BACKGROUND Rare diseases are of increasing concern to private and public healthcare insurance plans. Largely neglected by manufacturers before the 1983 passing of the Orphan Drug Act (ODA), orphan drugs have become a commercialization target of steadily increasing importance to the healthcare industry. The ODA mandates the coverage of rare diseases, which are defined in research communities as ...

At the outset of COVID-19 public health emergency, patients, providers, and payers suddenly found themselves using telemedicine more often for care that was previously only delivered in person. Telemedicine supported continuity during this time. There is merit continuing to track

BACKGROUND New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. OBJECTIVES T...

OBJECTIVE To develop a tool for estimating hospital-specific inpatient prices for major payers. DATA SOURCES AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. STUDY DESIGN Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. E...

This American College of Physicians position paper, initiated and written by its Health and Public Policy Committee and approved by the Board of Regents on 16 February 2016, reports policy recommendations from the American College of Physicians to address the escalating costs of prescription drugs in the United States. Prescription drugs play an important part in treating and preventing disease...

BACKGROUND While the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined. METHODS Using TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal in...

Private accreditation of health care institutions serves crucial quality assurance functions in the American health care system. Since the advent of widespread third-party payment for health care services in the mid-twentieth century, third-party payers have used private accreditation to thereby identify which health care institutions are qualified to provide services for payment to their benef...

The diffusion of new technology is significantly affected by coverage and reimbursement decisions. A variety of agencies (public and private) make decisions as to which technologies or treatments will be covered and what the levels of reimbursement will be. Recently, these agencies' coverage decisions have tended to be strongly affected by whether a technology is cost raising or cost reducing. ...