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Results for “Reimbursement, Incentive”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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PubMed2004

The significance of control models: intentional and unintentional effects.

Organization and control research has largely focused on the reform work and changes in the public sector. Many studies have focused on the reasons for reforms rather than on their significance. In this article, the authors deal with a control model applied in maternity health and based on remuneration for performance. At the end of the article, the authors note that formal control models are significant. Staff members have adapted to the model, but the model has also been adjusted to suit reality. This change has meant intentional effects, in the sense that the work has been adapted to suit the conditions given, but also unintentional effects in the form of attempts to outwit the system.

Female↗
PubMed1992

Managing care and the risk for managing quality.

The purpose of this paper is to outline the potential liability of managed care organizations. Specifically, the paper enumerates the various types of liability of health maintenance organizations for the negligent acts of its contracting physicians. The recent cases discussed below demonstrate both the extent to which courts are willing to stretch the liability of HMOs and also the limits that courts place on that liability.

Credentialing↗
PubMed2000

Employers: quality takers or quality makers?

This article provides a synthesis of past research to help understand the extent to which employers are using their considerable market power to drive health care quality. Are employers quality takers or quality makers? The literature provides some clues about aspects of quality employers are attempting to influence, strategies they are pursuing to influence quality, and their impact. Some employers are interested in some indicators of quality and are incorporating them in a variety of different purchasing strategies. The indicators most frequently used by employers, however, probably are not the ones that clinical experts and policy makers would select as most reflective of clinical quality. It appears that employers as a group are becoming more informed quality takers but are not yet quality makers--with the exception of a few well-resourced outliers. Recent events provide mixed signals about whether the future employer role in influencing quality will diminish, stall, or flourish.

Commerce↗
PubMed2003

Limiting inpatient substance use treatment: what are the consequences?

This study tested whether a managed care policy of substituting outpatient for inpatient treatment of substance use disorders shifted treatment costs to psychiatric providers. This was an observational study, based on administrative data of 25,450 adult disabled Medicaid beneficiaries treated for schizophrenia and major affective disorders. Eighteen percent had a diagnosis of substance use disorder. Multivariate regression was used to determine the odds of having a hospital admission and the relationship of managed care to hospital length of stay and total per person treatment expenditures. Hospital admissions and length of stay for both substance use disorder and psychiatric treatment were reduced, but adults with a dual diagnosis had higher annual expenditures compared to those with only a psychiatric diagnosis. There was no evidence of cost shifting. Although emphasis on outpatient treatment did not result in cost shifting, the combination of substance use disorder and psychiatric illness remains an expensive public health problem.

Adolescent↗
PubMed2006

Commentary.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Impact of pay-for-performance contracts and network registry on diabetes and asthma HEDIS measures in an integrated delivery network.

This article reviews the experience of a large, heterogeneous integrated delivery network that incorporated physician quality metrics into pay-for-performance contracts. The authors present criteria for including measures in pay-for-performance contracts and offer a practical approach to determining withhold return or bonus distribution based on improvement and performance. They demonstrate interventions undertaken to improve performance, including the development of a claims-based registry. Empirical data show that the network performance improved more than the comparable state and national performance during the period of this observational study. The authors conclude that pay-for-performance contracts led to development of medical management programs including a claims-based registry and nonphysician interventions, which helped significantly improve selected HEDIS scores.

Adolescent↗
PubMed2006

A methodology to estimate the potential to move inpatient to one day surgery.

BACKGROUND: The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. METHODS: Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. RESULTS: The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). CONCLUSION: The proposed approach allows the monitoring of the proportion of inpatient stay candidates for one day surgery. It could be used for infrastructure planning, resources negotiation and the surveillance of appropriate resource utilization.

Algorithms↗
PubMed1993

Improving the current system for supplying organs for transplantation.

The United States currently relies on a voluntary, altruistic system for supplying organs for transplantation. It is now generally recognized that this system, as currently operated, produces a seriously inadequate supply of organs. A number of scholars have argued that some type of (generally unspecified) market system is necessary. Two articles appearing in the Journal of Health Politics, Policy and Law have proposed relatively specific market systems for increasing the supply of organs. In this paper we argue that market systems are at best premature. In particular, there is little to suggest that any type of market system for organs will be permitted in the United States in the foreseeable future. We present data that strongly suggest that the current voluntary, altruistic system has not been developed to its full potential and offer a number of specific suggestions for improving the system.

Altruism↗
PubMed1994

How will we use clinical guidelines? The experience of Medicare carriers.

While support for the development of clinical guidelines is widespread, there is little agreement about how they should be used. Because cost control is the force behind the medical effectiveness movement, the payers' preference, to link clinical guidelines to reimbursement, will likely prevail. We examine the utilization review programs of Medicare Part B carriers and the carriers' attempts to use clinical guidelines to determine medical necessity for the purpose of payment. We find that because the utilization review programs are driven by concerns about cost control, the carriers' actual review process relies on aggregate utilization and spending targets that have little to do with clinical guidelines. The carriers' medical review rhetoric--using the terms medically unnecessary and fraud and abuse as synonyms--also highlights their focus on cost control and the lack of concern about why services are used inappropriately.

Attitude of Health Personnel↗
PubMed2000

Big bang and the policy prescription: health care meets the market in New Zealand.

This article discusses events that led up to and the aftermath of New Zealand's radical health sector restructuring of 1993. It suggests that "big bang" policy change facilitated the introduction of a set of market-oriented ideas describable as a policy prescription. In general, the new system performed poorly, in keeping with problems of market failure endemic in health care. The system was subsequently restructured, and elements of the 1993 structures were repackaged through a series of incremental changes. Based on the New Zealand experience, big bang produces change but not necessarily a predictive model, and the policy prescription has been oversold.

Health Care Sector↗
PubMed1979

Substitution of outpatient care for inpatient care:problems and experience.

This paper provides a logical framework for considering possible alternatives to inpatient care. First it presents the concept of a substitute-complement relationship among factors of production (or goods and services in consumption) and examines several problems often encountered when applying this concept. Second, it presents four general sources of substitution: (1) technological innovation; (2) changes in organization; (3) capital accumulation; and (4) the dissemination of knowledge. Third, it examines nine activities which are frequently mentioned as providing alternatives to inpatient care. Fourth, it examines some problems and consequences of governmental efforts to plan substitution. The general thrust of the paper is that the substitution process is complex and often depends upon amorphous variables whose influences are subtle, generally nonquantifiable, and often of overriding importance. These variables introduce a downward bias in estimates of program costs and an upward bias in the estimates of program accomplishments. The result is that government attempts to plan substitution are not well conceived and will generally fall short of announced goals and/or cost significantly more than original estimates.

Ambulatory Care↗
PubMed2001

Impact of payment method on behaviour of primary care physicians: a systematic review.

OBJECTIVE: To review the impact of payment systems on the behaviour of primary care physicians. METHODS: All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by computerised searches of the literature. Methodological quality assessment and data extraction were undertaken independently by two reviewers using a data checklist. Study results were qualitatively analysed. RESULTS: Six studies met the inclusion criteria. There was considerable variation in the quality of reporting, study setting and the range of outcomes measured. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on the quantity of secondary care services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive. CONCLUSIONS: There is some evidence to suggest that how a primary care physician is paid does affect his/her behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research. Future changes to doctor payment systems need to be rigorously evaluated.

Capitation Fee↗
PubMed2006

Remunerating primary care physicians: emerging directions and policy options for Canada.

How primary care physicians are remunerated is an important component of healthcare reform debates in Canada. This paper contributes to the policy debate by drawing together the theoretical insights gained from existing economic theory and evidence on how payment schemes affect physicians' behaviour. Several policy implications for the efficient and effective remuneration of physicians emerge from the analysis, as do directions for future research.

Canada↗