CALPERS TELLS 18 HEALTH-CARE PROVIDERS IT EXPECTS A 5% ROLLBACK IN PREMIUMS

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. A50-A50
Author(s):  
J. F. L.
Keyword(s):  
Magnetic Resonance Imaging ◽  
Health Care ◽  
Health Care Providers ◽  
Public Employees ◽  
Care Providers ◽  
Resonance Imaging ◽  
Invasive Procedures ◽  
Retirement System ◽  
And Performance ◽  
Care Costs

In it most aggressive swipe at health-care costs to date, the huge California Public Employees' Retirement System served notice that it expects health-care providers to agree to a 5% rollback in health-care premiums for 900,000 public employee families ... Calpers, which manages one of the country's largest groups of insured individuals and is often cited as a model of health-care reform, told 18 managed-care companies that it expects the 5% rollback to be effective in the 1994-95 contract year, which begins August 1 ... Providers expressed surprise and muted alarm at the depth of the cutback proposed ... The 5% target was based on numerous studies, not only of individual HMO fiscal data, but also on Rand Corp. studies showing the persistence of waste and overutilization in health care which documented excessive Caesarean deliveries, overuse of magnetic resonance imaging scans, overprescribing of drugs, and performance of unnecessary surgery when less invasive procedures would suffice.

MINNESOTA TAKES CONTROVERSIAL STEPS TO REFORM HEALTH CARE

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 560-560
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Reform ◽  
Income Tax ◽  
The State ◽  
Care Providers ◽  
Practice Parameters ◽  
The Law ◽  
Health Legislation ◽  
Care Costs

When Minnesota legislators last spring passed health legislation that included a tax on health care providers, many physicians thought the state had gone too far. As the state begins to implement the law, however (physicians will begin paying the tax in 1994), those same physicians are realizing that their troubles may have just begun. The tax is only one part of a larger health reform package that promises to change the way Minnesota physicians practice. Under the law, for example, the state will assign physicians to some patients. The law also requires the state to develop practice parameters and controls on technology... Beginning in 1994, physicians will pay a 2% income tax on their gross revenues. The tax, which will not be levied on Medicare or Medicaid services or on physicians employed by managed care providers, will help pay for health insurance for the state's approximately 400,000 uninsured. Many physicians opposed the legislation because it will cut into their pay... And to achieve its goal of reducing health care costs by 10% a year for five years, the state will develop and implement practice parameters in an attempt to avoid ineffective treatment.

Life Themes: A Method to Understand Terminal Illness

1995 ◽  
Vol 31 (3) ◽  
pp. 189-206 ◽  
Author(s):  
Debbie Messer Zlatin
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Care Providers ◽  
Incurable Cancer ◽  
Doctor Patient Communication ◽  
The Patient’S View ◽  
Care Costs

As health care costs in general soar, the high cost of terminal care is questioned. Yet little is known about what kinds of medical care terminally ill persons, themselves, want. To explore the patient's view, I conducted a qualitative study of eight patients with incurable cancer to answer the question, “How do terminally ill persons understand their illnesses and treatments?” Analysis of interview transcripts indicated that study participants created illness-understandings within the context of their daily life experiences via life themes. Since life themes integrate and give meaning to illness events in both emic and etic ways and help to explain patients' coping strategies, it is recommended that health care providers elicit patients' life themes and use them in their approaches to diagnosis and treatment. The possible benefits of the life theme method are more balanced doctor/patient communication, improved patient satisfaction and quality of life, and the containment of health care costs.

User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?)

1995 ◽  
Vol 14 (2) ◽  
pp. 360-390 ◽  
Author(s):  
Robert G. Evans ◽  
Morris L. Barer ◽  
Greg L. Stoddart
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Final Analysis ◽  
User Fees ◽  
Care Providers ◽  
Positive Effects ◽  
The Face ◽  
Care Costs

ABSTRACTCalls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

scholarly journals Alternative payment approaches for advancing comprehensive medication management in primary care

2020 ◽  
Vol 18 (4) ◽  
pp. 2238
Author(s):  
Katherine Pham
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Medication Management ◽  
Fee For Service ◽  
Care Providers ◽  
Care Community ◽  
Improved Outcomes ◽  
And Performance ◽  
Value Based Care

The increasing prevalence of complex, chronic conditions has profound implications on the growing demand and cost of health care. The Center for Medicare and Medicaid Innovation is testing data-driven approaches to care delivery and payment that are drawn from innovative practices of health care providers and other partners in the health care community. The shift from fee-for-service to value-based care and performance-based payment places increased priority on improved outcomes at lower costs. To advance comprehensive medication management, pharmacists need to understand the opportunities in the evolving value-based payment models and align medication optimization with the specific goals and incentives of these models.

scholarly journals Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence

2012 ◽  
Vol 40 (3) ◽  
pp. 452-466 ◽  
Author(s):  
Christopher Robertson ◽  
Susannah Rose ◽  
Aaron S. Kesselheim
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Conflicts Of Interest ◽  
Care Providers ◽  
Conflicts Of Interests ◽  
Conflicting Interests ◽  
Care Costs ◽  
Financial Relationships

Physicians, scholars, and policymakers continue to be concerned about conflicts of interests among health care providers. At least two main types of objections to conflicts of interest exist. Conflicts of interests may be intrinsically troublesome if they violate providers’ fiduciary duties to their patients or they contribute to loss of trust in health care professionals and the health care system. Conflicts of interest may also be problematic in practice if they bias the decisions made by providers, adversely impacting patient outcomes or wastefully increasing health care costs. This latter objection may be observed in differences in the prescriptions written, procedures performed, or costs billed by health care professionals who have conflicting interests, when compared to those that do not have such financial relationships.

Freestanding Emergency Centers: Regulation and Reimbursement

1985 ◽  
Vol 11 (1) ◽  
pp. 105-129
Author(s):  
Mitchell Katzman
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Health Care Market ◽  
Care Providers ◽  
Emergency Rooms ◽  
Hospital Emergency ◽  
Efficient Manner ◽  
Additional Layer ◽  
Care Costs

AbstractThe freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal.

Wait Times for Breast Cancer Surgery: Effect of Magnetic Resonance Imaging and Preoperative Investigations on the Diagnostic Pathway

2015 ◽  
Vol 11 (2) ◽  
pp. e131-e138 ◽  
Author(s):  
Carolyn Nessim ◽  
Julian Winocour ◽  
Diana P.M. Holloway ◽  
Refik Saskin ◽  
Claire M.B. Holloway
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Care Providers ◽  
Public Health Care ◽  
Breast Cancer Surgery ◽  
Cancer Center ◽  
Wait Times ◽  
Care Providers ◽  
Resonance Imaging ◽  
Diagnostic Pathway

A defined pathway and rapid access to an integrated multidisciplinary breast cancer center once an imaging abnormality has been identified are needed and should be addressed by public health care officials and health care providers.

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