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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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At least 865 records · Page 48Linked to original sources
PubMed2001

The payment of research subjects: ethical concerns.

PURPOSE/OBJECTIVES: To present models for the payment of research subjects, pros and cons of each, and the application of ethical principles in the current environment. DATA SOURCES: Federal regulations and guidelines, current and historical research, and opinions expressed in the nursing, medical, bioethics, pharmacology, and clinical trial literature. DATA SYNTHESIS: Relevant regulations are sparse. A variety of payment models exist, but all are somewhat problematic. Balancing the principles of respect for people and justice in our current society will not be entirely possible. Practice decisions must be made for individual situations. Special care must be taken with patients because they are subject to therapeutic misconception. CONCLUSIONS: No model fits all situations, but research nurses can use their skills to evaluate particular applications. As a society, nurses must promote participation in research as a socially responsible activity and prevent unethical payment models from predominating. IMPLICATIONS FOR NURSING PRACTICE: Oncology research nurses may be involved with the consent process, the development of protocols, and staff education. A thorough understanding of an issue that may impair the consent process or impinge upon subjects' rights is critical to effective and ethical practice.

Ethics, Medical↗
PubMed2001

Impact of global bundled payments on hospital costs of coronary artery bypass grafting.

The Health Care Financing Administration began the Medicare Participating Heart Bypass Center Demonstration in 1991, in which hospitals and physicians are paid a single negotiated global price for all inpatient care for heart bypass patients. This article analyzed the changes in total and departmental direct variable costs during the 1991-1993 period using micro-cost data. The results indicate that all participating hospitals had significant reductions in total direct variable costs, after controlling for preoperative risk factors and postoperative outcomes. However, the patterns in cost reductions across major departments were different across hospitals. The cost reductions primarily came from nursing intensive care unit, routine nursing, pharmacy, and catheter lab.

Boston↗
PubMed2001

Modernizing the Medicare Program using global payment policies.

This article describes efforts by HCFA to implement global payment demonstrations for Medicare fee for service inpatients. The Medicare Heart Bypass Center Demonstration operated from 1991 to 1996, and used global payments to pay for bypass surgery inpatient episodes. The demonstration operated effectively, with significant cost reductions at many sites and improvements in quality of care. The Medicare Program and its beneficiaries saved over $52 million in that demonstration. The planned Medicare Participating Centers of Excellence Demonstration and the Medicare Provider Partnerships Demonstration will also use global payment methods. These demonstrations will include cardiac and orthopedic care in the Centers demonstration, and all types of medical and surgical cases in Provider Partnerships. Successful implementation of these demonstrations could lead to expansion of global payment methods in the Medicare Program, with increases in efficiency and cost savings anticipated.

Aged↗
PubMed2001

The economics of health insurance plan design.

In developing insurance products, health insurers have often failed to incorporate member-level economic decision making into the underlying plan design. Instead, health insurers have either completely isolated members from economic choices within a restricted network or simply shifted costs without providing members with an opportunity to more efficiently purchase health care services. In either approach, the plan designs do not provide members with a rational economic framework to make efficient health care purchases. In order to analyze the economic framework in traditional plan designs, this article first outlines the characteristics of an efficient economic transaction and then compares these characteristics with traditional insurance plans. The article concludes by suggesting new plan designs that achieve more economically efficient outcomes through the application of episode of care technology.

Decision Making↗
PubMed2001

['Evidence-based' perioperative antibiotic prophylaxis policy in Belgian hospitals after a change in the reimbursement system].

The costs of antibiotics in Belgian hospitals are nearly fully reimbursed by the health insurance. Such a situation is not conductive to rational drug use. A new reimbursement system for perioperatively-administered antibiotics in Belgian hospitals was implemented in May 1997 by Royal Decree. A reimbursement code for antibiotic use was linked to the reimbursement of surgical interventions. This code represents a reimbursement which covers 75% of the cost of perioperative prophylaxis based on optimal indication, dose, and duration as recommended by international and Belgian consensus guidelines. The actual antibiotic prescribed during the 72-hour perioperative period (the day before, during and after surgery) is reimbursed at only 25% of its full cost. Thus, if the perioperative prophylactic antibiotic regimen complies with the evidence-based guidelines, the costs of antibiotic prescribing will be fully reimbursed by the health insurance (75% of the standard +25% of the actual costs). The new reimbursement system does not apply to antibiotics which are prescribed for treatment of intercurrent infections; these antibiotics continue to be fully reimbursed. Annual expenditures for antibiotics, for both antibiotic treatment and prophylaxis, nationwide and per hospital, have shown marked improvements in perioperative antibiotic use after the decree was implemented. Surgeons' adherence to the evidence-based standard of prophylactic antibiotic use has improved over time. In conclusion, rapid implementation of the perioperative antibiotic prophylaxis policy was achieved through changes in the reimbursement of antibiotics for surgery patients.

Antibiotic Prophylaxis↗
PubMed2001

DM programs and preventive care get new respect in OH initiative.

A physician-friendly approach to prevention and DM. Physicians have long complained that they are not being reimbursed to carry out many of the preventive functions often required of them by various payers. As a result, many would argue that DM efforts often suffer from a lack of provider enthusiasm and support. To get around this problem, an innovative initiative in Ohio is attempting to give physicians a greater voice in how DM efforts are carried out, and to reward them for providing certain non-traditional preventive services. The large employers backing this effort are hoping that better preventive care and DM will translate into lower health care costs over the long term.

Cooperative Behavior↗
PubMed2001

The economic and social costs of lung cancer and the economics of smoking prevention.

Lung cancer is a major cause of the premature loss of life and the costs to society of lung cancer are significant. Since smoking is the major cause of lung cancer, the main prevention strategy is to reduce smoking. Interventions to reduce smoking have been shown to be cost effective, from population measures such as tax and advertising restrictions through to individual or group treatments. Different groups of the population may well benefit from different interventions and there could be synergistic effects from a comprehensive programme. Treatment for smokers is an important part of any programme and especially important to prevent longer term smokers contracting lung cancer. However, most health care systems have not been successful in ensuring that smoking cessation interventions have a high priority. It should be an urgent task to ensure that the small additional resources for this work are fully reimbursed and incentives introduced to reap both major health gains and future reductions in health costs.

Cost of Illness↗
PubMed2002

CA health plans collaborate in 'pay for performance' program to boost chronic care management.

In an unprecedented move, six of California's largest health plans have agreed to go along with a common scorecard that will be used to measure provider groups on clinical quality and patient satisfaction. Developers of the program are taking specific aim at chronic care management as well as preventive medicine, and they're hoping the effort establishes a new model for boosting care at the provider level.

Benchmarking↗