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PubMedDate not supplied

Anesthesiology in the Belgian health care environment.

This article focuses on anesthesiology practice in the context of Belgian health care. The first part describes the organization of Belgian health care, the role of private and public initiatives, the division of responsibilities between the different health authorities, the financing mechanisms, and the central role of the compulsory social health care insurance. Quantitative information on the evolution of expenditures, services, providers, and facilities is presented. The second part of the article deals more specifically with anesthesiology and contains information on current practice. The emphasis, however, concerns recent developments in training and accreditation.

Accreditation↗
PubMed2006

Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma.

BACKGROUND: Evaluations of drug cost-sharing policies within the same population are needed for a fair comparison of different options. OBJECTIVE: The aim of this work was to analyze the impact of 2 changes in a public drug insurance plan on the use of inhaled medications in British Columbia (BC), Canada. METHODS: Data for the period from 1997 to 2004 were used to assess whether changes in the use of steroid, beta2-agonist, and anticholinergic inhalers were associated with insurance-plan changes in a large, natural experiment involving all BC residents aged>or=65 years. The 3 sequential policies included full coverage, fixed copayments at the beginning of 2002, and 25% coinsurance with an income-based deductible beginning May 1, 2003. Linkable prescription, physician billing, hospitalization, and mortality records were obtained from the BC Ministry of Health Services. From the total population of residents aged>or=65 years, we extracted data for all patients to whom inhaled steroids, beta2-agonists, or anticholinergics were dispensed on or after January 1, 1997. Multivariable linear regression was used to estimate inhaler use during a 60-month baseline period and during implementation of the subsequent copayment and coinsurance plus deductible policies. We used logistic regression to identify predictors of initiation and cessation use of inhaled medications among older patients. RESULTS: Use declined for inhaled steroids (-12.3%; P<0.001), inhaled anticholinergics (-12.2%; P<0.001), and inhaled beta2-agonists (-5.8%; P<0.001). Patients with new diagnoses of asthma or chronic obstructive pulmonary disease were 25% (95% CI, 14%-31%) less likely to initiate treatment with inhaled steroids when covered by the copayment or coinsurance plus deductible policies than when they had full coverage. Chronic users of inhaled steroids were 47% (95% CI, 40%-55%) more likely to cease treatment when they were covered by the copayment policy and 22% (95% CI, 15%-29%) more likely to cease when covered by the coinsurance plus deductible policy than when they had full coverage. CONCLUSIONS: The copayment and coinsurance plus deductible policies were associated with significant reductions in use of inhaled medications, mostly due to decreased initiation and increased cessation rates. However, the consequences of these policies on health outcomes have not yet been determined.

Administration, Inhalation↗
PubMed1994

Substitution laws, insurance coverage, and generic drug use.

This study examined the role of various policies (drug product substitution laws) that are usually motivated by cost containment objectives of insurers in facilitating entry by generic firms. Using data for six Canadian provinces over the years 1981-1988, we evaluated the impact of specific aspects of substitution laws on the level of generic use. We find that formularies and the passage of time are not significant determinants of substitution levels. Legal liability, mandatory product selection, deductible and co-payment schemes, and consumer awareness were found to be important variables. Price responsiveness of generic drugs is indicated but the evidence is not strong.

Canada↗
PubMed1988

Medicare program; SNF coinsurance amount for 1989--HCFA. Notice.

This notice announces that the skilled nursing facility coinsurance amount for calendar year 1989 for the 1st through 8th days of extended care services in a skilled nursing facility under Medicare's hospital insurance program (Part A) is $25.50. The Medicare statute specifies the method to be used to determine this amount.

Deductibles and Coinsurance↗
PubMed1987

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.

Adult↗
PubMed1998

A government purchaser perspective: TennCare--strengthening the safety net.

BACKGROUND: On January 1, 1994, in response to escalating Medicaid costs, the State of Tennessee implemented TennCare, a statewide managed health care system for three population groups: Medicaid eligibles, uninsurable individuals, and people who lacked access to insurance through their place of employment. METHODS: Under the TennCare program, the State contracts with ten managed care organizations to provide a comprehensive benefit package to each enrollee. Preventive services are exempt from copayment or deductible requirements. Each patient is assigned to a primary care provider who is responsible for assuring that the enrollee receives preventive services. RESULTS: More than 400,000 previously uninsured and uninsurable persons now receive health care coverage through the TennCare program. An extensive quality assurance program monitors managed care organization service delivery, with particular emphasis on prevention and access. Effective case management, combined with an enrollment cap, have enabled the program to grow at a predictable rate, without exceeding the annual rate of growth of state revenues. CONCLUSIONS: The TennCare program has been successful in using the savings experienced during the shift from a fee-for-service to a managed care Medicaid program to expand coverage to previously uninsured populations.

Humans↗
PubMed1990

The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization.

This study analyzed how the use and cost of pharmaceuticals varied by level of drug co-payment in a staff model health maintenance organization (HMO). An historical cohort design was used to study changes in drug utilization and drug costs in 19,982 continuously enrolled beneficiaries less than the age of 65. The beneficiaries initially had no drug co-payments, but experienced co-payment rates of $1.50, $3.00, and $3.00 plus other benefit changes during a three-year period. A comparison cohort of 23,164 beneficiaries was selected from the same setting who were subject to no drug co-payment during the same time period. Data on the use and cost of medications were obtained from an automated data system. Adjusted analyses for each time period controlled for age, sex, years in the Group Health Cooperative (GHC), and prior year utilization (or cost). The initial $1.50 drug co-payment was associated with a drop of 10.7% in the number of prescriptions filled relative to change in the comparison cohort. The decrease was greatest for discretionary drugs at each level of co-payment. The implementation of progressively greater levels of co-payments continued to have a significant effect on drug utilization since each co-payment level resulted in an additional reduction in drug utilization; 10.6% with the $3 co-payment and 12.0% when the $3 drug co-payment was combined with other cost-sharing provisions. Co-payments were associated with lower per capita drug costs and higher per prescription unit costs.

Deductibles and Coinsurance↗
PubMed2006

Consumer-directed health care: early evidence about effects on cost and quality.

Demand for consumer-directed health care (CDHC) is growing among purchasers of care, and early evidence about its effects is beginning to emerge. Studies to date are consistent with effects predicted by earlier literature: There is evidence of modest favorable health selection and early reports that consumer-directed plans are associated with both lower costs and lower cost increases. The early effects of CDHC on quality are mixed, with evidence of both appropriate and inappropriate changes in care use. Greater information about prices, quality, and treatment choices will be critical if CDHC is to achieve its goals.

Consumer Behavior↗
PubMed1983

Medicare program; hospital insurance entitlement and benefits--Health Care Financing Administration, Final rule.

These regulations implement thirteen legislative amendments concerning (1) entitlement of aged or disabled persons to Medicare, (2) requirements for receiving posthospital skilled nursing facility care and home health services, (3) determination of the deductible and coinsurance amounts for which a beneficiary is responsible, and (4) enrollment of individuals who must pay a monthly premium for Medicare. They also clarify, reorganize and renumber a major portion of our existing Medicare regulations.

Aged↗
PubMed1991

A simultaneous equations model of employer strategies for controlling health benefit costs.

We estimated a simultaneous equations model of employer health insurance cost control strategies and their effectiveness in reducing health plan premiums. We hypothesized that as premiums increase, employers will shop more actively for health plans, place incentives on providers to control medical care costs, increase employee cost sharing for medical care, and be more likely to offer an HMO. In turn, we expected each of these strategies, except offering an HMO, to reduce average health plan premiums. The model was estimated with 1985 data from a sample of 922 Minnesota employers. We found that high premiums are related to three of the proposed cost control strategies. Employers with higher premiums shop more, are more likely to seek provider incentives, and offer an HMO. However, these employers appear to have lower employee cost sharing. Employers with higher employee cost sharing and those that offer an HMO had lower health plan premiums.

Community Participation↗
PubMed1995

The effect of copayments and income on the utilization of medical care by subscribers to Japan's National Health Insurance System.

This study uses cross-sectional data from Japan's 47 prefectures covering subscribers to Japan's National Health Insurance system to analyze the effects of income and copayment levels on the utilization of medical care. Multivariate regression models were run for the years 1984 and 1989, with the utilization ratio (number of health insurance claims per 100 insurance subscribers) for total, inpatient, outpatient, and dental services as the dependent variable. Independent variables included copayment per patient day, deflated per capita income, population density, percentage of subscribers over age 65, number of beds and clinics per 1,000 persons, and number of doctors and dentists per 1,000 persons. The data were then stratified according to per capita income and percentage of insurance subscribers over the age of 65 in each prefecture. The copayment amount exhibited a small, but significant negative effect on the utilization of all medical services. Utilization of outpatient care was most sensitive to the copayment rate. The per capita income stratification models revealed the greatest copayment effect on inpatient care for the lowest income group. The results of the age stratification models support popular notions about the use of hospitals by the elderly as substitutes for elderly care facilities. The effects of copayments and income vary not only among the type of medical care (inpatient, outpatient, and dental) but also among the income and age stratifications of groups in the National Health Insurance system.

Age Factors↗
PubMed2006

Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study.

OBJECTIVE: To evaluate the effect of emergency department (ED) copayment levels on ED use and unfavorable clinical events. Data Source/Study Setting. Kaiser Permanente-Northern California (KPNC), a prepaid integrated delivery system. STUDY DESIGN: In a quasi-experimental longitudinal study with concurrent controls, we estimated rates of ED visits, hospitalizations, ICU admissions, and deaths associated with higher ED copayments relative to no copayment, using Poisson random effects and proportional hazard models, controlling for patient characteristics. The study period began in January 1999; more than half of the population experienced an employer-chosen increase in their ED copayment in January 2000. DATA COLLECTION/EXTRACTION METHODS: Using KPNC automated databases, the 2000 U.S. Census, and California state death certificates, we collected data on ED visits and unfavorable clinical events over a 36-month period (January 1999 through December 2001) among 2,257,445 commercially insured and 261,091 Medicare insured health system members. PRINCIPAL FINDINGS: Among commercially insured subjects, ED visits decreased 12 percent with the $20-35 copayment (95 percent confidence interval [CI]: 11-13 percent), and 23 percent with the $50-100 copayment (95 percent CI: 23-24 percent) compared with no copayment. Hospitalizations, ICU admissions, and deaths did not increase with copayments. Hospitalizations decreased 4 percent (95 percent CI: 2-6 percent) and 10 percent (95 percent CI: 7-13 percent) with ED copayments of $20-35 and $50-100, respectively, compared with no copayment. Among Medicare subjects, ED visits decreased by 4 percent (95 percent CI: 3-6 percent) with the $20-50 copayments compared with no copayment; unfavorable clinical events did not increase with copayments, e.g., hospitalizations were unchanged (95 percent CI: -3 percent to +2 percent) with $20-50 ED copayments compared with no copayment. CONCLUSIONS: Relatively modest levels of patient cost-sharing for ED care decreased ED visit rates without increasing the rate of unfavorable clinical events.

Cost Sharing↗
PubMed1992

A descriptive analysis of health insurance coverage among farm families in Minnesota.

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.

Agriculture↗