OBJECTIVE To assess the accuracy of data on "expected source of payment" in the patient discharge database compiled by the California Office of Statewide Health Planning and Development (OSHPD). DATA SOURCES The OSHPD discharge data for the years 1993 to 1996 linked with administrative data from the University of California (UC) health benefits program for the same years. The linked dataset c...

The Integrated Healthcare Association is coordinating an episode of care payment initiative involving prominent health plans, hospital systems, and physicians organizations in California. he fragmentation of payment methods undermines efficiency and quality of care due to its effects on both providers and consumers. This effect is especially pronounced when considering high-cost surgical proced...

Portugal created a NHS to achieve greater equity of access to health care. Successive governments continued to assert the importance of equity in the face of evidence of inequities in supply of hospital resources, but lacked methods to provide sound information on the degree of inequities in Portugal and hence how to achieve greater equity. Capitation formulae have been increasingly used in oth...

BACKGROUND The incidence of cancer and the cost of its treatment continue to rise. The effect of these dual forces is a major burden on the system of health care financing. One cost containment approach involves changing the way physicians are paid. Payers are testing reimbursement methods such as capitation and prospective payment while also evaluating how the changes impact health outcomes, r...

Introduction Between April 2008 and April 2009, five lawsuits1 were filed against the State of California to stop scheduled reductions (to rehabilitation providers, non-emergency medical transportation providers, pharmacies, physicians, and emergency physicians) in Medi-Cal payment rates. These legal challenges reflect California’s generally low payment rates: In the case of physician payments,...

A secure electronic cash scheme and its role-based access control (RBAC) management are proposed in this paper. The scheme uses electronic cash for payment transactions. In this protocol, from the viewpoint of banks, consumers can improve anonymity if they are worried about disclosure of their identities. A new role called anonymity provider agent (AP) provides a highly anonymous certificate fo...

OBJECTIVE To characterize the influence of dialysis facilities and nephrologists on resource use and patient outcomes in the dialysis population and to illustrate how such information can be used to inform payment system design. DATA SOURCES Medicare claims for all hemodialysis patients for whom Medicare was the primary payer in 2004, combined with the Medicare Enrollment Database and the CMS...

it seems that every other week something is new in our medical offices; we are bombarded from all directions. Insurance claims, electronic health records (EHRs), medical boards, hospital privileges—change has become the norm and medicine has become a moving target. Meaningful Use, through its application to EHRs, hopefully has the potential to drastically change how we practice medicine in the ...

reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. expanding the role of the electronic medical record (emr) to monitor provider practice, patient r...