Current de facto standard payment and billing models for commercial cloud storage services provide a plethora of information to the cloud provider about its clients. This leads to a hostile environment when seen from a privacy perspective. Motivated by recently leaked facts about large scale governmental surveillance efforts as well as the lack of privacy-preserving measures in existing commerc...

AIM To offer a capitation formula with greater capacity for guiding resource spending on population with poorer health and lower socioeconomic status in the context of financing and equity in primary health care. METHODS We collected two years of data on a sample of 10,000 individuals from a region in Chile, Valdivia and Temuco and evaluated three models to estimate utilization and expenditur...

Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of...

One commonly held explanation for high and rising health care costs in the United States points to the market power of health care providers. This third article of a 4-part series examines how the prices and quantities of health care services interact to influence health care expenditures. The article also reviews cost-containment strategies that are designed to reduce prices and quantities of ...

I’m sure that your P&T committee is grappling with a host of concerns related to the future affordability of health care. No doubt you’ve been briefed on pay-for-per formance, the Physician Quality Review Initiative (PQRI), and, of course, capitation. Perhaps you haven’t yet heard much about “evidence-informed case rates” (ECRs). I’d like to trace the recent history of ECRs, describe how they a...

With the U.S. health care system in the midst of a major transition spurred on by the Affordable Care Act (ACA), there is renewed debate over key health workforce policy issues. Health insurance coverage is expanding under the ACA, which will likely lead to increased demand for health care services. Longer-term, there will be increased emphasis on value, efficiency, and accountability within th...

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC g...

This final rule amends Medicare certification and payment requirements for rural health clinics (RHCs) as required by the Balanced Budget Act of 1997 (BBA). It changes the definition of a qualifying rural shortage area in which a Medicare RHC must be located; establishes criteria for identifying RHCs essential to delivery of primary care services that we can continue to approve as Medicare RHCs...

Shared savings is a payment strategy that offers incentives for providers to reduce health care spending for a defined patient population by offering them a percentage of net savings realized as a result of their efforts. The concept has attracted great interest, in part fueled by Affordable Care Act provisions that create accountable care organizations and by the movement among medical home pi...