BACKGROUND United States health care spending rose rapidly in the 2000s, after a period of temporary slowdown in the 1990s. However, the description of the overall trend and the understanding of the underlying drivers of this trend are very limited. This study investigates how well historical hospital cost/revenue drivers explain the recent hospital spending trend in the 2000s, and how importan...

This article identifies the impact of managed-care reforms on the utilization of medical services within the military health-services system. The data come from a recent demonstration project that substituted an HMO and PPO for traditional FFS arrangements. Results from a semiparametric model indicate that the generosity of benefits in the HMO increased demand for ambulatory services. Unlike...

OBJECTIVE To document changes in type of financing for office-based visits for the treatment of common skin conditions and to dermatologists. DESIGN Data from a national survey of visits to office-based practitioners conducted by the National Center for Health Statistics were used. The stratified sampling technique permits estimation of the total number of office visits with specific characte...

The O2O is a fast-growing emerging business model, the O2O business model framework is established and the most basic 7 major elements are identified in our research with Value Net theory as follow: customer, telecom operator, content provider, service provider, software provider, third-party payment platform and offline business entity. Then, we apply the Delphi method to identify 8 secondary ...

BACKGROUND Ghana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. The National Health Insurance Authority (NHIA) later introduced diagnosis-related-grouping (DRG) payment to contain cost without much success. The NHIA then introduced capitation payment, a decision that attracted complaints of falling...

Managed health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the to...

Key Data Findings. (1) The average rural Medicare Advantage (MA) plan enrollee in 2012 experienced a quality rating of 3.60 stars (of a potential 5.0), compared with a rating of 3.71 stars experienced by urban enrollees. (2) The measured rural-urban difference in the MA plan quality is a result of the difference in the composition of the enrollment and plan availability in MA markets, rather th...

Where a provider is excluded from a managed care payor network, patients are often required to pay a much higher “out-of-network” co-payment if they choose to be treated at such provider. In such a case, it may be viewed as a potential kickback, insurance fraud or grounds for disciplinary action against a physician to waive the co-payment, co-insurance or deductible.1 Further, a provider’s waiv...

Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrict...

results the findings of this study showed that in most selected countries, primary care services were provided by the private sector and the public sector has been mostly functioning as a supervisor in this area, but in iran, primary care services were provided by the government. the findings of this study also showed that hospital services in iran and selected countries (second and third level...