Article history: Received 5 August 2009 Accepted 7 August 2009 China has recently unveiled an ambitious new health-care reform plan, entailing a doubling of government health spending as well as a number of concrete reforms. While the details of the plan have not yet been completely announced, we offer a preliminary assessment of how well the reform is likely to achieve its stated goal of assur...

This paper examines the role of provider payment policy as an instrument for addressing government and market failures and controlling costs in the health sector, particularly in developing countries. We empirically evaluate the impact of provider payment reform in Hainan province, China, on expenditures for different categories of services that had been subject to distorted prices under fee-fo...

Since its inception, the Medicare Program has allowed for the participation of private health plans, but the relationship of private plans to the government-sponsored fee-for-service (FFS) plan has been the subject of debate. Increased payments to private plans, the introduction of regional preferred provider organizations (PPOs), and a mandated demonstration of price competition that includes ...

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In an earlier paper (Ma, 1994), I considered the implications of prospective payment and cost reimbursement systems on provider quality and cost reduction incentives in the health market. Patient dumping, in which costly patients are denied services by providers, was one of the issues discussed in that paper. Because pure prospective payment is a fixed-price mechanism, providers will suffer a l...

OBJECTIVE To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. METHODS Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from...

The post-Communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs regression-based generalizations of the difference-in-differences method ...

SNFs electing to be paid under the prospectively determined payment rate system may file a simplified cost report. The cost report contains a simplified method of cost finding to be used in lieu of cost methods described in § 413.24(d). This method is specified in the instructions for Form HCFA– 2540S, contained in sections 3000–3027.3 of Part 2 of the Provider Reimbursement Manual. This form m...

Issue Expanded Medicaid enrollment under the Affordable Care Act has heightened the importance of states’ roles as principal purchasers of health care for low-income and medically vulnerable populations. Concurrently, the federal government has augmented states’ purchasing tools. Goal To examine the evolution of payment and delivery system reform in 10 ACA Medicaid expansion states. Methods...

Introduction In an effort to moderate the unsustainable rate of increase in health care costs and improve the quality of patient care and health outcomes, Blue Cross Blue Shield of Massachusetts (BCBSMA) introduced in 2009 a new provider payment model called the Alternative Quality Contract (AQC). Hospitals and physicians who enter into the AQC agree to take responsibility for the full continuu...