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At least 433 records · Page 24Linked to original sources
PubMed2003

Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative.

OBJECTIVE: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. METHODS: Qualitative and quasi-experimental quantitative methodologies were used. FINDINGS: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at "case" health centres but increased by 30.5% at "control" health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. CONCLUSION: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentives must be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay.

Burkina Faso↗
PubMed1992

Toxicology consultation fees to health care facilities: a successful revenue generating program for poison centers.

Poison information center funding is a continuous problem and is growing more critical as cost containment effects the health care industry. Although a limited number of poison centers are partially funded by governmental agencies, general poison center operational support is derived from a variety of sources, and there is significant pressure upon centers to identify alternative funding sources. Affiliated members of our member hospital treatment network have provided one revenue source, but not all hospitals within our service region have subscribed. Furthermore, hospitals outside of our service region have utilized the service without any financial responsibility despite recommendations to use their local center. Therefore, to provide an incentive for local hospitals to subscribe to the service and to dissuade hospitals from outside of the region from using the service, we implemented a toxicology consultative fee for service on all calls emanating from non-member hospitals. In just 19 mo, recruitment of 16 new member hospitals has generated $65,150 additional revenue. Non-member hospitals electing not to affiliate but to remunerate for toxicology consultations (226 cases) have generated $20,400 (98% collection rate). A startling 95% reduction in calls from hospital outside of region has resulted since this fiduciary initiative began. New revenue totaling $85,550 has been generated by establishment of a toxicology consultation fee, and our staff is now able to dedicate priceless time and resources to the poison information needs of the residents of our region.

Fees and Charges↗
PubMed2004

Inpatient utilization by dual Medicare-Medicaid eligibles in Medicare risk HMOs and fee for service, California, 1991-1996.

Inpatient use among dual Medicare-Medicaid eligible beneficiaries in California Medicare HMOs and fee-for-service plans from 1991 to 1996 was compared, using a unique dataset that links Medicare enrollment data to inpatient discharge data. Dual eligibles in HMOs were found to have lower discharge rates, shorter lengths of stay, and fewer inpatient days than dual eligibles in the traditional fee-for-service system. Both, however, had higher discharge rates and inpatient days than non-dual-eligible beneficiaries. The results are consistent with previous findings documenting the high cost of dual eligibles, with the lower use in HMOs likely the result of differences in beneficiary characteristics and delivery of care between systems.

Aged↗
PubMed2005

[Surgeons' fees--What they should be?].

Changes in medical technology and economic conditions in Japan require that we reexamine the allocation of medical resources and the structure of surgeon's fees. A new payment system based on Diagnosis Procedure Combination (DPC) and an associated cost accounting system went in to use in 2001. Through quantitative analysis and critique of data gathered by these new systems, it might be possible to establish fair surgeons' fees and to improve the efficiency of the medical care delivery system. For its social responsibility and autonomy, the profession of medicine should take an active leadership role in current health care reforms.

Fee-for-Service Plans↗
PubMed2005

Ethical evaluation of "retainer fee" medical practice.

This article examines the reasons that some physicians have recently opted to reduce the size of their practice rosters to allow more time for each patient in exchange for a retainer fee from patients. These physicians also offer supplementary, nonmedical amenities to patients as part of their service. Because physicians have reduced the size of their practice rosters and have increased the price tag for their services, some patients have lost access to their care. We have tried to assess the ethical propriety of such a change in the design of medical practices by weighing plausible, ethically relevant arguments favoring and opposing RFMP. Physicians are ethically obligated first and foremost to promote and protect the health of their patients. RFMP fulfills this duty directly by ensuring prompt and ample professional time for the care of patients. It does so indirectly by allowing time for physicians' continuing education, which in turn should upgrade the quality of care. It also advances the ethical goals of autonomy as it allows patients to choose their own physicians and to spend their money as they please. On the other hand, these ethical positives are offset by the cost of retainer fees that may exclude access of patients to their physicians' care. Even if ethical tradition obligates physicians primarily to patients under their specific care, as professionals and as private citizens, they also have a responsibility to support the health of the entire community. RFMP does little to advance this cause, except that by optimizing the conditions under which their own private patients receive healthcare, they call attention to shortcomings in prevailing public healthcare policies, which by comparison fall short of that standard. An assumption that health is not properly a market commodity, and that all people should receive healthcare on equal terms, would expose RFMP to moral reproof. From an ethical perspective, we find sufficient cause for concern and caution in this innovative style of practice. Nevertheless, the weight of arguments presented here does not seem to justify unequivocal moral condemnation of RFMP. As neither pro nor con views seem to have settled the ethical question, definitive moral judgment on RFMP will probably depend on the outcome of future experience and ongoing evaluation. The implications of RFMP for any future healthcare system are not clear, at least to us.

Ethical Analysis↗
PubMed2005

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2006 and certain provisions related to the Competitive Acquisitions Program of outpatient drugs and biologicals under Part B. Final rule with comment.

This rule addresses Medicare Part B payment policy, including the physician fee schedule that are applicable for calendar year (CY) 2006; and finalizes certain provisions of the interim final rule to implement the Competitive Acquisition Program (CAP) for Part B Drugs. It also revises Medicare Part B payment and related policies regarding: Physician work; practice expense (PE) and malpractice relative value units (RVUs); Medicare telehealth services; multiple diagnostic imaging procedures; covered outpatient drugs and biologicals; supplemental payments to Federally Qualified Health Centers (FQHCs); renal dialysis services; coverage for glaucoma screening services; National Coverage Decision (NCD) timeframes; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. In addition, the rule finalizes the interim RVUs for CY 2005 and issues interim RVUs for new and revised procedure codes for CY 2006. This rule also updates the codes subject to the physician self-referral prohibition and discusses payment policies relating to teaching anesthesia services, therapy caps, private contracts and opt-out, and chiropractic and oncology demonstrations. As required by the statute, it also announces that the physician fee schedule update for CY 2006 is -4.4 percent, the initial estimate for the sustainable growth rate for CY 2006 is 1.7 percent and the conversion factor for CY 2006 is $36.1770.

Competitive Bidding↗
PubMed2005

Copy fees and patients' rights to obtain a copy of their medical records: from law to reality.

Patients have a legal right under HIPAA to a copy of their medical records. Personal life-long medical records rely on patients' ability to exercise this right inexpensively and in a timely manner. We surveyed 73 hospitals across the US, with a geographic concentration around Boston, to determine their policies about fees for copying medical records and the expected time it takes to fulfill such requests. Fees range very widely, from $2-55 for short records of 15 pages to $15-585 for long ones of 500 pages. Times also range widely, from 1-30 days (or longer for off-site records). A few institutions provide records for free and even fewer make them accessible on-line. We argue that electronic records will help solve the problem of giving patients access to their own records, will do so inexpensively and in a format more likely to be useful than paper.

Confidentiality↗
PubMedDate not supplied

[Fee psychology].

The problem of dental fees is always a difficult issue to discuss because of the great subjectivity of the word money and its emotional load in the dentist-patient relationship. The teaching of dentistry with the emphasis on the technical aspects as a primary goal, usually neglects the study of the person and of the factors that lead to stressful situations in the dental practice. The author insists on the importance of analysing the objective handicaps and inner, unconscious, barriers in order to attain a more mature attitude in this matter, and also makes some considerations concerning fees in pediatric dentistry.

Dentist-Patient Relations↗
PubMedDate not supplied

Determinants of preventive practices in fee-for-service primary care.

A study of primary care physicians was conducted in the provinces of Quebec and New Brunswick, Canada, to ascertain their patterns of preventive practice with respect to cancer in four anatomic sites: breast, cervix, colon-rectum, and lung. The determinants of preventive practices among 552 fee-for-service physicians in both provinces are explored. Scales were created for the practice behaviors related to each type of cancer (dependent variables) and for knowledge and belief (independent variables). The content of these scales was delineated through factor analysis and their reliability assessed using Cronbach's alpha. Other variables were considered in the analysis, including continuing education activities, perceived barriers to prevention, and other sociodemographic and professional variables. Bivariate analysis and multivariate techniques were used. The explanatory factors were regrouped into cognitive, sociodemographic, and organizational determinants. Particular patterns were delineated for each cancer type. In a fee-for-service reimbursement setting without specific incentives for preventive practices, the creation of favorable organizational environments and the conveying of agreed-upon information to physicians are important ways of enhancing the integration of preventive activities into clinical practice. Identification of the sociodemographic determinants of preventive practices reveals the complexity of physicians' behaviors.

Breast Neoplasms↗
PubMed1990

The impact of the fee-for-service reimbursement system on the utilisation of health services. Part II. Comparison of utilisation patterns in medical aid schemes and a local health maintenance organisation.

This study reports the results of a retrospective analysis of the use of a range of inpatient and outpatient services by the members of a health maintenance organisation (HMO), in which most providers are salaried, and by the members of three medical aid schemes in which providers are paid on a fee-for-services basis. The analysis shows significantly higher utilisation of all services by medical aid scheme members than by HMO members. Medical aid scheme patients saw all doctors 33% more often than their HMO counterparts. For general practitioners and specialists specifically, the differences were 36% and 18% respectively. Doctors looking after medical aid scheme beneficiaries ordered 133% more radiological procedures and 14% more pathological investigations than did those caring for HMO beneficiaries. Hospital utilisation was also higher for medical aid patients. While quality of care is difficult to measure, there are no reasons to suspect that significant differences in quality exist between the two systems described here. One factor that may contribute to the higher utilisation rates in the medical aid group is the higher average income of this group. However, these results also demonstrate that providers working in the fee-for-service system are likely to increase the supply of services compared with providers who are salaried. The different methods of reimbursement are compounded by the different practice settings in which these groups of doctors work; the HMO generates an awareness of costs that is absent from the independent practice, 'third-party payment' system of the medical aid schemes.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Laboratory Techniques↗
PubMed1990

The impact of the fee-for-service reimbursement system on the utilisation of health services. Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors.

The caesarean section (CS) rate among white women aged 20-35 years and having their first baby was examined, comparing the private fee-for-service medical aid sector with Johannesburg Hospital. The chance of having a CS in the private sector was 50% greater than in the public sector (28.7% v. 19.5%). Twice as many CSs were done on weekdays as over weekends, and it is argued that only a quarter of these are accounted for by elective procedures (planned before labour begins). We also found that in the private sector the daily frequency of non-caesarean deliveries was 56% higher during the week than on Saturdays or Sundays. Considering non-caesarean deliveries separately, it is inferred that the rate of induction of such deliveries was 28.7% in the private sector compared with 2.8% in Johannesburg Hospital. The evidence strongly confirms the international experience that the CS rate in a given population is not objectively determined by medical factors and is strongly influenced by individual doctors' decisions. Moreover, fee-for-service reimbursement of doctors leads to increased intervention in delivery, in the form of more frequent induction of labour and more CSs.

Adult↗
PubMed1989

Preventive attitudes, beliefs, and practices of physicians in fee-for-service and health maintenance organization settings.

To identify the self-reported differences in preventive practices, attitudes, and beliefs of physicians practicing in fee-for-service (FFS) and health maintenance organization (HMO) settings, we surveyed a 100% sample of primary care physicians practicing in a large, urban, closed-panel HMO and a random sample of physicians, in the same county, who were in an FFS practice. The FFS physicians were more likely to consider behavioral risk factors important than were HMO physicians, and they were more likely to ask their patients about behavioral risk factors. Fee-for-service physicians were more likely than HMO physicians to use continuing medical education courses to upgrade their skills in modifying behavioral risk factors. There was little difference in the self-reported proportion of patients with specific behavioral risks in the FFS and HMO practices. Also, both groups were comparable in their perception of their ability to do behavioral counseling and their perceived success in such counseling. We conclude that FFS physicians are more likely to have positive preventive beliefs, attitudes, and practices than are HMO physicians.

Attitude of Health Personnel↗
PubMed1989

The variability of general practitioners' fees.

A random sample of the general practitioners in the Auckland urban area was surveyed in 1985. Data on fee levels, costs and workload was collected. Analysis of this data shows the variability of doctors' fees is not easily explained in terms of indicators of quality of practice, workload, practice structure or the location of the practice.

Family Practice↗
PubMed1988

Fee controls as cost control: tales from the frozen North.

Uniform and binding fee schedules for physicians have been advanced as a cost-control strategy that can also improve patient access to care, as well as spread costs more equitably. Counter-arguments, however, predict very different effects on utilization and costs. Empirical evidence to challenge economic theories of physician behavior may be drawn from Canada. The experience of innovative policies of two provinces--within a national framework--emphasizes a multipronged approach to fees, practice patterns, and numbers of physicians; political will and ongoing negotiations are necessary.

British Columbia↗
PubMed1983

Contingent fees in medical malpractice litigation - a qualitative assessment.

The medical profession has experienced high liability insurance premiums accompanied by widespread use of contingent fees in medical malpractice litigation. It is worthwhile, therefore, to assess qualitatively the merits of contingent fees, the evidence suggesting that they are associated with unjustified litigation and their implications for the medical and legal professions.

Fees and Charges↗
PubMed1982

Establishing a fee for handling investigational drug studies.

The administrative aspects of a pharmacy coordinated investigational drug service and its related costs are described. The policies and procedures for administering investigational drug studies were reviewed and divided into tasks. The staff involved were interviewed to determine the time they spent performing each task. The space for storage of the investigational drugs was measured. The personnel and storage costs were calculated. An average of five hours is required to coordinate pharmacy participation in a drug study. A drug information specialist spends about 1.5 hours/study developing a data sheet on the investigational drug. Record keeping time is approximately 11 hours/study. The total annual personnel cost is +177/study. The space for storing the drugs costs +15.50/year/study. The pharmacy department charges a fee of +200/year for its involvement in investigational drug studies. This does not include dispensing fees, which are charged to the patient. At this hospital, the revenue generated can support a pharmacist half-time or a technician full-time.

Clinical Trials as Topic↗
PubMed1981

Assessing fees for nutritional counseling.

Questionnaires from hospital dietetic departments in the South and Midwest were used to make recommendations for fee assessment for nutritional counseling. About one-half charged for outpatient diet instruction, while only 9 percent charged for inpatients. The amount charged ranged from $2.50 to $25 per instruction, with a mean amount of $12.57 per hour. Recommendations for assessing fees for nutritional counseling included defining routine nutritional care. Nutritional counseling is not reimbursed by Medicare and Medicaid and only to a limited extent by private insurance companies. More studies are needed to establish the cost and benefits of nutrition services before reimbursement will be routinely provided by government and private health insurance.

Counseling↗
PubMed1976

Contrasts in HMO and fee-for-service performance.

This study compares various aspects of HMO performance in 10 plans with that of the fee-for-service system for the Medicaid population. Additionally, it examines utilization differences between several types of HMO's, grouped according to organization and provider payment. Four areas of behavior were studied--enrollment selectivity, utilization of services, accessibility of care, and satisfaction. The only significant difference between the two systems was in hospital utilization. Group-practice MNO's had significantly lower hospital utilization than the fee-for-service groups: foundation HMO's did not. This difference seems to indicate that capitation payment to an HMO alone is not significant enough to produce major changes in utilization and that the organized multispecialty group-practice arrangement with largely salaried physicians may be more significant. For the other variables--previous health status, ambulatory-care use (including preventive care), accessibility, and satisfaction--the two groups were remarkably similar.

Adolescent↗