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Results for “Insurance, Health, Reimbursement”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 19 recordsLinked to original sources
PubMed1979

Cost containment through risk-sharing by primary-care physicians.

A new type of independent practice association has been organized to encourage primary-care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician or pediatrician and must be referred by that physician for all specialized care. The primary-care physician authorizes payment from his own account for all care provided to his patients. He shares any dificit or surplus remaining at the end of the year. After four years of operation, United Healthcare has 610 primary-care physicians treating 23,000 patients. Total hospital use during 1978 and 293 bed-days per 1000 patients, as compared with 479 for Blue Cross. The hospital-admission rate per 1000 was 88, as compared with 101 for Blue Cross. Average lengths of stay were 3.3 and 4.7 dyas, respectively. This plan represents another means to control costs in the private medical marketplace.

Consumer Behavior↗
PubMed1979

Reimbursing hospice care: a Blue Cross and Blue Shield perspective.

The Associations' "Initial Statement on Hospice Care and Payment for Hospice Services" comprises three criteria and many recommendations. The statement can guide local Plans and other third party payers, wary of repeating past mistakes that increased costs without improving care.

Blue Cross Blue Shield Insurance Plans↗
PubMed1978

Third-party payers: to pay or not to pay.

Insurance companies have traditionally been wary of providing coverage for mental illness for two reasons: 1) they fear that people would bring a mental illness on themselves or would use treatment for self-actualization, and 2) they fear the risk of providing never-ending treatment for "incurable" illness. The author states that the insurers' fears are groundless but suggests that psychiatrists research the utilization and costs of their treatments in insurance plans collaboratively with the actuaries who determine policy and premiums. Retrospective and prospective criteria for outcome and effectiveness of psychiatric treatment must be developed and applied.

Attitude of Health Personnel↗
PubMed1979

HCFA's trapped.

Explore the source record for details and available documents.

Costs and Cost Analysis↗
PubMed1978

Day hospitalization as a cost-effective alternative to inpatient care: a pilot study.

Two private day hospitals and an insurance company offering group health coverage to federal employees undertook a pilot study to determine if providing insurance coverage for day hospitalization on the same basis as for inpatient treatment was a feasible means of controlling the cost of psychiatric care. The study included 31 patients who otherwise would have been hospitalized; most had histories of severe psychiatric disorders and extensive treatment. Using the measure that the day hospital patients would have been in inpatient treatment for the same number of days, the authors estimate that the use of day treatment saved the insurer more than $255,000. They recommend that day hospitalization be reimbursed on the same basis as inpatient care if a day hospital can meet stringent criteria ensuring that it provides active, appropriate treatment, and they present a list of such criteria.

Adolescent↗
PubMed1979

Physician participation in Medicaid: evidence from California.

The objective of this paper is to investigate physician participation in the Medicaid program. In particular, how sensitive is the physician's involvement with Medicaid to variations in Medicaid reimbursements? How important are fee levels in the private market? What is the impact of inflation on the costs of physicians' inputs, particularly if the Medicaid fee remains relatively constant? These questions are explored through an empirical analysis fo data from the California Medicaid program. Two aspects of physician participation form the focus of the study: 1) the percentage of physicians participating in Medicaid in a given county and 2) the average number of nonaged, Medicaid patients treated by each participating physician. Information on these variables and on Medicaid fees and private charges come from Medicare and Medicaid claims records for more than 3,000 physicians. The most significant result of the study is the reaffirmation of the importance of the amounts of both private charges and Medicaid payments in determining participation rates and average Medicaid case loads per participating physician. Both dependent variables are, as expected, inversely related to physicians' average billed revenue per patient and are positively related to average Medicaid payments per patient. In addition, it appears that the long-run impact of a change in billed revenue is significantly larger in absolute value than a corresponding change in the amount that Medicaid is willing to pay.

California↗
PubMed1978

Tax and Medicare aspects of hospital malpractice insurance. Part 1.

This first part of a two-part article on how tax laws and Medicare regulations affect hospital malpractice insurance discusses self-insurance mechanisms, particularly trust funds. Relationships among tax exemptions, Medicare and other intermediaries' reimbursements, investment income from such funds, and payments to and from the funds are examined.

Income Tax↗