Effective October 1, 1958, the four public assistance titles of the Social Security Act were amended to change the basis of Federal financial participation in assistance payments under State programs for old-age assistance, aid to the blind, aid to the permanently and totally disabled, and aid to dependent children. The amendments had a threefold effect: (1) They made available some additional ...

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, MA plans have, for the past six years, been paid more for their enrollees than they would be expected to cost in traditional fee-for-service Medicare. Payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional M...

In two important health policy contexts - private plans in Medicare and the new state-run "Exchanges" created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance ma...

In some countries, including France, patients can choose between consulting a physician working in the regulated sector where, general, fees are fully covered by health insurance (whether public, private or mixed), unregulated sector, where balance billing scheme operates. latter, might not be insurance, and must make out-of-pocket payments. The paper analyses signalling properties of this mech...

Relationships between health professionals and pharmaceutical manufacturers can unduly influence clinical practice. These relationships are the focus of global transparency efforts, including in Europe. We conducted a descriptive content analysis of the transparency provisions implemented by February 2017 in nine European Union (EU) countries concerning payments to health professionals, with du...

OBJECTIVES To determine the mean, median and 10th and 90th percentile levels of fees and out-of-pocket costs to the patient for an initial consultation with a consultant physician; to determine any differences in fees and bulk-billing rates between specialties and between states and territories. DESIGN, PARTICIPANTS AND SETTING Analysis of 2015 Medicare claims data for an initial outpatient a...

Payments to physicians absorb the second largest share of the health care dollar in the United States. In 1979, the share was 19 percent of the total, or $40.6 billion (Gibson, 1980). The Health Care Financing Administration (HCFA) alone spent $8.6 billion for physician services, representing approximately 16 percent of all public funds disbursed under HCFA programs. This paper presents an over...