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[Financing of international organizations for health programs].

This paper discusses the role that the international agencies have played in financing health programs. The different types of organisms are identified and classified according to the support they offer, the nature of their relationship with the recipient countries and their public or private character. The main problems associated with external financing of health problems are also discussed and the case of the W.K. Kellogg Foundation is presented to illustrate some of the issues previously analyzed.

Global Health↗

Medicare program; shared-services organizations and cost to related organizations--Health Care Financing Administration. Withdrawal of notices of proposed rulemaking.

This notice withdraws two notices of proposed rulemaking relating to Medicare reimbursement of providers of health care services. Current regulations limit the amount a provider may be reimbursed when it obtains services, facilities, or supplies from an organization to which it is related by common ownership or control. We published two proposed amendments to those regulations. The first would have exempted, from the related organizations regulations, costs incurred by providers for items furnished by certain shared-services organizations. The second proposal would have revised the definition of a related organization and made certain other changes in application of the rules. After considering the responses of the public to the proposed regulations and our own policy analyses, we have concluded that we should retain the flexibility provided by existing regulations and that there is no current need to amend these regulations. We are, therefore, withdrawing the proposals from further action.

Costs and Cost Analysis↗

Medicare program; solvency standards for provider-sponsored organizations. Health Care Financing Administration (HCFA), HHS. Final rule.

The Balanced Budget Act of 1997 established a new Medicare+Choice (M+C) program that offers eligible individuals Medicare benefits through enrollment in one of an array of private health plans that contract with us. Among the new options available to Medicare beneficiaries is enrollment in a provider-sponsored organization (PSO). This final rule revises and responds to comments on solvency standards that certain entities must meet to contract as PSOs under the new M+C program. These standards, originally established in an interim final rule published on May 7, 1998, apply to PSOs that have received a waiver of the requirement that M+C organizations must be licensed by a State as risk-bearing entities.

Financial Management↗

The competitive impact of health maintenance organizations on hospital finances: an exploratory study.

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggest that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend. This study concludes that if competition is to succeed it must encompass more than HMOs. HMOs may be important, but they are only one agent in the market. Thus, public policy created to induce competition must go beyond the simple stimulus of HMO growth.

Blue Cross Blue Shield Insurance Plans↗

[Work-time regulations--organization--liability and financing. Why young physicians run away from hospitals].

Junior doctors refuse to work in German hospitals as working conditions are outrageous. The German Working Time Law has not correctly transposed the European Union's Working Time Directive (EU 93/104). The Marburger Bund is fighting for a reform of the working conditions and has developed a new model for organising working hours, which would not only lead to a correct transposition of the EU Directive, but would also bring better working conditions and better patient care to German hospitals.

Germany↗