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At least 19 recordsLinked to original sources
PubMed1995

[Problems of national health insurance reimbursement revision, especially for laboratory tests].

The reimbursement fees for laboratory tests are lowered at every revision of Health Insurance Reimbursement (HIR), carried out every 2 years. This leads to the financial trouble for laboratory operation in university hospitals as well as general hospitals. Medical care costs in Japan account for 6% of GNP and is not as high as that in advanced countries such as USA, Canada, and Germany. The Central Pharmaceutical Affairs Councils gives manufacturing and sales approval for in-vitro diagnostics after examination of the applied documents. The Committee on Application of Medical Care Remuneration in the Japan Medical Association decides the following; Propriety of reimbursement establishment for new in-vitro diagnostics, reimbursement fees for new in-vitro diagnostics, propriety of reimbursement establishment for medical devices and propriety of reimbursement for new drugs. The MOSS (Market-Oriented, Sector-Selective) approach was initiated also in the in-vitro diagnostics field in January 1985 the target of which is to abolish the economic barrier and relax regulations in Japan. The Ministry of Health and Welfare lowered the reimbursement fees based on actual prices in commercial laboratories, which is very low because of price dumping through excess competition. In future, we would like to propose additional reimbursement fees for in-house emergency tests. Furthermore, we would like to request the judgment fee for diagnosis of myelogram, immunoelectrophoresis and isoenzymes for which clinical laboratory physicians play a role.

Clinical Laboratory Techniques↗
PubMed2001

Rate of health insurance reimbursement and adherence to anti-hypertensive treatment among Japanese patients.

BACKGROUND: Although several studies have reported the effects of free medical care on compliance in patients with hypertension, no study has reported the effects of an economic incentive, such as subsidized medical costs, on compliance with medication protocol, in patients with hypertension. The unique characteristics of the Japanese health insurance system provide for a 10% decrease in the subsidy for medication immediately on retirement (approximately 60 years of age) for insured patients, and a 100% subsidy for insured patients who are 70 years of age or older. We examined the association between level of health insurance coverage and follow-up rate of medical treatment among Japanese patients with hypertension. METHODS: The subjects, from throughout Japan, were patients with hypertension (n=1236). The study was conducted in 1991. The odds of completing a 1-year treatment in relation to the rate of health insurance reimbursement were calculated using multiple logistic regression analysis. RESULTS: We found the following. (1) Compared with the base group, the odds of completing a 1-year treatment increased to 2.62 or 2.51 in the group whose reimbursement rate was 100%. (2) Compared with the base group, the odds of completing a 1-year treatment was no larger than 1 in the group whose reimbursement rate had been 100% for more than 6 years ('76-'). (3) Compared with the base level, the odds of completing a 1-year treatment increased to 1-1.81 in the group whose liability decreased to 80%. CONCLUSION: Although the results imply that even a small economic incentive might be effective in securing a patient's compliance with anti-hypertensive medical treatment, the effect appear limited in both duration and magnitude.

Aged↗
PubMed2006

Price vs. quantity in health insurance reimbursement.

While "integrated" systems regulate the quantity of health services, "Bismarckian" systems regulate their price. This paper compares the consumers' allocations implemented within the two reimbursement systems. In the model, illness has a negative impact on labor productivity while public insurance is financed through income tax. Consumers have private information with respect to a parameter which can be interpreted as heterogeneity either in intensity of their preferences for treatment or in the type of illness. The social planner may be constrained to adopt uniform insurance plans, or may be free to choose self selecting plans. The analysis of uniform plans shows that Bismarckian systems dominate integrated systems from the social welfare point of view; whereas the opposite ranking holds with self-selecting plans.

Consumer Behavior↗
PubMed1988

Optimal reimbursement health insurance and the theory of Ramsey taxation.

This paper explores the trade-off between risk sharing and the incentives to consume increased medical care inherent in reimbursement insurance. The results for the theory of reimbursement insurance are compared with those on Ramsey taxation. It is shown that there is a close formal analogy and interpretations are given.

Health Expenditures↗
PubMed2005

Physician reimbursement levels and adherence to American Academy of Pediatrics well-visit and immunization recommendations.

BACKGROUND: There is concern that commercial health insurance reimbursement levels for immunizations and well-child visits may not be meeting the delivery and practice overhead costs within some areas of the country. There is also concern that insufficient physician reimbursement levels may negatively affect the quality of children's health care. OBJECTIVE: We examined the relationships between commercial health insurance reimbursement levels to physicians for pediatric services and rates of immunization and well visits for children and adolescents. DESIGN: Quality of care was measured by examining state-level immunization and well-visit rates for 2002, which were obtained from the National Committee for Quality Assurance, Health Plan Employer Data and Information Set (HEDIS). Reimbursement data were obtained from the American Academy of Pediatrics Medical Cost Model. Variations in the child and adolescent HEDIS measures were examined as a function of physician reimbursement levels for pediatric services across states. HEDIS data were available for a total of 32 states. Partial correlations controlled for pediatrician concentration, as collected from the US Bureau of the Census and the American Medical Association Physician Masterfile data. RESULTS: Compliance with HEDIS immunization rates for all recommended vaccines was 60% for children and 24% for adolescents. By excluding the varicella vaccine, these rates increased to 70% for children and 44% for adolescents. Adherence rates for well visits were also higher for infants (60%) and children (59%) than for adolescents (34%). Physician reimbursement levels for pediatric services varied from 16.88 dollars per member per month to 32.06 dollars per member per month across states. Statistically significant positive correlations for reimbursement levels were found for 8 of the 16 HEDIS measures examined. Correlations with reimbursement levels were found for childhood immunizations (r = 0.42), infant well visits (r = 0.44), childhood well visits (r = 0.46), and adolescent well visits (r = 0.42). Reimbursement levels were especially strongly related to the rates of adolescent varicella vaccination (r = 0.53). When partial correlations were examined to control for pediatrician concentration, the correlations were reduced by 0.09 on average, suggesting that pediatrician supply may serve as an intermediary of the reimbursement relationship. CONCLUSIONS: Immunization and well-visit rates for infants, children, and adolescents were positively linked with physician reimbursement rates for those services. Although methodologic limitations suggest caution when interpreting these findings, more attention should be given to physician reimbursement levels as a possible predictor of immunization and well-visit rates as measures of quality of care and to the importance of reimbursement levels for pediatrician recruitment.

Adolescent↗
PubMed1981

Determining health insurance coverage of technology: problems and options.

By deciding which medical procedures are eligible for reimbursement, health insurance programs possess the potential to affect significantly technology use and health care spending. Traditionally, insurers have adopted a passive stance and made relatively few negative coverage determinations. However, resistance to rapidly rising costs has created a powerful inducement for third-party payors to become more prudent purchasers of health care services. Consequently, both Medicare and Blue Cross--Blue Shield are considering the implementation of changes that may ultimately result in more restrictive coverage decisions. This article examines the coverage process of Medicare and Blue Cross--Blue Shield and the policy changes that both programs are considering. In addition, it discusses the strengths and drawbacks of four coverage policy options: restricting insurance coverage of unproven procedures, introducing cost-effectiveness criteria, educating physicians and educating consumers.

Blue Cross Blue Shield Insurance Plans↗