In the United States, federally-funded health plans are mandated to measure the quality of care. Adherence-based medication quality metrics depend on completeness of administrative claims data for accurate measurement. Low-cost generic programs (LCGPs) cause medications fills to be missing from claims data as medications are not adjudicated through a patient's insurance. This study sought to as...

At the same time, promoting health care “value” has become a focal point of state and national policymakers in their efforts to improve the health care system. The 2010 Patient Protection and Affordable Care Act (ACA) directs states to set up exchanges where consumers and small businesses can purchase health insurance. These exchanges are required by legislation to present information on value,...

BACKGROUND Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research p...

OBJECTIVE To evaluate selected Children's Health Insurance Program Reauthorization Act claims-based quality measures using claims data alone, electronic health record (EHR) data alone, and both data sources combined. METHODS Our population included pediatric patients from 46 clinics in the OCHIN network of community health centers, who were continuously enrolled in Oregon's public health insu...

The increasing awareness of the scarcity of health care resources is forcing the health care industry to improve quality while lowering the cost. One method by which employers and insurance companies are attempting to do this is with value-based insurance design. In these plans, patients pay a lower amount for certain services that are considered high value and a higher amount for services that...

The Japan Obstetric Compensation System for Cerebral Palsy was established in January 2009 with collaboration of the government and obstetricians. It aims to help children having delivery-related disabilities and their parents to promote urgent settlements of disputes in relation to delivery, and to improve the quality of maternity care. The system is essentially based on a private insurance sc...

this research explores the effective ways of sales promotion at liability insurance according to upgrade policies in tehran. the goal is development of planning strategic to help iran insurance industry.  first, we evaluate opinions and views of iran insurance company experts and iran insurance sales agents in tehran on sales promotion (also, priority of the promotion policies) of liability ins...

INTRODUCTION Previous studies have consistently documented that racial/ethnic minority patients with diabetes receive lower quality of care, based on various measures of quality of care and care settings. However, 2 recent studies that used data from Medicare or Veterans Administration beneficiaries have shown improvements in racial/ethnic disparities in the quality of diabetes care. These inco...

As many as 37 million Americans have no medical insurance, but no data exist on the mental health needs of community samples of the uninsured. Using interview data from a household sample in Los Angeles, we found that the uninsured had a higher prevalence of serious psychiatric disorder (16%) than those with private health insurance (12%), but had a prevalence similar to those with Medicaid (18...

ONE YEAR AFTER THE HISTORIC PASSAGE OF THE AFfordable Care Act (ACA), the individual mandate is subject to ongoing scrutiny both by the federal courts and Congress. This provision of the ACA would require most individuals to purchase health insurance, and recent attention has focused on the important legal issues associated with such a mandate. However, far less attention has been devoted to th...