Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care or...

A recent policy perspective was published in the New England Journal of Medicine March 5, 2015 by the Secretary of Health And Human Services, Sylvia Burwell, on setting value-based payment goals for Medicare [1]. These goals include having at least 30 % of the Medicare payments provided through such mechanisms as accountable care organizations (ACOs) and bundled episodes of care by 2016, rising...

background being in a position of vulnerability, distress and uncertainty reduces the ability of the parents to protect their children and makes them need support from others. the first step to aid clients more is to identify their supportive sources. this study aimed to determine parents' experiences of supportive sources during their children surgery. materials and methods this is a desc...

Healthcare reimbursements in the US have been traditionally based upon a fee-for-service (FFS) scheme, providing incentives for high volume of care, rather than efficient care. The new healthcare legislation tests new payment models that remove such incentives, such as the bundled payment (BP) system. We consider a population of patients (beneficiaries). The provider may reject patients based o...

In 2009, the methods for paying SHI-affiliated physicians in ambulatory care were changed. The era of capitation fees and strict budgeting is over. GPs and specialists are now paid on a capped fee-for-service basis, with a payment ceiling that is set for each doctor and adjusted for specialization, the number of cases and patient age. Instead of a floating-point fee schedule, a fee schedule wit...

This paper describes forms of risk sharing between insurers and the regulator in a competitive individual health insurance market with imperfectly risk-adjusted capitation payments. Risk sharing implies a reduction of an insurer's incentives for selection as well as for efficiency. In a theoretical analysis, we show how the optimal extent of risk sharing may depend on the weights the regulator ...

Using data from the 1991 Medicare Current Beneficiary Survey (MCBS), multiple regression-based models predicting 1992 Medicare costs are developed and compared. A comprehensive model incorporating demographic, diagnostic, perceived health, and disability variables is shown to be stable and to fit the data well over the full range of Medicare-covered annual per capita expenses and for a variety ...