A health care provider chooses medical service quality and cost-reduction e§ort. Both choices are noncontractible. An insurer observes both quality and cost e§ort, and may credibly disclose them to consumers. In prospective payment, the insurer fully discloses care quality, and sets a prospective payment price. In cost reimbursement, the insurer discloses a value index, a weighted average of qu...

We propose an architecture called InterPay for managing nancial interactions with for-pay digital library services. The approach accommodates multiple payment mechanisms, interaction models, and charging policies. Key components of our model are payment agents and payment capabilities that encapsulate payment policy and the details of payment on behalf of the user. Collection agents and collect...

This list contains codes identifying home infusion therapy products/services. 530 National Council for Prescription Drug ProgramsReject/Payment Codes SIMPLE DATA ELEMENT/CODE REFERENCES1270/RX, 1271 SOURCENational Council for Prescription Drug Programs Data Dictionary AVAILABLE FROMNCPDP4201 North 24th StreetSuite 365Phoenix, AZ 85016ABSTRACTA listing of ...

In this commentary, we discuss the advantages and disadvantages of the following incentive-based remuneration systems in dentistry: fee-for-service remuneration, per capita remuneration, a mixed payment system (a combination of fee-for-service remuneration and per capita remuneration) and pay-for-performance. The two latter schemes are fairly new in dentistry. Fee-for-service payments secure hi...

Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value. This brief reviews nurses’ contribution to value, highlight...

background informal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. many countries are putting reforms in place with the aim of reducing informal payments. in order to be successful, such policies should be informed by the...

Objectives: This study aimed to assess the components of oral health care system in some developed countries and propose a model for Iran   Methods: The present study was a qualitative, cross-sectional, and comparative research that took place in 2012. Oral health care systems in some developed countries were reviewed to propose a framework for Iran. This framework was discussed and revie...

This Data Watch presents data on geographic variation in medical costs across a sample of forty-six cities, using enrollment-weighted average Federal Employees Health Benefits Program (FEHBP) health maintenance organization (HMO) premiums. Variation of average HMO premiums is markedly less than variation of per capita fee-for-service costs as measured by Medicare's adjusted average per capita c...

In many countries, competing health plans receive capitation payments from a sponsor, whether government or a private employer. All capitation payment methods are far from perfect and have raised concerns about risk selection. Paying health plans partly on the basis of capitation and partly on the basis of actual costs ("risk sharing") reduces plans' incentives for selection but sacrifices some...