the sample already possessing donor cards were more knowledgeable about the issue of organ transplantation than others, were less squeamish, and had relatives who favoured organ donation. The strength of a person's desire to donate body parts was related positively to self-respect and whether the individual was 'religious'; and negatively to (i) squeamishness and (ii) having relatives who objected to transplantation. Altruistic preferences vis-à-vis organ donation were associated with knowledgeability, self-esteem, family background, low levels of squeamishness, and the extent to which a person experienced 'helper's high.' People who were financially well-off were the most self-centred in the organ donation context. Overall the results imply substantial disparities between public policy and contemporary public opinion regarding transplant donation incentives.

Adolescent↗
PubMedDate not supplied

Pay for performance: its influence on the use of IT in physician organizations.

The introduction of information technology (IT) in physician organizations and practices is a source of great interest to physician leaders and policy makers. In this article, the authors describe what may be the nation's largest pay-for-performance program, its performance metrics, and incentives for the implementation and use of IT in medical groups and independent physician associations (IPAs). Results include the increased use of electronic clinical data, point-of-care technology, and the generation of more actionable reports for quality improvement. Noteworthy are the efforts by physician organizations to enhance data collection to demonstrate improved clinical performance and earn financial incentives.

California↗
PubMed1991

Universal health insurance through incentives reform.

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Aged↗