Objectives: The present study aimed to provide an estimation of the current financial burden of renal transplantation therapy for insurance organisations.Methods: An Excel-based model was developed to determine the treatment costs of current clinical practice in renal transplantation therapy (RTT). Inputs were derived from Ministry of Health and insurance organizations` database, hospital and p...

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...

Günümüzde suistimal, küresel anlamda işletmelerin karşı karşıya kaldığı ve sürekliliğini tehdit eden en yaygın problemlerden biridir. İşletmelerin sürekliliklerini sağlayabilmeleri faaliyetlerine devam edebilmeleri için suistimal ile mücadele konusu kritik önem taşımaktadır. İşletmelerde farkındalığının sağlanması korunması ise konusunun önemli yapı taşlarından birini oluşturmaktadır. Bunun seb...

Inappropriate payments by insurance organizations or third party payers occur because of errors, abuse and fraud. The scale of this problem is large enough to make it a priority issue for health systems. Traditional methods of detecting health care fraud and abuse are time-consuming and inefficient. Combining automated methods and statistical knowledge lead to the emergence of a new interdiscip...

Many believe that employees’ health and economic factors plays an important role in their likelihood to purchase health insurance. However decision to purchase health insurance is not trivial matters as many risk factors that influence decision. This paper presents a decision model using fuzzy inference system to identify the likelihoods of purchasing health insurance based on the selected risk...

Patients in health maintenance organizations (HMOs) often trust their physicians less than those with other forms of insurance coverage. Recent studies have reported a backlash of criticism against managed care, especially HMOs. In response to this, some have argued that managed care has become more responsive to patients’ wishes. We use data from the Community Tracking Study (CTS) Household Su...

In Brazilian health insurance sector, the fee-for-service model still remains the major payment method for health services, and predominates in the relationship between hospitals and private health insurance companies. After the creation of Health Insurance Qualification Program (HIQP), which focuses on the quality of the assistance given to consumers, the health insurance companies will be eva...

Lean Management has been successfully implemented in production organizations since several decades. The study at hand investigates the implementation of Lean Management to IT organizations (Lean IT). The study offers three contributions: First, it explains on a conceptual level how Lean Management can be transferred from production to IT organizations (philosophy, principles, tools). Second, i...