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PubMed1994

[Management of health services--financing method tool].

Financing methods for health care have great actuality in the Nordic countries. Incentive theory background is briefly presented. The main categories and subcategories of financing methods are listed. For the global budget solutions capitation and global budget based on historical costs, the advantages and problems are discussed. The two main categories per-case reimbursement, retrospective and prospective, are presented. The retrospective category includes per-diem rates and fee-for-service payment. Prospective reimbursement can be done on the basis of product definitions or episodes of care. The possibility of result grading the per-case reimbursement is mentioned. Problem solving by hybrid methods of financing is presented. Requirements to reimbursement methods can be: 1) They should be clinically neutral or assist in reaching formulated goals. 2) They should not result in unwanted use of any level of care. 3) They should not present barriers to justified referral between any level of care.

Budgets↗
PubMed1999

Training osteopathic geriatric academicians: impact of a model geriatric residency program.

The need for osteopathic geriatric academic leaders who are educators and researchers is well recognized. The University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine's Geriatric Residency program, a federally funded Faculty Training Project in Geriatric Medicine and Dentistry, has served as a model program in the osteopathic medical professional since its inception in 1989. Targeting internal medicine and family medicine physicians interested in academic careers in geriatrics, the program promotes interdisciplinary training, which develops clinical, research, and teaching/administrative skills. A survey of program graduates assessed their perceptions about the field of geriatrics and the impact of training on career choice and level of satisfaction. Results indicated that 100% of the former trainees entered the field of geriatrics; 57% hold full-time faculty appointments at an osteopathic medical school, and 43% practice as clinical geriatricians. Of those in an academic setting, all taught medical students and housestaff and were involved in research. All of the respondents wee satisfied with their career choice, although 71% indicated that a higher salary and greater respect for the discipline would further enhance their satisfaction. Greater than half perceived the need for additional geriatricians and ranked complexity of care, lower salaries, inadequate reimbursement, and indebtedness after medical school as significant barriers to entering the field. This program has been successful in training academic geriatricians, it has created role models for students, and it has responded to the shortage of osteopathic academic and clinical geriatricians. Financial incentives and reimbursement that is commensurate with complexity of care would serve to attract more trainees to this important primary care discipline.

Clinical Competence↗
PubMed2003

Medicare launches financial incentive program to reward hospital quality care.

The pay-for-performance movement received a boost in July when Department of Health and Human Services Secretary Tommy Thompson announced a new Medicare pilot project, which starts October 1, that will use financial incentives to encourage hospitals to provide high-quality care for 35 measures in five clinical areas.

Aged↗
PubMed1987

Variations in ambulatory test use: what do they mean?

This article discusses the meaning of variations in ambulatory test use with emphasis on practice setting, availability of testing services, financial incentives, and physician and patient characteristics.

Ambulatory Care↗
PubMed1992

Reform debate must address appropriate capital incentives.

In the broad debate over health care reform, the issue of how to regulate hospital capital spending is being touched on lightly. Many options exist--from incentives built into a national payment mechanism to market-driven plans.

Capital Expenditures↗
PubMed1998

Getting the incentives right for children.

OBJECTIVE: One way to improve the functioning of the American child healthcare system is through the design of incentives. Objective: to examine what we know and need to know about designing incentives to encourage the production of high-quality care both for healthy children and for children with serious illnesses. SUMMARY AND CONCLUSIONS: For healthy children, incentives should encourage the provision of preventive services, including services that encourage healthy behavior. For children with serious illnesses, incentives should reduce risk selection, promote collaborative systems of care, and ensure access to appropriate specialty services. Research findings needed for incentive design includes information on the actual working of existing incentive mechanisms as well as information about risk adjustment, mixed payment system, carve-outs, and other mechanisms to reduce risk selection; options for defining service scope that encourage collaboration; and information about the ways in which quality measurement interacts with payment incentives.

Capitation Fee↗
PubMed1992

Incentive payments to nursing homes based on quality-of-care outcomes.

The federal Omnibus Budget Reconciliation Act of 1987 specifies that a state may establish a program to reward--through public recognition, incentive payments, or both--nursing facilities that provide the highest quality care to residents entitled to Medicaid. As state policymakers, providers, and advocates consider development of systems for rewarding quality in nursing homes, including incentive payments based on resident outcomes, theoretical and practical dilemmas must be addressed. The article examines the impetus for combining incentives with outcome measures and the conceptual dilemmas that outcome-based payments pose. Issues basic to successful implementation of incentive payments to nursing homes based on quality of care outcomes are also delineated.

Health Services Research↗
PubMed1993

Evolution of a quality-based compensation model: the third generation.

U.S. Healthcare (USHC) contracts for care with primary care physicians who are compensated through capitation (i.e., a fixed payment at specific intervals per member for all care provided, irrespective of the number of services). The amount of capitation is dependent upon their quality assessment rating and their ability to manage the cost of care effectively. In January of 1992 USHC implemented its current, third-generation incentive model and significantly altered its Quality Care Compensation System. The evolution of this model is presented to demonstrate that this third-generation Quality Care Compensation Model is a fair and effective means of measuring and valuing the delivery of health care to a population. It rewards physicians who expend the extra effort to manage both quality and cost. The experience of USHC continues to demonstrate that it is possible to develop and monitor incentive mechanisms in a systematic fashion with quality improvement as the outcome.

Adult↗
PubMed2005

Prescribing incentive schemes : a useful approach?

INTRODUCTION: From 2000 to 2004, primary care organisations (PCOs) in England were legally required to operate a prescribing incentive scheme for their general practices. A statutory framework specified the types of target, maximum rewards and use of 'good cause for failure' provisions that schemes should include. Our objective was to explore whether schemes might be a useful approach to encourage 'good quality' prescribing. METHODS: We requested copies of the original schemes from all PCOs in England in 2001 and 2002. Data were extracted on the rewards offered, types of budgetary targets set and additional conditions specified. RESULTS: Many schemes had not been finalised, some PCOs had no scheme, and one scheme operated without rewards. Although schemes covered similar therapeutic areas, they varied considerably in their length, complexity, reward levels and reward structure. Over half the schemes contained no 'good cause for failure' provision. DISCUSSION/CONCLUSION: PCOs are offering diverse incentives to general practices and some have interpreted the statutory framework imaginatively. Better use of the 'good cause for failure' provision may help to overcome inflationary pressures on prescribing, but further research is needed to clarify the role of financial incentives in influencing prescribing.

Drug Prescriptions↗