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At least 55 records · Page 3Linked to original sources
PubMed1988

Recent developments in federal reimbursement for home health-care services and products.

The current status of reimbursement for home health-care (HHC) products and services is described, and the influence of competition and consolidation on the HHC industry is discussed. Despite inadequate financing and reimbursement pressures, the demand for HHC services continues to grow. The degree of competition in the HHC industry is reflected in bundling of services (gathering payments for services into a single per-capita rate), prospective price negotiations, and competitive bidding. This competition within the home-care industry and pressure on operating margins have spawned a flurry of recent mergers, acquisitions, and corporate restructuring. HHC agencies and suppliers, particularly durable medical equipment suppliers, have been squeezed by inadequate Medicare cost-finding methods, low reimbursement rates, and a high number of denials of Medicare coverage. Three important recent federal measures revised definitions of Medicare coverage, established minimum and maximum payment periods for Medicare reimbursement, reduced payments for services and products covered under Medicare Parts A and B, resurrected prospective-pricing demonstration projects, reduced payments for durable medical equipment and home oxygen supplies, and expanded coverage of services for AIDS patients. State Medicaid program budgets are threatened by recurring administration proposals to cap federal matching payments and by the adoption of a competitive-bid approach to health-care contracting. To survive over the next few years, home health agencies and home-care suppliers will need to monitor operating costs even more closely and pay attention to the patient (payer) mix.

Competitive Bidding↗
PubMed1983

Pharmaceutical Reimbursement Board; suspension of maximum allowable cost limits on specific drug products--HCFA.

The Pharmaceutical Reimbursement Board announces the suspension of the Maximum allowable cost (MAC) limit on penicillin G potassium, oral tablets, 800 mu, effective August 18, 1963. The limit for this drug product was published on December 11, 1978 (43 FR 57972) and became effective on October 15, 1979. The suspension of the MAC limit on penicillin G potassium, oral tablets, 800 mu, results from the unavailability of this product in the marketplace at or below the MAC limit. The Pharmaceutical Reimbursement Board may establish a new MAC limit on this drug product in the future.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Hard decisions about fundamental values.

The lead paper provides a helpful review of the implications of last-dollar and first-dollar reimbursement of pharmaceuticals. Yet, the issue is extremely complex, and there are no easy solutions. Ultimately, the benefits and costs of drugs will force us as a society to make some very hard decisions about fundamental human values such as access, equity and affordability.

Canada↗
PubMedDate not supplied

More the same than different: worldwide drug policy issues.

Pharmaceutical policies in Europe were described in the previous issue of the journal. These policies were described in 5 areas: regulation and access; pricing, price control, and cost; publicly administered drug insurance; patient advocacy; and research ethics. While the underlying policy issues are strikingly similar, each country has developed its own set of solutions to address them. This article provides insight into the Canadian drug policy environment by comparing and contrasting it with the European experience.

Ethics, Research↗