In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with ...

BACKGROUND The geographical distribution of general practitioners (GPs) is a persistent policy concern within the National Health Service. Maldistribution across family health service authorities in England and Wales fell between 1974 and the mid-1980s but then remained, at best, constant until the mid-1990s. AIM To estimate levels of maldistribution over the period 1994-2003 and to examine t...

This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006-2007 based on measures of qu...

OBJECTIVE To assess changes in the quality of primary care in two megacities following the introduction of health system reforms in China. METHODS We conducted multistage stratified random face-to-face surveys of patients visiting community health centres in Shanghai in 2011 and 2013, and Shenzhen in 2012 and 2013. Quality of primary care was measured using an assessment tool. Difference-in-d...

PURPOSE This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). METHODS ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under ...

BACKGROUND Significant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches. METHODS The stud...

C urrent discussions of the future of Medicare include proposals to increase the enrollment of beneficiaries in private health insurance plans. These proposals would provide incentives for beneficiaries to join private plans, rely on more loosely structured health plans such as preferred provider organizations (PPOs), change the way health plans are paid, and in some cases create competition be...

Conventional risk adjustment, which sets capitation payments equal to the average cost of individuals with similar observable characteristics, is not optimal if health plans can use private information to select low-cost enrollees. "Cost-minimizing risk adjustment" minimizes the sum of capitated HMO premiums plus FFS costs by balancing the gains from HMO cost efficiency against the overpayments...

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay co...

Nowadays, an in-app payment mechanism is offered in most existing mobile payment solutions. However, current solutions are not flexible and impose certain restrictions: users are limited to predefined payment options and merchants need to adapt their payment mechanisms to each payment provider they use. Ideally mobile payments should be as flexible as possible to be able to target various marke...