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Secondary care: reimbursing hospitals

Jan Abel Olsen

in Principles in Health Economics and Policy

This chapter presents three alternative reimbursement systems for hospitals, and discusses the pros and cons of each system. In their pure form, none of these systems emerges as the ideal solution, ... More

This chapter presents three alternative reimbursement systems for hospitals, and discusses the pros and cons of each system. In their pure form, none of these systems emerges as the ideal solution, which explains why we observe blended systems in practice. Exercises and suggested readings are included at the end of the chapter.Less

The Different Measures of Recovery and their Terminology

Jeroen Kortmann

in Altruism in Private Law: Liability for Nonfeasance and Negotiorum Gestio

This chapter gives an account of the different measures of recovery and elaborates the meaning of the different terms used for those measures. For while ‘reimbursement’, ‘compensation’, ... More

This chapter gives an account of the different measures of recovery and elaborates the meaning of the different terms used for those measures. For while ‘reimbursement’, ‘compensation’, ‘remuneration’, ‘reward’, and ‘restitution’ are part of every lawyer's vocabulary, these terms can have many different meanings, depending on the context in which they are employed. These terms have been given different definitions by different authors and this chapter tries to explain them by providing various different examples. The aim of this short chapter is merely to avoid confusion by defining the terms. It is not suggested thereby that these definitions are in any way superior to those adopted in other writings on the subject.Less

An Overview of Supportive Care in Heart Failure

Sarah J. Goodlin and James Beattie

in Supportive Care in Heart Failure

This chapter provides an introduction to the concept of supportive care in heart failure (HF). It starts by presenting the concepts of supportive and palliative care. It addresses the delivery of ... More

This chapter provides an introduction to the concept of supportive care in heart failure (HF). It starts by presenting the concepts of supportive and palliative care. It addresses the delivery of supportive care and the framework for supportive care in HF. It is shown that the comprehensive HF care combines evidence-based HF care and supportive care. Further study is important to determine how best to enhance quality of life and reduce the symptoms and burdens associated with HF. While challenges presented by delivery and reimbursement systems may require organized schemes to achieve comprehensive HF care, framing supportive care as integral to comprehensive HF care allows clinicians to better meet the needs of the patient and family now recognized as essential to ‘patient-centered care’.Less

Health Reform, Government Initiative, and the Future of American Health Care

Robert I. Field

in Mother of Invention: How the Government Created "Free-Market" Health Care

The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on ... More

The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on private insurance companies to expand coverage. It facilitates a market for individual policies and expands Medicaid, which is widely administered by private plans. Obama garnered political supportfor the law through alliances with key industry sectors that stood to gain, including insurers, hospitals, physicians, and pharmaceutical firms. The ACA thereby extends to new lengths the public-private partnership underlying all American health care. Future reforms should address the partnership’s most glaring failings. These would transition reimbursement from fee-for-service to bundled payments, reduce administrative complexity, limit medicine’s specialist tilt, lessen the profession’s commercialization, and control the proliferation of expensive technology. Government activism created American health care, and it will always be the essential force in keeping it sustainable andvibrant.Less

You Get What You Pay For

Frederick M. Barken

in Out of Practice: Fighting for Primary Care Medicine in America

This chapter discusses a key issue in the financing of primary care: physician reimbursement. It first considers the widening disparity between the obligations of the primary doctor as communicator ... More

This chapter discusses a key issue in the financing of primary care: physician reimbursement. It first considers the widening disparity between the obligations of the primary doctor as communicator and his rate of pay and asks why surgery and other invasive procedures intuitively carry more weight, and consequently higher remuneration, than careful consideration, diagnostic acumen, patience, communication, and management of chronic conditions. It then explores the paradigm shift in physician payment with the advent of the Medicare Economic Index and some of the reasons why physicians today prefer group practice. It also looks at the viability of pay for performance (P4P) and a revised reimbursement model for primary care of the elderly that incorporates pay for connectedness (P4C).Less

The Medical School in Wartime

Antonio M. Gotto and Jennifer Moon

in Weill Cornell Medicine: A History of Cornell's Medical School

This chapter describes how Dr. William Ladd's tenure as dean coincided with a period of intense societal change triggered by the Depression. The impact was felt at Cornell, as questions about the ... More

This chapter describes how Dr. William Ladd's tenure as dean coincided with a period of intense societal change triggered by the Depression. The impact was felt at Cornell, as questions about the evolving relationship between medicine and society became increasingly urgent. In keeping with the rising costs, medicine as a profession had become increasingly prestigious, and the average take-home pay for a physician was about four times the national average. For most Americans, the increase in health care expenses was financially burdensome. Public discussion turned to the problem of access to health care. Some politicians began advocating for federal- and state-sponsored health insurance plans; other insurance models, such as third-party reimbursement, were also proposed. In response, Cornell University President Livingston Farrand urged graduating physicians to involve themselves in social problems.Less

The Continental Doctrine of ‘Negotiorum Gestio’ 1

Jeroen Kortmann

in Altruism in Private Law: Liability for Nonfeasance and Negotiorum Gestio

This chapter contains an introductory account of the basic scope and meaning of the doctrine of negotiorum gestio. It should again be stressed that it is not here intended to describe the doctrine in ... More

This chapter contains an introductory account of the basic scope and meaning of the doctrine of negotiorum gestio. It should again be stressed that it is not here intended to describe the doctrine in all its details, or to give a full report of the ways in which an intervener might recover in the continental systems here discussed. Instead, the purpose of this chapter is merely to illustrate how a general principle allowing necessitous interveners to recover — negotiorum gestio — operates within a modern legal system. Thus, this chapter does not contain any discussion of, for example, the intervener's possible claims in contract or tort, nor of the specific provisions in the German civil code entitling the finder of lost goods to reimbursement of his expenses as well as a reward.Less

The Position in English Law

Jeroen Kortmann

in Altruism in Private Law: Liability for Nonfeasance and Negotiorum Gestio

This chapter contains an introductory account of the position in English law. English Law in principle denies the intervener a claim, be it for reward or for mere reimbursement of his expenses. Yet, ... More

This chapter contains an introductory account of the position in English law. English Law in principle denies the intervener a claim, be it for reward or for mere reimbursement of his expenses. Yet, as with the rule of no liability for nonfeasance, it proves surprisingly difficult to find any authority for this supposed principle. While there seems to be no authority for the supposed principle of denying voluntary interveners a claim, English law does not appear to contain a general principle that does grant interveners a claim. And whilst most of the English doctrines discussed in this chapter merely allow claims for reimbursement of expenses and/or compensation of loss, the salvage cases form an obvious exception, as well as some cases in equity, where trustees were on occasion remunerated for services voluntarily rendered.Less

Promoting equity through health services

Bo Burström

in Healthcare Public Health: Improving health services through population science

The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care ... More

The provision of healthcare should be in relation to the need of care, but this is not always the case, as examples given in this chapter illustrate. The impact on equity in the utilization of care of need-based resource allocation versus recent market-oriented choice reforms and changes in reimbursement systems in primary care in Sweden are discussed. Examples are given of alternative ways of providing services in primary care in disadvantaged areas. Further, the chapter describes an applied example of the concept of proportionate universalism in child healthcare services, where extra postnatal home visits are provided in a disadvantaged area of Stockholm. Finally, the emerging needs of integrated care in an ageing population are contrasted against current health policy reform, which emphasizes freedom of choice of providers, and discussed.Less

Rule 91: Interlocutory revision by the European Patent Office

Markus Kuczera

in Unified Patent Protection in Europe: A Commentary

If, after the interlocutory revision, the EPO does not make a statement within the required time period, it is expressing that it deems the claimant’s application to be unfounded. This must at ... More

If, after the interlocutory revision, the EPO does not make a statement within the required time period, it is expressing that it deems the claimant’s application to be unfounded. This must at least be noted in the necessary documentation in order to prove that the interlocutory revision took place. Less

How Medicare Changed the AHCs

Eli Ginzberg

in Teaching Hospitals and the Urban Poor

This chapter examines the overall impact of Medicare in the U.S. medical care system. It first provides an overview of the passage of Medicare and then describes how Medicare expanded the financing ... More

This chapter examines the overall impact of Medicare in the U.S. medical care system. It first provides an overview of the passage of Medicare and then describes how Medicare expanded the financing of the nation's leading research-oriented academic health centers (AHCs). Medicare's reimbursement policies helped improve the financial position of AHCs. One of the most important of the new financing arrangements under Medicare was the payment that the federal government made to hospitals for the direct and indirect costs connected with the operation of residency and fellowship training programs.Less

Physicians’ Financial Incentives to Personalize Medicine

David H. Howard, Jason Hockenberry, and Guy David

in Economic Dimensions of Personalized and Precision Medicine

Advocates for “personalized medicine” tests claim they can reduce health care spending by identifying patients unlikely to benefit from costly treatments. But most tests are imperfect, and so ... More

Advocates for “personalized medicine” tests claim they can reduce health care spending by identifying patients unlikely to benefit from costly treatments. But most tests are imperfect, and so physicians have considerable discretion in how they use the results. We show that when physicians face incentives to provide a treatment, the introduction of an imperfect prognostic test will increase treatment rates. We study the interaction of incentives and information in physicians’ choice between conventional radiotherapy and intensity modulated radiation therapy (IMRT) for Medicare patients with breast cancer. IMRT is far more costly. Patients with left-side tumors are more likely to benefit from IMRT, though it is unnecessary for the vast majority of patients. IMRT use is 18 percentage points higher in freestanding clinics, where physician-owners share in the lucrative fees generated by IMRT, than in hospital-based clinics. Patients with left-side tumors are more likely to receive IMRT in both types of clinics. However, IMRT use in patients with right-side tumors (the low benefit group) treated in freestanding clinics is actually higher than use in patients with left-side tumors (high benefit group) treated in hospital-based clinics. Prognostic information affects use but does nothing to counter incentives to overuse IMRT.Less

The Seven Years’ War and the Politics of Empire

Justin du Rivage

in Revolution Against Empire: Taxes, Politics, and the Origins of American Independence

This chapter offers an account of the British debate over the war. Although establishment Whigs were initially reluctant to commit money and men to rebuff French encroachments in North America, ... More

This chapter offers an account of the British debate over the war. Although establishment Whigs were initially reluctant to commit money and men to rebuff French encroachments in North America, military defeats and angry denunciations from radical Whigs on both sides of the Atlantic eventually led to an alliance with radical Whig leader William Pitt. Pitt's strategy of colonial reimbursement and global warfare helped make the Seven Years' War one of the most expensive in Britain's history, and it led politicians to accuse him of warmongering and demagoguery. Although authoritarian reformers were initially a voice in the wilderness, the accession of George Grenville and the fall of the Pitt–Newcastle ministry gave them the opportunity they needed to enact a sweeping program of reform and austerity. They cut back the war effort, negotiated peace with France, and stifled dissent—even as radical and establishment Whigs cried out against them.Less

Government as Plaintiff

in Mass Torts in a World of Settlement

This chapter concentrates on litigation by the government to recover the additional increment of expenditures from the public fisc said to be caused by a defendant industry's wrongful conduct. It ... More

This chapter concentrates on litigation by the government to recover the additional increment of expenditures from the public fisc said to be caused by a defendant industry's wrongful conduct. It explains why the idea of the government as plaintiff points the law of mass torts down a blind alley. In tobacco litigation, government reimbursement suits are more properly described as mass restitution actions than as mass torts per se. Government reimbursement litigation against the firearms industry produced the opposite result from tobacco: plenty of doctrinal testing and no settlement. The chapter then draws upon the Master Settlement Agreement (MSA) to show what is problematic about government reimbursement litigation more generally. The impact of the MSA was to increase cigarette prices for a discrete political minority within each state comprised of persons who do not exactly elicit great sympathy from the electorate at large.Less

The Medicaid Program

Thomas Buchmueller, John C. Ham, and Lara D. Shore-Sheppard

in Economics of Means-Tested Transfer Programs in the United States, Volume I

In both its costs and the number of its enrollees, Medicaid is the largest means-tested transfer program in the United States. It is also a fundamental part of the health care system, providing ... More

In both its costs and the number of its enrollees, Medicaid is the largest means-tested transfer program in the United States. It is also a fundamental part of the health care system, providing health insurance to low-income families, indigent seniors, disabled adults and, in some states, low-income adults more broadly. This paper reviews the history and structure of the Medicaid program and the large body of economic research that it has spawned in the nearly half century since it was established. We begin by summarizing the program’s history, goals and current rules. We then present program statistics, mainly related to enrollment and expenditures. Finally we turn to the research on the impact of Medicaid on a broad range of outcomes, discussing theoretical and methodological issues important for understanding these effects and reviewing the empirical literature, describing what has been learned thus far, investigating areas where studies seem to reach different conclusions and pointing to areas where we believe additional research would be fruitful.Less

The Effect of Tuition Reimbursement on Turnover: A Case Study Analysis

Colleen Flaherty Manchester

in The Analysis of Firms and Employees: Quantitative and Qualitative Approaches

Gary S. Becker's (1964) seminal work on investment in human capital makes a fundamental distinction between general and firm-specific skills, which has implications for investment and employee ... More

Gary S. Becker's (1964) seminal work on investment in human capital makes a fundamental distinction between general and firm-specific skills, which has implications for investment and employee turnover. Firm-specific human capital is defined as having value only to the current employment relationship, while general human capital is valuable to both current and potential employers. Becker's theory predicts that employees will bear the full cost of general skills training—either by paying for training directly or by accepting lower wages during training periods—because employers face the threat of not capturing the return on their investment due to “poaching” of trained employees by other employers. Tuition reimbursement programs are an example of general skills training provided by firms. This chapter examines empirically whether employees who participate in tuition reimbursement have higher retention rates than non-participants using a case study analysis of workers at a nonprofit institution. The results indicate that participation reduces employee turnover. Hence, general skills training increases retention.Less

Cost Growth in Medicare: 1992 to 2006

Amitabh Chandra, Lindsay Sabik, and Jonathan S. Skinner (eds)

in Explorations in the Economics of Aging

This chapter examines trends in Medicare spending from 1992 to 2006 across all hospital referral regions (HRRs) in the United States. The cost growth has been segregated into changes in the ... More

This chapter examines trends in Medicare spending from 1992 to 2006 across all hospital referral regions (HRRs) in the United States. The cost growth has been segregated into changes in the distribution of the population among high- and low-spending HRRs, spending per enrollee, number, or medical encounters, and spending per encounter. This chapter also looks at the differences between types of spending growth, and between different service categories within Part A and Part B. The study looks first at aggregate trends in Medicare spending and enrollment. Overall per capita Medicare fee-for-service spending grew at a real rate of 3.8 percent per year between 1992 and 1999, and at a rate of 2.7 percent per year from 1999 to 2006. Throughout both of these periods growth in Part B spending was higher than growth in Part A spending.Less

The U.S. Medical Care System for the Elderly

David M. Cutler and David A. Wise

in Health Care Issues in the United States and Japan

This chapter investigates the structure of the American medical care system, especially the system of care for the elderly. It concentrates on three sets of interactions: coverage rules (how people ... More

This chapter investigates the structure of the American medical care system, especially the system of care for the elderly. It concentrates on three sets of interactions: coverage rules (how people get health insurance and who pays for it), the reimbursement system (how providers are paid), and access rules (what are the financial and nonfinancial barriers to receipt of care). Medicare is significantly less generous than the typical private insurance policy. The various reimbursement systems differ enormously in the incentives they provide. The United States' medical care system has become substantially less generous in payment for care in the past two decades, and this has affected the care provided. About three-quarters of the elderly have some supplemental insurance, through Medicaid or private supplements. In general, the coverage in the United States is spotty—quite good for the elderly, especially those with supplemental insurance, but not guaranteed for the nonelderly.Less