BACKGROUND How many physicians are needed in the United States and how they should be allocated geographically and among specialties has been the subject of intense debate, a debate that has often focused more on costs to third-party payers and government than on benefits to health. Child health is a central aspect of public health, and immunization is one of its most cost-effective and easily ...

This paper studies a model in which Puo payers contract with one hospital. True costs per patient are not a possible basis for payment, and contracts can only be zuritten on the basis of allocated cost. Payers choose a contract that is fully prospective or fully based on cost allocation, or n paynient scheme that zuould give some weight to eack of these two. We ckaracterize the payers‘ equilibr...

Public and private payers face complex decisions regarding whether, when, and how to cover and reimburse for next generation sequencing (NGS)-based tests. Yet a predictable reimbursement pathway is critical both for patient access and incentives to provide the market with better clinical evidence. While preliminary data suggests that payers will use similar evidentiary standards as those used t...

In 1992, Medicare reformed its physician payment method by implementing the Medicare fee schedule (MFS), of which the resource-based relative value scale (RBRVS) is a major component. Using a recent survey and case studies, we examine the diffusion of Medicare's RBRVS to non-Medicare payers and how those payers use and perceive the RBRVS and MFS policies. We find that approximately one-third of...

This document amends the regulations of the Department of Veterans Affairs (VA) concerning the reimbursement of medical care and services delivered to veterans for nonservice-connected conditions. This rule applies in situations where third-party payers are required to reimburse VA for costs related to care provided by VA to a veteran covered under the third-party payer's plan. This final rule ...

Lucien Roberts, a practice administrator for Gastrointestinal Specialists, Inc., a 22-provider specialty practice with seven offices spread throughout Central Virginia, has been involved in practice management for over 20 years and during that time has seen many changes in payer relations. But one thing that hasn't changed is his desire to craft strong working relationships with his payers. "Al...

BACKGROUND Some orphan drugs can cost hundreds of thousands of dollars annually per patient. As a result, payer sensitivity to the cost of orphan drugs is rising, particularly in light of increased numbers of new launches in recent years. In this article, we examine payer coverage in the United States, England and Wales, and the Netherlands of outpatient orphan drugs approved between 1983 and 2...