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Results for “Reimbursement, Incentive”

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PubMed1989

No cure, no pay: an acceptable way of financing fertility treatments?

Recently three cost-effectiveness studies in health care have been carried out with the explicit goal to support reimbursement policy. The authors of this article were the main researchers for one of these studies: a cost-effectiveness analysis on in vitro fertilization. After the most important conclusions of the study are summarized, possible and impossible regulatory options for IVF and for other fertility treatments are discussed. Finally, these options are related to the actual decisions that have been made since the end of this study.

Cost-Benefit Analysis↗
PubMed1993

Dental care in the NHS: reforms with teeth?

Dental services in the UK are currently undergoing a period of major upheaval. This paper examines recent policy initiatives with respect to patient charges, dentists' remuneration, information and patient choice, the supply of dental personnel, and the prevention of dental diseases. It is argued that changes in dentists' remuneration and the greater use of auxiliary personnel are likely to improve efficiency, whereas changes in patient charges are not. Water fluoridation remains the most efficient and equitable means of promoting dental health.

Capitation Fee↗
PubMed1993

Caring for people efficiently.

The UK government's plans and objectives for community care in the 1990s are examined. The objective of providing care in the community 'wherever possible' is unlikely to be efficient unless the costs and benefits of providing such care are accounted for. Even if it were efficient to provide more care in the community, the mechanisms aimed at ensuring the transfer of funds have been inadequate in terms of encouraging such an objective. These same principles (i.e. the need to assess costs and benefits) should be applied to the design of individual packages of care in the community, when the costs and benefits of carers' time become more important. Case management offers the opportunity to assess individual circumstances which is necessary for the design of efficient packages of care. However, case management is likely to suffer from the problems of fragmentation which makes organisation of flexible packages of care difficult.

Community Health Services↗
PubMed1993

Facility reimbursement: a critical comparison between hemodialysis and peritoneal dialysis.

The population of patients on dialysis in the United States is growing at between 8% and 9% annually. The increasing patient load places a burden on existing dialysis facility capacity and creates a challenge for physicians and administrators to meet patient demand in the future. Increasing costs, reductions in reimbursement, and volatile regulatory policy have increased the risks associated with operating and investing in dialysis facilities. It is important that administrators and physicians understand the economics associated with the modalities available to treat patients on dialysis and that they incorporate this understanding into their planning for the future.

Hemodialysis Units, Hospital↗
PubMed2005

An analysis of U.S. practices of paying research participants.

BACKGROUND: Despite controversy about paying research subjects, little is known about actual practices in the U.S., including what type of studies offer payment, to what type of subjects, and how amounts are determined. OBJECTIVE: To document current U.S. practices regarding payment to research subjects. METHODS: The protocols and consent forms of 467 studies offering payment to research subjects approved by 11 IRBs across the U.S. were reviewed to analyze how they describe and justify payment to subjects. RESULTS: Money was offered in a wide variety of study types, from short term physiologic studies to large clinical trials of therapeutic interventions, to both patient (61%) and healthy (24.4%) subjects or both (14.6%). Dollar amounts varied widely and were infrequently explicitly described as based on time (19%) or procedures (12%). Unexplained variation in dollar amounts occurred in similar studies or in the same (multi-site) study at different sites, and for similar procedures across studies sometimes even within one site. Although the range was wide ($5-$2000), total amounts were usually modest (overall median $155), and almost always described in the consent form (94.4%) and usually as pro-rated (73%). CONCLUSIONS: Both patient and healthy subjects are offered payment in a wide variety of types of research in the U.S. Variation in the dollar amounts offered is largely unexplained.

Choice Behavior↗
PubMed2005

Impact of a restriction in the number of embryos transferred on the multiple pregnancy rate.

OBJECTIVE: To study the impact of the introduction of reimbursement of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) laboratory costs in Belgium which is linked to an embryo transfer strategy leading to prevention of multiple pregnancies. The impact on the incidence of multiple and twin pregnancy rate as well as on ongoing pregnancy rate in our centre is calculated. STUDY DESIGN: Observational cohort study of all patients in the first year (July 1, 2003-June 30, 2004) since the implementation of the law and comparison of ongoing pregnancy rate and multiple pregnancy rate of our centre with Belgian data. RESULTS: Our results of one year of IVF/ICSI since reimbursement of laboratory costs show a total conception rate of 42.2% with 29.7% ongoing pregnancies beyond 25 weeks amenorrhea. The multiple pregnancy rate was 8.5% including five monozygotic twin pregnancies. These data show an important decline of multiple pregnancy rate when compared to Belgian data (2002) with 24.4% multiple pregnancy rate in the year prior to reimbursement. CONCLUSION: The introduction of reimbursement of IVF/ICSI laboratory costs coupled to a restriction in the number of embryos for transfer has reached the goal of halving the multiple pregnancy rate since its introduction while maintaining an optimal ongoing pregnancy rate.

Adult↗
PubMed2006

A transaction costs analysis of changing contractual relations in the English NHS.

The English National Health Service has replaced locally negotiated block contracting arrangements with a system of national prices to pay for hospital activity. This paper applies a transaction costs approach to quantify and analyse the nature of how contracting costs have changed as a consequence. Data collection was based on semi-structured interviews with key stakeholders from hospitals and Primary Care Trusts, which purchase hospital services. Replacing block contracting with activity based funding has led to lower costs of price negotiation, but these are outweighed by higher costs associated with volume control, of data collection, contract monitoring, and contract enforcement. There was consensus that the new contractual arrangements were preferable, but the benefits will have to be demonstrated formally in future.

Contracts↗
PubMed2004

Changes before and after a policy to restrict antimicrobial usage in upper respiratory infections in Taiwan.

The Bureau of National Health Insurance (BNHI) of Taiwan issued a new reimbursement regulation effective from 1 February 2001 forbidding the use of antimicrobials in ambulatory patients with upper respiratory infections (URI) without evidence of bacterial infection. We evaluated the effect of this regulation by analysing changes in the types of infections diagnosed and the amount of antibiotics prescribed in 1999, 2000 and 2001. Between 1999 and 2001, antimicrobials for respiratory infections decreased from 18.0 to 9.97 DDD/1000 per day or by 44.6% (P=0.0000+). Antimicrobials for URI decreased from 8.32 in 1999 to 3.28 DDD/1000 per day in 2001 or by 60.6% (P=0.0000+); from 2000 to 2001 the decrease was 55.8%. Reduction of antimicrobials for URI from 1999 to 2001 accounted for 62.8% of the reduction of antimicrobials in respiratory infections or 51.3% of the total reduction of antimicrobials. Reduction in aminopenicillins was responsible for most of the decrease.

Ambulatory Care↗
PubMed2005

Follow-up of antibiotic prophylaxis: impact on compliance with guidelines and financial outcomes.

In order to enhance the quality of antibiotic use, a new financial system was introduced in Belgium in 1997, which links reimbursement of antibiotic costs incurred during prophylaxis in surgery and obstetrics to compliance with evidence-based guidelines. At University Hospitals Leuven (UHL), this reimbursement scheme was supplemented with a follow-up programme in 2001 that informs physicians of their compliance with the guidelines and outlines the financial consequences of their use of prophylactic antibiotics. The aim of this paper is to evaluate the impact of the follow-up programme developed and implemented by a clinical pharmacist at UHL. The analysis drew on data on consumption and costs of antibiotics used in standard prophylaxis that were retrieved from patient invoices. Both financial outcomes and results on consumption patterns of antibiotics point to an increasing compliance with guidelines. An average annual loss of 92,353 Euro associated with prophylactic antibiotic use prior to the implementation of the follow-up programme evolved into a profit of 27,269 Euro following its introduction. The share of consumption of prophylactic antibiotics held by cefazolin and metronidazole, the two main antibiotics recommended by the guidelines, increased substantially or remained stable as a result of the follow-up programme, whereas the shares held by other antibiotics generally fell. Moreover, the range of antibiotics consumed during standard prophylaxis narrowed. This follow-up programme thus reduced antibiotic costs, improved profitability and increased physician compliance with guidelines.

Anti-Bacterial Agents↗
PubMed2006

The implications of "pay-for-performance" reimbursement for Otolaryngology-Head and Neck Surgery.

OBJECTIVE: To introduce otolaryngologists to outcomes-linked reimbursement ("pay-for-performance"), identify clinical practice implications, and recommend changes for successful transition from the traditional "pay-for-effort" reimbursement model. STUDY DESIGN: Policy review. RESULTS: Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, "pay-for-performance" programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Because performance criteria for reimbursement have not yet been proposed within otolaryngology-head and neck surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation. CONCLUSION: "Pay-for-performance" reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists.

Humans↗