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At least 199 records · Page 11Linked to original sources
PubMed1993

Dental fees: a candid discussion.

Many dental fees have been determined illogically since the beginning of dentistry. Setting fees, however, can be relatively easy and quite equitable for all concerned if they are based on clinical time involved, procedure difficulty and quality of service. Our goal should be to provide the highest quality oral care possible at the lowest fees. It can be done. But changes need to be made, individually and as a profession, in fee structures and the manner in which we deliver treatment.

Dental Auxiliaries↗
PubMed2002

Physician fees and managed care plans.

One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

Catchment Area, Health↗
PubMed1992

Limited revision of fee schedules--NRC. Final rule.

The Nuclear Regulatory Commission (NRC) is amending its regulations to make two limited changes to its assessment of license and annual fees. The final rule assesses license fees, which are based on the full-cost method, quarterly instead of semiannually and establishes a lower tier small entity annual fee for those licensees that are small entities with relatively low annual gross receipts or supporting populations. These final amendments are intended to improve NRC financial management and further mitigate the impact of the annual fee on small licensees with relatively low annual gross receipts or supporting populations.

Fee Schedules↗
PubMed1993

The impact of Medicaid adoption of the Medicare fee schedule.

In this article, the authors simulate the effects on Federal and State Medicaid expenditures of increasing Medicaid fees to Medicare fee schedule (MFS) levels. Strict adoption of the MFS by the States would increase total Medicaid spending by approximately 4 percent, $2.5 to $2.9 billion. Because Medicaid fees vary across States, so does the impact of adopting the MFS. Medicaid spending would increase significantly in some wealthy States with large Medicaid populations and in a few small, relatively poor States. Some States currently pay more than the MFS for obstetrical services. If these fees continued at higher levels for obstetrical care, total Medicaid spending would increase by $3.5 to $4.0 billion.

Adult↗
PubMed1997

Prepaid capitation versus fee-for-service reimbursement in a Medicaid population.

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.

Aid to Families with Dependent Children↗
PubMed1997

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program.

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.

Aged↗
PubMed1999

Your fee schedule.

For doctors to be able to establish and protect their fees, it is imperative that they understand exactly what a fee is, as well as what it is not. This article will define the myriad of terms associated with fees and will illustrate the methods used by third-party payers to determine benefit amounts payable. This should help doctors better understand and protect the inherent value of annually updated fees.

Employee Retirement Income Security Act↗
PubMed1990

The impact of the fee-for-service reimbursement system on the utilisation of health services. Part I. A review of the determinants of doctors' practice patterns.

The impact of different methods of reimbursement on the practice patterns of doctors has received little attention in the local literature. This series of three papers attempts to address this gap. Here the international evidence on this issue is reviewed. The 'information gap' between doctors and their patients allows doctors to induce demand for their services. This leads to the potential for doctors to increase the supply of services when they stand to gain financially from doing so, as is the case in the fee-for-service system. There is extensive international evidence, at both national and micro levels, of the link between increased utilisation and the fee-for-service payment system. This is in contrast with the pattern noted in the salary system, used in some health maintenance organisations (HMOs) in the USA, or in the capitation system, used in the British National Health Service. The 'practice setting' in which doctors operate also affects patterns of practice. In the local fee-for-service sector, 'third-party payment' means that both doctors and patients have little awareness of the direct costs of services. In other systems, such as HMOs, there is a strong cost consciousness on the part of practitioners. These differences in practice setting account in part for the different patterns of utilisation in these systems. The fee-for-service system, as it is structured in South Africa, thus leads to extreme inefficiency, and the development of alternatives is becoming an urgent necessity. All systems of reimbursement have certain problems, and some combination may be the best solution.

Capitation Fee↗
PubMed1993

Ophthalmology and the Resource-Based Relative Value Fee Scale.

The Medicare Resource-Based Relative Value Scale for ophthalmology has significantly reduced the level of reimbursement for surgical fees and only minimally increased evaluation and management fees. Some observers have felt that the methods for determining fees were flawed, and, generally, practitioners have been concerned about a potential loss of income. While reimbursement for individual services is being cut, projections through 1996 indicate that ophthalmology, as a specialty, will receive 55% more funding due to historical trends and increasing ranks of providers. This will translate into a more moderate global reduction in revenue of approximately 11%. The possible implications of the Resource-Based Relative Value Scale include a concentration of ophthalmic surgery into fewer practices, which may be able to distribute medical liability costs over a larger number of procedures. To counter the constraints of fee limits, individual physicians will probably seek to enhance their net income by greater use of paraprofessional personnel, the acquisition of new technologies, and the application of improved management skills.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Quid pro quo: fee for services delivered in a psychology training clinic.

The present study evaluated the use of a sliding-fee scale at a training clinic for doctoral students in clinical psychology. A chart review of 209 individual therapy clients and a follow-up telephone interview of 87 of these clients were conducted. Results of the chart review revealed a client group of relatively low income, with only a very small number receiving social assistance or a disability pension. The follow-up survey found that the large majority of clients were satisfied with the fees charged. Service use (i.e., frequency and number of sessions), client satisfaction with services, and treatment outcome did not vary with out-of-pocket costs incurred by clients. Overall, findings suggest that training clinics can charge fees without affecting services, although future research needs to examine the extent that fee charging by training clinics may be an obstacle to service access for the poorest segments of the population.

Adult↗
PubMed1983

The effects of patients' fee payment source on the duration of outpatient psychotherapy.

Investigated the effects of fee payment source alone, as well as in combination with selected demographic factors (race, sex, education, and socioeconomic status), on the duration of outpatient psychotherapy. One hundred and sixty outpatients receiving treatment at a medical center based community mental health center served as Ss. These Ss were divided into four groups: Medicaid, insurance, insurance plus self-payment, and scaled self-payment only. Univariate results indicated that patients who paid a scaled fee had significantly more sessions than those whose fee was paid by Medicaid. Multivariate results, however, indicated that education and sex, which were highly correlated with fee payment source, accounted for most of the variance in treatment duration.

Ambulatory Care↗
PubMed1990

Perceptions of therapists as a function of professional fees and treatment modalities.

Consumers, therapists, and researchers share an interest in the topic of service fees. The issue of fees can affect clients' evaluation of the provider as well as the likelihood of using the service being offered. In a between-subjects design, adult males (n = 84) and females (n = 78) read a brief description of a psychologist who provided individual or group therapy for a fee of $50, $80, or $110. While fees had no effect, treatment mode and participant sex did relate to perceptions of therapist credibility. A triple interaction emerged with respect to participants' willingness to consult the psychologist. Implications for service providers are discussed.

Adult↗
PubMed1982

The impact of fee setting procedures in a mental health center setting.

The impact of fee setting procedures on psychotherapy has received little research attention. Furthermore, there is a shortage of information about this area which is useful for both mental health management and clinicians. Procedures for establishing fees were examined from several perspectives: fees, cash, no shows, number of sessions, cancellations, months of service, ratings by the therapists of treatment outcome, satisfaction of the clients, and the ratings by the clients of treatment outcome. Overall, the results suggest that the procedures used to set fees may have no adverse effects upon the welfare of the clients or the operations of a center, although some client perceptions may be altered. Hence, rigorous future research with stronger manipulations becomes more ethically feasible.

Community Mental Health Centers↗
PubMed1993

The therapeutic value of fees: what do practitioners believe?

Theorists have proposed that out-of-pocket fee payment helps clients benefit from psychotherapy. 159 staff members of a public mental health agency completed a fee attitude survey. Aggregate results indicated neutral beliefs. Significant differences appeared by gender, population served, and organizational role. Women were less likely than men to endorse TVF beliefs. Addiction services staff held strongest TVF beliefs, child and adult mental health staffs were neutral, and victim services staff rejected TVF beliefs. Clinical service providers were less likely to endorse TVF concepts than were clinicians in management roles, and non-clinical support staff held the strongest TVF beliefs. By understanding the relationships between fee attitudes, organizational role, and populations served, mental health administrators may be better able to manage changes in fee procedures.

Attitude of Health Personnel↗
PubMed2006

Outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care.

This study compared outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care programs. Interviews were conducted with 305 Medicaid clients in rural Oregon (166 in fee for service and 139 in managed care). Logistic and multivariate regression analyses were used to examine client satisfaction, safety, symptoms, functioning, and family satisfaction in the fee for service versus managed care groups. There was no evidence that conversion of the Medicaid mental health system from fee for service to managed care led to changes in outcomes for rural clients with severe mental illness.

Acute Disease↗
PubMed1986

Health care financing in Kenya: a simulation of welfare effects of user fees.

This paper examines the efficiency and equity effects of introducing user fees in public health facilities in Kenya. These effects are studied with the aid of a simulation technique. It is found that through their favourable effects on quality of medical services, the user fees in public clinics would yield welfare gains. However, these gains might involve unacceptable equity trade-offs. Thus, in general, the net welfare effects of user charges on medical services is ambiguous. More specifically, if the user fees were imposed across the board in government health facilities, the equity trade-offs would be large, and for that reason, the user fees would be socially and politically unacceptable. But, if the user charges are restricted to government hospitals, the attendant equity problem would not be too difficult to manage.

Developing Countries↗
PubMed1993

Increasing reliance on user fees as a response to public health financing crises: a case study of El Salvador.

Since the early 1980s, the Ministries of Health of most Developing Countries have been plagued by significant and persistent resource shortages. One response of many Third World countries to this health financing crisis has been to turn to user fees. This article presents a case study of the evolution of public health care system fees in El Salvador in the decade of the 1980s. Since 1980 falling levels of real funding of the Ministry of Health of El Salvador have resulted in falling supplies of drugs, materials and equipment throughout the public health system, and have contributed to declining utilization levels of public health facilities. Local public health providers and their community health boards (patronatos) have responded to this crisis by creatively institutionalizing decentralized, revolving accounts based on 'voluntary' user fees for ambulatory care, collected and retained at individual facilities. This article describes the legal foundations, organization, functioning, incentive structures, financial performance, and the institutional development of El Salvador's local user fee systems.

Community Health Services↗
PubMed1999

Delay in gynecologic surgical treatment: a comparison of patients in managed care and fee-for-service plans.

OBJECTIVE: To determine whether membership in a managed care organization is associated with a delay in receiving definitive surgical treatment for benign gynecologic or gynecologic oncologic diseases. METHODS: Four hundred patients who had definitive surgery between 1994 and 1997 were divided into those with benign gynecologic (n = 207) and gynecologic oncologic diagnoses (n = 193). Each group was subdivided into managed care patients and fee-for-service patients. Subgroups were analyzed for delay in surgical treatment, emergency room visits, length of stay, age, clinic visits, prior evaluation, prior treatment, second opinions, operating room time, estimated blood loss, and surgical complications. RESULTS: There were 122 managed care and 85 fee-for-service patients with benign gynecologic diagnoses. The time from initial presentation to the date of definitive surgery was significantly longer for the managed care patients (133.7 +/- 21 days compared with 84.9 +/- 12.8 days, P = .03). Of the 193 patients with gynecologic cancer 96 were in the managed care group and 97 were under fee-for-service arrangements. There was no significant difference in the time from initial presentation to the date of definitive surgery between these two groups (35.7 +/- 7.4 days compared with 20.5 +/- 2.5 days, P = .29). There were no significant differences between groups in emergency room or clinic visits, prior evaluations or treatments, or surgical complications when stratified by diagnosis. The mean age of managed care patients was significantly lower than that of fee-for-service patients for gynecologic diagnoses (46.4 +/- 9.7 years compared with 56.5 +/- 14.9 years, P < .001), and gynecologic oncologic diagnoses (47.5 +/- 13.2 years compared with 60.9 +/- 15.8 years, P < .001). CONCLUSION: Membership in a managed care organization is associated with a delay in receiving definitive surgical care for benign gynecologic, but not gynecologic oncologic, diseases.

Arizona↗