The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
Costs which are directly identifiable with a particular service.
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.
Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.
That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.
A measurement index derived from a modification of standard life-table procedures and designed to take account of the quality as well as the duration of survival. This index can be used in assessing the outcome of health care procedures or services. (BIOETHICS Thesaurus, 1994)
Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.
The confinement of a patient in a hospital.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Ratio of output to effort, or the ratio of effort produced to energy expended.
The period of confinement of a patient to a hospital or other health facility.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
A stochastic process such that the conditional probability distribution for a state at any future instant, given the present state, is unaffected by any additional knowledge of the past history of the system.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.
A graphic device used in decision analysis, series of decision options are represented as branches (hierarchical).
Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.
Services for the diagnosis and treatment of disease and the maintenance of health.
Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.
Economic aspects related to the management and operation of a hospital.
System of recording financial transactions.
Economic aspects of the fields of pharmacy and pharmacology as they apply to the development and study of medical economics in rational drug therapy and the impact of pharmaceuticals on the cost of medical care. Pharmaceutical economics also includes the economic considerations of the pharmaceutical care delivery system and in drug prescribing, particularly of cost-benefit values. (From J Res Pharm Econ 1989;1(1); PharmacoEcon 1992;1(1))
Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.
Amounts charged to the patient as payer for health care services.
A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.
Elements of limited time intervals, contributing to particular results or situations.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Those funds disbursed for facilities and equipment, particularly those related to the delivery of health care.
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
Organized periodic procedures performed on large groups of people for the purpose of detecting disease.
Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.
Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)
The concept concerned with all aspects of providing and distributing health services to a patient population.
The chemical reactions involved in the production and utilization of various forms of energy in cells.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.
Amounts charged to the patient as payer for medical services.
The remuneration paid or benefits granted to an employee.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
Chronic absence from work or other duty.
The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.
A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.
Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Federal, state, or local government organized methods of financial assistance.
An examination, review and verification of all financial accounts.
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.
The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
Apparatus, devices, or supplies intended for one-time or temporary use.
Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.
Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.
The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
An infant during the first month after birth.
Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment.
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
Directions written for the obtaining and use of DRUGS.
An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.
Economic aspects of the nursing profession.
A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task.
The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.
Based on known statistical data, the number of years which any person of a given age may reasonably expected to live.
Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references.
Total pharmaceutical services provided by qualified PHARMACISTS. In addition to the preparation and distribution of medical products, they may include consultative services provided to agencies and institutions which do not have a qualified pharmacist.
Use for articles on the investing of funds for income or profit.
Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)
Cost-sharing mechanisms that provide for payment by the insured of some portion of covered expenses. Deductibles are the amounts paid by the insured under a health insurance contract before benefits become payable; coinsurance is the provision under which the insured pays part of the medical bill, usually according to a fixed percentage, when benefits become payable.
Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.
Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.
Evaluation of biomedical technology in relation to cost, efficacy, utilization, etc., and its future impact on social, ethical, and legal systems.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.
Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, Sint Maarten, formerly included in the NETHERLANDS ANTILLES.
A method of examining and setting levels of payments.
Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)
The total process by which organisms produce offspring. (Stedman, 25th ed)
Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.
The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
Computer-based representation of physical systems and phenomena such as chemical processes.
The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.
The design, completion, and filing of forms with the insurer.
An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.
Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.
The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra.
Hospitals maintained by a university for the teaching of medical students, postgraduate training programs, and clinical research.
The area of a nation's economy that is tax-supported and under government control.
The use of DRUGS to treat a DISEASE or its symptoms. One example is the use of ANTINEOPLASTIC AGENTS to treat CANCER.
A broad approach to appropriate coordination of the entire disease treatment process that often involves shifting away from more expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept includes implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. (From Hosp Pharm 1995 Jul;30(7):596)
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.
The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.
The prediction or projection of the nature of future problems or existing conditions based upon the extrapolation or interpretation of existing scientific data or by the application of scientific methodology.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
Diagnostic, therapeutic and preventive health services provided for individuals in the community.
A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)
Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)
Revenues or receipts accruing from business enterprise, labor, or invested capital.
Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.
Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc.
The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.
Planning for the equitable allocation, apportionment, or distribution of available health resources.
Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.
Societal or individual decisions about the equitable distribution of available resources.
A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.
The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.
Hospitals controlled by various types of government, i.e., city, county, district, state or federal.
Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.
Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.
The condition in which individuals are financially unable to access adequate medical care without depriving themselves and their dependents of food, clothing, shelter, and other essentials of living.
Organized services for the purpose of providing diagnosis to promote and maintain health.
A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly.
An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.
Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.
Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.
A country in western Europe bordered by the Atlantic Ocean, the English Channel, the Mediterranean Sea, and the countries of Belgium, Germany, Italy, Spain, Switzerland, the principalities of Andorra and Monaco, and by the duchy of Luxembourg. Its capital is Paris.
The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.
Damage inflicted on the body as the direct or indirect result of an external force, with or without disruption of structural continuity.
The obtaining and management of funds for institutional needs and responsibility for fiscal affairs.
The process of cumulative change over successive generations through which organisms acquire their distinguishing morphological and physiological characteristics.
Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex (ARC), to acquired immunodeficiency syndrome (AIDS).
Hospitals engaged in educational and research programs, as well as providing medical care to the patients.
The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.
Services designed for HEALTH PROMOTION and prevention of disease.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up.
Social and economic factors that characterize the individual or group within the social structure.
Subsequent admissions of a patient to a hospital or other health care institution for treatment.
Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy.
Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.
Diagnostic procedures, such as laboratory tests and x-rays, routinely performed on all individuals or specified categories of individuals in a specified situation, e.g., patients being admitted to the hospital. These include routine tests administered to neonates.
Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided.
Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment.
A republic in southern Africa, the southernmost part of Africa. It has three capitals: Pretoria (administrative), Cape Town (legislative), and Bloemfontein (judicial). Officially the Republic of South Africa since 1960, it was called the Union of South Africa 1910-1960.
In statistics, a technique for numerically approximating the solution of a mathematical problem by studying the distribution of some random variable, often generated by a computer. The name alludes to the randomness characteristic of the games of chance played at the gambling casinos in Monte Carlo. (From Random House Unabridged Dictionary, 2d ed, 1993)
Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.
Facilities equipped for performing surgery.
Voluntary cooperation of the patient in following a prescribed regimen.
An absence from work permitted because of illness or the number of days per year for which an employer agrees to pay employees who are sick. (Webster's New Collegiate Dictionary, 1981)
The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)
Organizations which assume the financial responsibility for the risks of policyholders.
The seeking and acceptance by patients of health service.
Insurance coverage providing compensation and medical benefits to individuals because of work-connected injuries or disease.
The room or rooms in which the physician and staff provide patient care. The offices include all rooms in the physician's office suite.
Parliamentary democracy located between France on the northeast and Portugual on the west and bordered by the Atlantic Ocean and the Mediterranean Sea.
The capability of an organism to survive and reproduce. The phenotypic expression of the genotype in a particular environment determines how genetically fit an organism will be.
That segment of commercial enterprise devoted to the design, development, and manufacture of chemical products for use in the diagnosis and treatment of disease, disability, or other dysfunction, or to improve function.
Outside services provided to an institution under a formal financial agreement.
Voluntary cooperation of the patient in taking drugs or medicine as prescribed. This includes timing, dosage, and frequency.
Studies determining the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. For drugs and devices, CLINICAL TRIALS AS TOPIC; DRUG EVALUATION; and DRUG EVALUATION, PRECLINICAL are available.
Nursing care given to an individual in the home. The care may be provided by a family member or a friend. Home nursing as care by a non-professional is differentiated from HOME CARE SERVICES provided by professionals: visiting nurse, home health agencies, hospital, or other organized community group.
Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.
A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.
The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.
Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.
Techniques used to carry out clinical investigative procedures in the diagnosis and therapy of disease.
A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.
Facilities for the preparation and dispensing of drugs.
A stand-alone drug plan offered by insurers and other private companies to beneficiaries that receive their Medicare Part A and/or B benefits through the Original Medicare Plan. It includes Medicare Private Fee-for-Service Plans that do not offer prescription drug coverage and Medicare Cost Plans offering Medicare prescription drug coverage. The plan was enacted as the Medicare Prescription Drug, Improvement and Modernization Act of 2003 with coverage beginning January 1, 2006.
The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.
Institutions with an organized medical staff which provide medical care to patients.
The state of being engaged in an activity or service for wages or salary.
An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006)
Individuals licensed to practice medicine.
Organized services in a hospital which provide medical care on an outpatient basis.
Excessive, under or unnecessary utilization of health services by patients or physicians.
Organized collections of computer records, standardized in format and content, that are stored in any of a variety of computer-readable modes. They are the basic sets of data from which computer-readable files are created. (from ALA Glossary of Library and Information Science, 1983)
Major administrative divisions of the hospital.
The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)
Behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals.
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.

Financial incentives and drug spending in managed care. (1/393)

This study estimates the impact of patient financial incentives on the use and cost of prescription drugs in the context of differing physician payment mechanisms. A large data set was developed that covers persons in managed care who pay varying levels of cost sharing and whose physicians are compensated under two different models: independent practice association (IPA)-model and network-model health maintenance organizations (HMOs). Our results indicate that higher patient copayments for prescription drugs are associated with lower drug spending in IPA models (in which physicians are not at risk for drug costs) but have little effect in network models (in which physicians bear financial risk for all prescribing behavior).  (+info)

Who bears the burden of Medicaid drug copayment policies? (2/393)

This DataWatch examines the impact of Medicaid prescription drug copayment policies in thirty-eight states using survey data from the 1992 Medicare Current Beneficiary Survey. Findings indicate that elderly and disabled Medicaid recipients who reside in states with copay provisions have significantly lower rates of drug use than their counterparts in states without copayments. After controlling for other factors, we find that the primary effect of copayments is to reduce the likelihood that Medicaid recipients fill any prescription during the year. This burden falls disproportionately on recipients in poor health.  (+info)

User charges in government health facilities in Kenya: effect on attendance and revenue. (3/393)

In this paper we study demand effects of user charges in a district health care system using cross-sectional data from household and facility surveys. The effects are examined in public as well as in private health facilities. We also look briefly at the impact of fees on revenue and service quality in government facilities. During the period of cost-sharing in public clinics, attendance dropped by about 50%. This drop prompted the government to suspend the fees for approximately 20 months. Over the 7 months after suspension of fees, attendance at government health centres increased by 41%. The suspension further caused a notable movement of patients from the private sector to government health facilities. The revenue generated by user fees covered 2.4% of the recurrent health budget. Some 40% of the facilities did not spend the fee revenue they collected, mainly due to cumbersome procedures of expenditure approvals. The paper concludes with lessons from Kenya's experience with user charges.  (+info)

The impact of alternative cost recovery schemes on access and equity in Niger. (4/393)

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax+fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax+fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax+fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.  (+info)

Protecting the poor under cost recovery: the role of means testing. (5/393)

In African health sectors, the importance of protecting the very poor has been underscored by increased reliance on user fees to help finance services. This paper presents a conceptual framework for understanding the role means testing can play in promoting equity under health care cost recovery. Means testing is placed in the broader context of targeting and contrasted with other mechanisms. Criteria for evaluating outcomes are established and used to analyze previous means testing experience in Africa. A survey of experience finds a general pattern of informal, low-accuracy, low-cost means testing in Africa. Detailed household data from a recent cost recovery experiment in Niger, West Africa, provides an unusual opportunity to observe outcomes of a characteristically informal means testing system. Findings from Niger suggest that achieving both the revenue raising and equity potential of cost recovery in sub-Saharan Africa will require finding ways to improve informal means testing processes.  (+info)

Improving quality through cost recovery in Niger. (6/393)

New evidence on the quality of health care from public services in Niger is discussed in terms of the relationships between quality, costs, cost-effectiveness and financing. Although structural attributes of quality appeared to improve with the pilot project in Niger, significant gaps in the implementation of diagnostic and treatment protocols were observed, particularly in monitoring vital signs, diagnostic examination and provider-patient communications. Quality improvements required significant investments in both fixed and variable costs; however, many of these costs were basic input requirements for operation. It is likely that optimal cost-effectiveness of services was not achieved because of the noted deficiencies in quality. In the test district of Boboye, the revenues from the copayments alone covered about 34% of the costs of medicines or about 20% of costs of drugs and administration. In Say, user fees covered about 50-55% of the costs of medicines or 35-40% of the amount spent on medicines and cost-recovery administration. In Boboye, taxes plus the additional copayments covered 120-180% of the cost of medicines, or 75-105% of the cost of medicines plus administration of cost recovery. Decentralized management and legal conditions in the pilot districts appeared to provide the necessary structure to ensure that the revenues and taxes collected would be channelled to pay for quality improvements.  (+info)


esearch note: does cost recovery for curative care affect preventive care utilization?  (+info)

Research note: price uncertainty and the demand for health care.(8/393)


Policies with value-based insurance design gained in popularity among US private employer-sponsored plans beginning in the 2000s13,14 and have since gained traction in public policy. For example, the 2010 Patient Protection and Affordable Care Act required health plans to include certain preventive drugs and services without cost-sharing, such as certain generic statins.15 More recently, the US federal government has charged the Medicare Advantage program (managed care coverage for older adults) and the TRICARE program (coverage for civilian personnel in the US Department of Defense) to pilot value-based insurance programs that reduce cost-sharing for targeted high-value health services.16,17 No other country explicitly uses value-based insurance design; however, policies more broadly aimed at aligning cost-sharing and value exist in other countries, albeit in different forms (e.g., France uses a form of value-based co-insurance design, wherein the level of co-insurance under the French social ...
Policies with value-based insurance design gained in popularity among US private employer-sponsored plans beginning in the 2000s13,14 and have since gained traction in public policy. For example, the 2010 Patient Protection and Affordable Care Act required health plans to include certain preventive drugs and services without cost-sharing, such as certain generic statins.15 More recently, the US federal government has charged the Medicare Advantage program (managed care coverage for older adults) and the TRICARE program (coverage for civilian personnel in the US Department of Defense) to pilot value-based insurance programs that reduce cost-sharing for targeted high-value health services.16,17 No other country explicitly uses value-based insurance design; however, policies more broadly aimed at aligning cost-sharing and value exist in other countries, albeit in different forms (e.g., France uses a form of value-based co-insurance design, wherein the level of co-insurance under the French social ...
Take a patient who has diabetes. If a health plan implements a value-based insurance design (VBID), the employers health plan will cover certain diabetes drugs for a reduced copayment. As a result of that reduced copayment, the patient continues to to use his diabetes drug, and therefore the condition is managed better. The employer and health plan see lower overall health care costs because of reduced complications.. Avalere Health, a consulting company, taking a page from the private insurer playbook, says that Medicare could immediately modernize its benefit structure by incorporating VBID because VBID tailors cost-sharing so that the beneficiary pays less for a needed medication or therapy, making him more likely to use it. The employer and health plan benefit because the patient has fewer costly complications.. The report, Value-Based Insurance Design in the Medicare Prescription Drug Benefit: An Analysis of Policy Options, points out that Medicare Part D, with its 26 million enrollees, is ...
Value-based insurance design bases cost sharing on a medications clinical value, not its price. This study shows the effectiveness of value-based insurance design.
In an effort to alleviate their rising health care costs, employers have sought to share more of these expenses with their workers. To assess the impact of changes in employee cost-sharing on the use, cost, and quality of preventive and therapeutic care, the project investigators will examine medical claims and personnel data at two or three St. Louis firms for up to 70,000 employees and dependents. The analysis will include a special focus on workers earning low to moderate wages. If this work proceeds satisfactorily, a second phase will be proposed to assess the effect of cost-sharing on emergency room visits, inpatient hospitalization, and mortality. Study findings will inform policymakers and employers about the personal health and financial implications of imposing higher levels of cost-sharing. Cofunders are being sought for this project.. ...
New Alexander-Murray bipartisan bill includes V-BID Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) reached an agreement on Tuesday, October 17th regarding their bipartisan bill to fund key insurance subsidies. The cost-sharing reduction payments reimburse insurance companies for lowering deductibles, co-payments and other out-of-pocket costs for low-income customers. Page 11 of the draft bill language includes a section on value-based insurance designs: (iii) waivers encouraging or requiring health plans in such State to deploy value-based insurance designs which structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services; Value-Based Insurance Design (V-BID) is a potential solution built on the principle of lowering or removing financial barriers to essential, high-value clinical services and providers. V-BID plans align patients out-of-pocket costs, such as copayments and deductibles, with the value of ...
E-Pflicht-Sammlung. The impact of increased cost-sharing on utilization of low value services : evidence from the state of Oregon / Jonathan Gruber (MIT and NBER), Johanna Catherine Maclean (Temple University, NBER and IZA), Bill Wright (CORE, Providence Health & Services), Eric Wilkinson (Temple University), Kevin G. Volpp (Corporal Michael J. Crescenz VAMC and University of Pennsylvania) ; IZA, Institute of Labor Economics. Bonn, Germany : IZA Institute of Labor Economics, January 2017
WASHINGTON, D.C. - U.S. Senators Cory Booker (D-NJ) and Bob Menendez (D-NJ) today introduced a bill aimed at helping Americans with the medical costs of any tests, care, or treatment related to the novel Coronavirus, also known as COVID-19. The Care for COVID-19 Act would require health insurance plans to cover both diagnostic and treatment services related to the virus, with no cost-sharing to the patient. This includes the cost of prescriptions, vaccines, diagnostic tests, and visits to the emergency room, urgent care facilities, or doctors office. The bill would also create a special enrollment period to allow individuals impacted by COVID-19 to enroll in a health plan through the health insurance marketplace.. For so many Americans, fears of health care costs and potential medical debt are major barriers standing in the way of getting the care they need, Booker said. During a public health emergency like the one we are experiencing right now, its even more imperative that people are ...
Last week, CMS asked Medicare Advantage Organizations for feedback on Medicare Advantage Value Based Insurance Design model test that will begin on January 1, 2017
This paper develops a model of health insurance that incorporates behavioral biases. In the traditional model, people who are insured overuse low value medical care because of moral hazard. There is ample evidence, though, of a different inefficiency: people underuse high value medical care because they make mistakes. Such behavioral hazard changes the fundamental tradeoff between insurance and incentives. With only moral hazard, raising copays increases the efficiency of demand by ameliorating overuse. With the addition of behavioral hazard, raising copays may reduce efficiency by exaggerating underuse. This means that estimating the demand response is no longer enough for setting optimal copays; the health response needs to be considered as well. This provides a theoretical foundation for value-based insurance design: for some high value treatments, for example, copays should be zero (or even negative). Empirically, this reinterpretation of demand proves important, since high value care is ...
In light of the varied requirements and flexibilities pertaining to the design of benefit packages and to cost-sharing amounts in Medicaid and the Marketplace, and to illustrate the impact of different state policy choices on working people with disabilities, this issue brief considers the rules as they might affect representative individuals in different situations. The rest of this paper presents three profiles of hypothetical working people with disabilities and examines how their benefits and cost-sharing obligations may differ as they move between Medicaid state plan and new adult ABP coverage and between Medicaid and Marketplace QHPs. The analysis focuses on selected categories of benefits that are important to many people with disabilities, including mental health and substance use treatment services, prescription drugs, rehabilitative and habilitative services and devices, and LTSS.. The analysis considers the benefits and cost-sharing rules that apply to newly eligible adults in ...
PERRY COUNTY - The Perry County Soil and Water Conservation District has received a Clean Water Indiana Grant to be used for a cost-sharing program for pasture and land used for hay production. The purpose of this cost-share program is to provide technical and financial assistance to Perry County landowners for pasture and hay land planting this fall. The program is open to all Perry County landowners and offers a cost-share payment of 50 percent of the actual cost for a pasture-hay land planting, not to exceed $150 per acre with a cap of $750 per landowner.
DOWNERS GROVE - The Downers Grove Village Council voted unanimously Tuesday to expand the cost-share program to help churches make capital improvements that would reduce their stormwater fees.
Owen County farmers will soon be able to pick up applications for the new Phase I cost-share program. The program applications will be available for pick-up at the extension office Monday. The deadline for completing the applications and turning them in is Sept. 9.
The Houston-Galveston Area Council has been collecting aerial imagery for the Houston-Galveston metropolitan region since 2000. Imagery is flown by highly qualified orthoimagery companies, and delivered to cost-share participants within 6-8 months of flight times.. ...
Searchable text of the 54 USC 101701 - Challenge cost-share agreement authority (US Code), including Notes, Amendments, and Table of Authorities
Background: Treatment for metastatic breast cancer (MBC) that is not concordant with the NCCN Guidelines for Breast Cancer has been associated with higher healthcare utilization and payer costs. However, a significant knowledge gap exists regarding the impact of guideline-discordant care on patient cost responsibility. This study examined this question among patients with MBC in the year postdiagnosis. Methods: This retrospective cohort study used data from the SEER-Medicare linked database from 2000 through 2013. Guideline discordance, defined by year-specific NCCN Guidelines, was assessed for first-line antineoplastic treatment and grouped into discrete categories. Patient cost responsibility (deductibles, coinsurance, copayments) in women with MBC were summed for all medical care received in the year postdiagnosis. The difference in patient cost responsibility by guideline discordance status was estimated using linear mixed-effect models. Results: Of 3,709 patients with MBC surviving at least ...
In recent weeks, the market has been inundated with evaluations of value-based insurance design (VBID) so its no surprise that I was asked to comment on a recent study of VBID published in American Health and Drug Benefits. For one large employer, asthma patients who volunteered to participate in a care management program that included…
H.R. 1995. To amend title XVIII of the Social Security Act to provide for national testing of a model of Medicare Advantage value-based insurance design to meet the needs of chronically ill Medicare Advantage enrollees. In, a database of bills in the U.S. Congress.
This brief discusses how coverage, federal spending and private premiums could change if the federal government stopped reimbursing insurers for the ACAs cost-sharing reductions.
A continually popular question that I receive is how high can specialty copays be set before patients stop taking their medication? Unfortunately, empirical data to guide the answer to this question is fairly limited. Four studies of elasticity of specialty medications have been published, most examining data from the early to mid-2000s. The first…
Wadena County Soil & Water Conservation District - State Cost Share - In May of 1958, the Wadena SWCD was established to provide technical and financial assistance to landowners in order to protect and preserve the land and water resources in Wadena County.
It is often argued that cost-sharing -- charging a subsidized, positive price -- or a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument through a field experiment in Kenya, in which we randomized the price at which prenatal clinics could sell long lasting anti-malarial insecticide-treated nets (ITNs) to pregnant women. We find no evidence that cost-sharing reduces wastage on those that will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the average prenatal client in the area in terms ...
Free Online Library: WTO patient costs poverty report. by International News; News, opinion and commentary General interest Poverty Economic aspects Reports
The drug, called Aduhelm, was approved by the Food and Drug Administration this week and quickly sparked controversy over its price tag and questionable benefits.
CHICAGO - New research suggests giving patients easier-to-take medicine and no-copay medical visits can help drive down high blood pressure, a major contributor to poor health and untimely deaths nationwide.
Learn the top 3 things to know about a COVID-19 vaccine including when it is coming, whether there will be a cost-share and how limited supplies may be handled.
Ever wondered how to buy shares in Costco Wholesale Corporation? We explain how and compare the best share dealing platforms. Plus a detailed analysis of the discount stores specialists financials and forecast.
After mentioning it for months, President Donald Trump has officially decided to stop paying the cost-sharing reduction subsidies that help insurers keep premiums down for lower-income Americans.
Apr 24, 20 11:50 PM. If the patient had an inhaler and based on the directions it would be a 60 day supply which the insurance charges two copays. He says he cant afford 2. Read More. ...
Copayments, rather than coinsurance, apply to the majority of workers covered by health plans that have three or more drug tiers, according to a recent Kaiser Family Foundation report. Percentages vary slightly across drug types, mostly because some plans have copayments for some drug tiers and coinsurance for others.. For members in plans with three or more tiers of cost sharing, average copayments in 2011 were consistent with the amounts reported in 2010, says the report. The 2011 averages were $10, $29, $49, and $91.. Coinsurance levels can be described in a similar way.. Members in plans with three, four, or more tiers of cost sharing for prescription drugs who pay coinsurance rather than copayments face coinsurance levels that average 18 percent for first-tier drugs, 25 percent for second-tier drugs, and 39 percent for third-tier drugs - similar to the percentages reported last year.. The report says 14 percent of covered workers are in a plan that has four or more tiers of cost sharing for ...
Of the many factors that contribute to poor medication adherence among the chronically ill, the portion of drug costs borne by patients appears to be central. Pitney Bowes is one of a handful of large employers and insurers that have begun experimenting with reduced copays for essential medications. In 2007, the company reduced or eliminated cost-sharing for medications used to treat coronary artery disease and osteoporosis, with the goal of improving employees medication adherence and health outcomes. This project will examine Pitney Bowes claims data to determine the impact that reduced copayments have had on medication adherence, clinical outcomes, health care utilization, and costs. The findings will aid employers, private insurers, the Medicare program, and policymakers in crafting changes to the structure of health benefits that lead to increased use of prescription drugs known to be effective for managing chronic disease.. ...
Why Certify?. Organic certification allows a farm or processing facility to sell, label, and represent their products as organic in the marketplace. Certification by USDA-accredited agents often adds significant value to products, helping to increase farmer revenues, and also helps to ensure that all organic products meet or exceed national organic standards.. The process of transitioning to organic requires significant time and resources for inspection, licensing, certification, and proper bookkeeping. By certifying and applying to the cost-share program, farmers can significantly reduce some of their financial resource burden.. Cost Share Funding - Authorization and Appropriations. Support for the cost-share program pulls from funds authorized in the 2014 Farm Bill, which increased funding for NOCCSP and kept AMA funding unchanged from the 2008 Farm Bill.. While full mandatory funding was available for both programs in FY 2016, Congressional appropriators are still in the process of ...
Coinsurance and Insurance Plans - Coinsurance and insurance plans come with a wide range of options. Learn about coinsurance and insurance plans and find out how indemnity insurance works.
o assess the potential financial impact of increased patient cost sharing, HSC used actuarial models to estimate patients expected average annual out-of-pocket costs under a range of benefit structures for single coverage (see Data Source). Benefit Option 1 serves as the baseline, with patient cost sharing of $10 for primary care and specialist visits and no deductible (see Table 1). Option 2, which doubles physician visit copayments and includes a $150 copayment for emergency department visits and a $250 per day inpatient hospital copayment, represents typical copayment increases. Next, out-of-pocket costs for benefit structures with successively higher levels of deductibles and coinsurance (Options 3, 4, 5 and 6) are estimated for up to a $2,500 deductible with 30 percent coinsurance for in-network care and 50 percent coinsurance for out-of-network care.. Patients total out-of-pocket costs typically are capped by maximum out-ofpocket limits. In 2002, 41 percent of people in preferred provider ...
OKLAHOMA CONSERVATION COMMISSION CONSERVATION COST-SHARE PROGRAM Locally Led - Program Year 12 Allocation Period: December 7, 2009 - June 30, 2010 Program Year Completed: June 30, 2011 PREPARED BY OKLAHOMA CONSERVATION COMMISSION CONSERVATION PROGRAMS DIVISION This publication is issued by the Oklahoma Conservation Commission as authorized by Mike Thralls, executive director. Copies have not been printed but are available through the agency website, http:/ BY AREA AREA I AMOUNT AMOUNT UNOBLIGATED ALLOCATED OBLIGATED AMOUNT DISTRICT PY 12 PY 12 PY 12 Alfalfa $ 20,500.00 $ 13,174.03 $ 7,325.97 Beaver $ 20,500.00 $ 20,683.96 $ (183.96) Blaine $ 12,300.00 $ 12,241.25 $ 58.75 Central North Canadian River $ 10,250.00 $ 10,000.00 $ 250.00 Cimarron County $ 12,300.00 $ 9,305.00 $ 2,995.00 Cimarron Valley $ 16,400.00 $ 4,755.00 $ 11,645.00 Dewey $ 20,500.00 $ 20,500.00 $ - East Canadian $ 12,300.00 $ 12,036.09 $ 263.91 East Woods $ 12,300.00 $ 9,730.00 $ 2,570.00 Ellis $ 20,500.00 $ ...
Jul 1, 2020 • Products & Programs / Pharmacy Beginning July 1, 2020, most of Empire BlueCross BlueShields (Empire) ACA-complaint non-grandfathered health plans will cover pre-exposure prophylaxis (PrEP) medication at 100% with no member cost share, when used for prevention of HIV and dispensed at an in-network pharmacy with a prescription. Since medications used for PrEP can also be used to treat HIV, Empire will review medical and pharmacy claims data to determine if a member has been diagnosed and prescribed treatment for HIV or prescribed PrEP for preventive purposes. When prescribed for prevention of HIV, this drug is covered with no member cost share. When prescribed for treatment of HIV, member cost shares apply based on the members benefit plan. Coverage includes Truvada (200- 300 mg), and its generic components, Emtriva 200mg and tenofovir 300mg. When medically necessary, a prior authorization process is available for Descovy to be covered with no member cost share when used for ...
Organic Producers and Handlers May Apply for Certification Cost Share Reimbursements; Expanded Eligibility for Transition and State Certification Cost WASHINGTON, Dec. 21, 2016 - The U.S. Department of Agriculture (USDA) today announced that starting March 20, 2017, organic producers and handlers will be able to visit over 2,100 USDA Farm Service Agency (FSA) offices to apply for federal reimbursement to assist with the cost of receiving and maintaining organic or transitional certification. USDA reimburses organic producers up to 75 percent of the cost of organic certification, but only about half of the nations organic operations currently participate in the program, said FSA Administrator Val Dolcini. Starting March 20, USDA will provide a uniform, streamlined process for organic producers and handlers to apply for organic cost share assistance either by mail or in person at USDA offices located in almost every rural county in the country. USDA is making changes to increase participation ...
Accompanying editorial calls for further refinements in value-based insurance design to reduce unintended use of low-value care, reports the latest issue of The American Journal of Managed Care®. May 14, 2019 10:40 AM Eastern Daylight Time CRANBURY, N.J.-(BUSINESS WIRE)-When a large national employer removed cost sharing for primary care visits, medical utilization fell, as did […]. Read More ...
The MarketScan claims database contains information about health benefit claims and encounters for several million individuals each year provided by large employers. The advantage of using claims information to look at out-of-pocket spending is that we can look beyond the plan provisions and focus on actual payment liabilities incurred by enrollees. A limitation of these data is that they reflect cost sharing incurred under the benefit plan and do not include balance-billing payments that beneficiaries may make to health care providers for out-of-network services or out-of-pocket payments for non-covered services. We use a sample of between 1.05 million and 15.3 million enrollees per year to analyze the change from 2006 to 2016 in average health costs for covered benefits overall, the average amount paid by health benefit plans, and the average amounts attributable to deductibles, copayments, and coinsurance. The analysis of costs for each year was limited to enrollees with more than six months ...
Health, ...New York NY November 2 2010An initiative by the U. S. technology co...The study led by Niteesh K. Choudhry at Brigham and Womens Hospital...Pitney Bowes also lowered copayments for all employees and beneficiari...According to the authors the findings are significant because this is...,Eliminating,or,reducing,cost-sharing,for,high-value,prescription,drugs,improves,medication,use,medicine,medical news today,latest medical news,medical newsletters,current medical news,latest medicine news
Alicia: UnLeashed! July 2019 article: Copays, Caps and Cost Savings: A look at recent apparent efforts to reduce the cost of living with diabetes.
New research suggests that parents in low-income families were less likely to delay asthma care for their children if they had lower levels of health insurance cost-sharing.
The Trump administration is discontinuing cost-sharing reduction payments to health insurance companies, according to a statement released by HHS Acting Secretary Eric Hargan and CMS Administrator Seema Verma.
President Donald Trump plans to end the cost-sharing subsidies that have helped some lower-income Americans purchase health insurance on the Obamacare marketplace.
President Donald Trump plans to end the cost-sharing subsidies that have helped some lower-income Americans purchase health insurance on the Obamacare marketplace.
Trump boxed in on health subsidies after states legal win. The Washington Post: Jonathan Adler, the Johan Verheij Memorial Professor of Law, weighed in on whether President Donald Trump has the authority to cut cost-sharing reduction payments through the Affordable Care Act after a group of states were granted the right to defend the subsidies.. ...
The waiver of coinsurance and deductibles owed by patients treated by physicians and other health care providers has come under increased scrutiny recently. Although there are no clear legal prohibitions, commercial health insurers have aggressively pursued out-of-network provides who fail to collect or waive amounts owed by their insureds under different statutory regulations.
Using statistical analysis drawing on new data sources, this research project empirically analyzes the impact of deposit insurance on banks, on the stability of the banking system, and on the way a countrys financial system evolves. Our ultimate purpose is to turn the considerable amount of theoretical work on financial regulation in developed countries into a tested body of theory that can support reliable policy recommendations about how to tailor deposit insurance design to the particular environments of developing countries. Policy advice given by Bank economists on deposit insurance design must be sensitive to variations in institutional starting points and transition costs. There is no one-size-fits-all solution to individual country problems of financial reform and development. We expect the results to significantly enhance our understanding of issues in deposit insurance design and improve Banks policy advice in this area ...
Based on surveys of the individual and small-group insurance market, examines the distribution of purchasers of each type of coverage among various deductibles. Outlines median coinsurances, annual out-of-pocket maximums, and copayments for each level.
access while protecting a riverbank.. Erosion, deposition and changes in course are natural events in a rivers life cycle. However, human activities can alter the rate at which these events occur. Erosion in particular can cause problems when it occurs more rapidly than it would in an undisturbed system. Landowners can lose valuable property, fish lose critical habitat, and sediments deposited in river bottoms can prevent fish eggs from hatching.. To help protect private property and fish habitat, the Cost-Share program works with applicants to develop bank protection and restoration projects. Persons interested in applying for the program submit an application packet that includes drawings and written descriptions of the proposed project, cost estimates, and photographs of the riverbank.. Projects are selected based on their value in sustaining, restoring, or creating fish habitat. Projects must use methods that not only provide for bank stabilization and rehabilitation but also sustain or ...
Anderson County farmers can sign up beginning Feb. 1 for the state cost share program. Sign-ups will continue through Feb. 28 at Anderson County Conservation District, 145 W. Woodford St., Lawrenceburg. Hours are Tuesdays, Wednesdays and Thursdays from 10 a.m. to 4 p.m. For details, call 839-5567.
Q: Is balance billing legal?. A: In some circumstances it is and in some it is not.. Healthcare providers that are in-network have agreed to accept the insurance plans negotiated fees. Balance billing would not be permitted under an in-network agreement because the healthcare provider has agreed to accept the negotiated fees as payment in full plus any applicable deductible, coinsurance, or copay. In the above example this would mean that the healthcare provider would accept the $200 plus the $100 (deductible, coinsurance, or copay amount) as payment in full and would adjust off the remaining $200 balance. In this situation, balance billing is NOT legal.. Healthcare providers that are out-of-network have not agreed to accept the insurance plans negotiated fees and could balance bill the patient. Without a signed agreement between the healthcare provider and the insurance plan, the healthcare provider is not limited in what they may bill the patient and may seek to hold the patient responsible ...
January 10, 2014 ( - The Bipartisan Budget Act of 2013, signed into law in December, increases both the flat- and variable-rate single-employer Pension Benefit Guaranty Corporation (PBGC) premiums.
By the early 1960s, it was glaringly obvious that the private insurance sector was incapable of funneling elderly, poor, and disabled patients into the health care system. The fact that these companies business model was incompatible with supporting those who most needed it ought to have been a decisive repudiation against private insurers right to be doing this in the first place.. Instead, the US government enacted Medicare and Medicaid in 1965, shifting the care of vulnerable populations to the public sector and leaving the easiest and cheapest patients in the same private market whose failures the government had just stepped in to alleviate. Even worse, these new federal programs eventually adapted one of the private sectors cost-reduction tricks: the copayment.. The cliched justification for charging copays is to relieve doctors offices of the burden of patients showing up at the first sign of a sniffle. (Never mind that we observe no such behavior among the wealthy, for whom copays are ...
IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. Limitations, copays, and restrictions may apply. Copays for prescription drugs may vary based on the level of Extra Help you receive. Benefits and copayments may change on January 1 of each year. The List of Covered Drugs and pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. For more information, call IEHP DualChoice Member Services or read the IEHP DualChoice Member Handbook. Information on this page is current as of September 30, ...
In 2018 the average employer in the US spent on healthcare $16,900 per (insured) employee per year. That number comes from Milliman Care Guidelines, a national organization that gives guidelines for good care and whose recommendations are followed by thousands of hospitals.. Mind you, thats NOT premiums … thats the actual cost of medical care that the employees incurred and paid for, either directly (deductibles, copays, coinsurance) or via the plan (what the plan paid on their behalf). Premiums were on top and would add an additional 18-20% to that number.. That number is calculated at the cost per employee per year. Yet some people are young, others old, some groups have lost of families; some are mostly singles. High-cost areas, low-cost areas.. If your group is younger than average, thatll reduce the yearly cost; older will increase it. If you have more than the average number of employees with dependents, that will increase that cost; mostly singles will reduce it.. The key isnt so ...
If there are still documents that you do not have, you should not put off your application because you can submit them later during the interview process. Some few members of MaineCare pay a premium. This is what you pay every month for the insurance coverage. Once your application has been approved, the notice of decision of your eligibility in the program will notify you if you must pay a monthly premium. You will receive a coupon every month you owe if you are required to pay. Return it, along with your payment when its due. Do not disregard this since you may lose your coverage if you do not pay. There are services and prescription drugs that have co-payments. How much you need to pay is based on the amount MaineCare pays for the medical service or drugs (unless you are exempted). Once you have paid 5% of the income you have each month, you no longer need to make additional co-payments. The following are the services that have co-payments: ...
There is not an all-inclusive list of drugs for all of the categories because there are a large number of generics and many preferred...
New health insurance policies beginning on or after Sept. 23 must cover _ without charge _ preventive care thats backed up by the best scientific evidence. Most people will see this benefit, part of the Obama administrations health care overhaul, starting Jan. 1.
I know bisqueing about copays when many dont even have insurance seems bisque-y, but they add up! On top of medications, those $30-50 visits are tough when there are multiples and then copays for tests too. Id need about $450 to do all the things Im supposed to do (including endoscopy with anesthesia). But when everything is just in a mountain of small bills, they wont work with you. All my physical therapy bills are under $100 and each visit is a new account number, so they wont even do a payment plan ...
Hamilton County Property Assessor Marty Haynes wants to set the record straight about sharing reappraisal costs with the countys 10 cities.
A new study by researchers at RTI International has found that cancer patients faced with increased Medicaid copayments are less likely to comply with their prescription drug treatments.
The Governmental Accounting Standards Board (GASB) recently finalized Statement No. 78, intended to help certain governments meet the reporting requirements of GASB Statement No. 68, Accounting and Financial Reporting for Pensions-an amendment of GASB Statement No. 27. Read more here.
Christine Roberts has been publishing a blog about ERISA matters titled E is for ERISA since 2011. Read more about Christine and her blog here: See Christines latest postings the blogs main page here: ...
Cost Sharing Reduction is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health...
Currently enacted child support guidelines primarily focus on maintaining childrens economic well-being when a single household is split into two. This article
Get exclusive access to a library of resources and weekly content from farmer Darby Simpson focusing on the business of profitable livestock farming.
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Now that Trump wants to take away birth control funding, you could have to pay on average $600 more per year in copays. And if you want to get an IUD, it could cost you up to $1,100 - it basically amounts to a woman tax. But dont fret: This brillian…
Your Financial Responsibility. A significant part of the trust involved in the Doctor-Patient relationship involves each person fulfilling their responsibilities toward each other. One of the patients, or parents, responsibilities is to pay for services provided. Please read and be familiar with the policies below.. Payment. Payments may be made by mail or by calling 615-543-2270 or 615-859-6650. Statements with an outstanding balance must be paid on receipt of statement. All accounts over 90 days old are considered delinquent and subject to collection. We accept cash, checks, debit cards, and all major credit cards. First Visit. New patients are asked to pay on the day of their first visit. We will try to verify your deductible prior to your appointment to give you an estimate of payment. Insurance co-payments are always due at the time of service.. Deductibles. Until you have met your deductible, we require a $50.00 deposit at each visit. This deposit does not apply to any previous balance on ...
Pre-existing condition:. Pays up to $1,000 subject to the chosen Deductible and Coinsurance for Covered Medical Expenses resulting from a sudden, unexpected recurrence of a Pre-existing Condition while traveling outside the Covered Persons Home Country. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the Effective Date of coverage. ...
espondents agreed that CalPERS size and leverage in California health care markets were important to carrying out the reference pricing program, but some believed other California purchasers with less leverage still have an opportunity to do this by closely following CalPERSs lead and directing their enrollees to CalPERS-designated hospitals.. As one health plan respondent explained, Small employers shouldnt expect that hospitals not on the [designated] list would be motivated to modify their prices [to accommodate that employers reference pricing program] since their employees represent such a small fraction of [the hospitals] book of business. But, the employers will benefit from savings if they can steer their members to the lower-price hospitals. Similarly, in markets outside of California, purchasers could likely establish a reference pricing program by steering members to low-price providers through cost-sharing incentives. However, without a large number of enrollees in a ...
Ive been thinking about this lately, because I like to use this argument, myself. Ive heard it said this way: Pay the farmer now, or pay the doctor later. I tend to agree, BUT…in thinking about the economics of health care these days, Im not so sure it works this way anymore. I am NOT an expert in this stuff, so if Im dead wrong here, someone please chime in and help me understand.. The way I see it, unless youre uninsured, your health care costs *dont* generally reflect your state of health. If you have decent insurance, you could be on a hundred prescriptions and have to see five different doctors every month and even though yes, you might have some nominal copays, your costs arent all that astronomical. There *isnt* much of a financial incentive to be proactive about health for the well-insured. Its the people who would have to pay out of pocket for every doctor visit and every bottle of pills who really need to focus on preventive care.. The long-term incentive for people to ...
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  • The most common forms of cost sharing are: deductibles (an amount that must be paid before most services are covered by the plan), copayments (fixed dollar amounts), and coinsurance (a percentage of the charge for services). (
  • The Affordable Care Act (ACA) requires insurers to provide cost-sharing reductions (CSRs) that lower deductibles, co-payments, co-insurance, and out-of-pocket maximums for people eligible for tax credits and with incomes below 250 percent of the federal poverty level. (
  • Examples of out-of-pocket payments involved in cost sharing include copays, deductibles, and coinsurance. (
  • The program was intended to reduce cost sharing (deductibles, copays) for less wealthy people purchasing policies on the Exchanges. (
  • In an infographic , the groups note that more than 70% of voters, including 68% of conservatives who make less than $50,000 a year, support help with out-of-pocket health care costs, such as deductibles and copays, according to a recent survey. (
  • V-BID seeks to align patients' out-of-pocket costs , meaning their copayments, deductibles, and premium payments, with the value of health services, the center says. (
  • Payments of Medicare deductibles and other cost-sharing made by state Medicaid programs, private insurance plans, or 'other' public health insurance programs would be reflected as payments by the appropriate program, not as out of pocket. (
  • Aetna, which was acquired by CVS in 2018, and many other insurers had already committed to eliminating copays , deductibles and other forms of cost-sharing for COVID-19 diagnostic tests, even before President Donald Trump signed a bill into law last week requiring them to do so . (
  • Obamacare plans continue to raise costs on patients in the form of higher deductibles, out-of-pocket maximums, and premiums. (
  • Under the ACA, about 6 million low- and moderate-income people enrolled through the marketplaces are eligible for CSRs, which lower their deductibles and other out-of-pocket costs. (
  • That means that enrollees entitled to CSRs could still access plans with lower deductibles and other cost sharing, so long as a marketplace plan is available where they live. (
  • This includes copays, deductibles, and cost sharing. (
  • While drastically cutting the Affordable Care Act's (ACA) premium tax credits, the House Republican health bill also eliminates the other, lesser-known marketplace subsidies - cost-sharing reductions (CSRs) - that reduce deductibles, co-payments, and other out-of-pocket costs for more than 6 million marketplace enrollees. (
  • The study results suggest that employers and health plans that are raising deductibles and other types of cost-sharing for all services might be missing opportunities to improve their enrollees' health and achieve savings. (
  • WASHINGTON, Dec. 21, 2016 - The U.S. Department of Agriculture (USDA) today announced that starting March 20, 2017, organic producers and handlers will be able to visit over 2,100 USDA Farm Service Agency (FSA) offices to apply for federal reimbursement to assist with the cost of receiving and maintaining organic or transitional certification. (
  • Despite Boost In Social Security, Rising Medicare Part B Costs Leave Seniors In Bind " by Judith Graham, Kaiser Health News (October 5, 2017). (
  • The subsidies are expected to cost the federal government about $7 billion in 2017. (
  • These costs are effective 10/1/2017. (
  • In her experience, most patients confronted with this choice will "incur the cost no matter what" by using a credit card, but some will decide to skip treatment altogether. (
  • Over 2 million lower-income older adults ages 50-64 rely upon subsidies known as cost-sharing reductions to help make health care more affordable and accessible. (
  • Cost-sharing subsidies are most important to low-income people with high medical expenses-including older adults with chronic conditions-who, without the subsidy, would be at risk of unaffordable out-of-pocket cost burdens and medical debt. (
  • I recognize that I am in the minority when I say this, but I do NOT believe that the markets are going to go hay-wire on account of the decision to cancel the cost-sharing subsidies. (
  • Speaking of the CBO report on cancelling the cost-sharing subsidies, back in August - when the CBO report was released - I wrote up my reaction to the agency's conclusions. (
  • Ironically, Should Advocates of Increasing the ACA's Premium Subsidies Be Okay With Cancelling the Cost-Sharing Subsidy Payments? (
  • For people with household incomes between 133 percent and 250 percent of the poverty level, the ACA offers cost-sharing subsidies for private plans purchased through the marketplaces. (
  • We have eliminated cost sharing for COVID-19 testing and treatment and are working with members with income changes to help them stay covered. (
  • How Would Coverage, Federal Spending, and Private Premiums Change if the Federal Government Stopped Reimbursing Insurers for the ACA's Cost-Sharing Reductions? (
  • Elimination of federal cost-sharing reductions could increase marketplace spending by 18 percent or increase the uninsured by 9.4 million, depending on insurer response. (
  • Perhaps the most serious remaining legal challenges to the Affordable Care Act is the lawsuit brought by the House of Representatives challenging the use of money from the federal treasury to pay for "cost sharing reductions. (
  • Put another way, if Congress did not appropriate the money and insurers had to absorb the cost of the reductions themselves, the gross premium for policies would need to increase about $450, roughly 10% of the average premium. (
  • It is crystal clear that Congress never explicitly appropriated money for the cost sharing reductions program in the way that it did for many other parts of Obamacare. (
  • Over a third (35 percent) of adults receiving cost-sharing reductions are older adults ages 50-64. (
  • By reducing these barriers, cost-sharing reductions provide critical financial protection for consumers, especially older adults with chronic conditions or significant health care needs. (
  • With obesity, sugar and alcohol consumption on the rise, but even with lower tobacco usage and Obama cost reductions, we're headed for a cost of healthcare train wreck not yet experienced even at current cost levels and write-offs. (
  • The chief executive, Don Voelte, unveiled cost-cutting initiatives and capital expenditure reductions that would deliver $75 million improved cash flow this year compared with expectations from a few months ago. (
  • Insurers have enough time before the start of the plan year to incorporate their anticipated CSR costs into a surcharge placed on silver plan premiums. (
  • These findings would be even more dramatic if premiums were considered costs of the persons who paid them. (
  • Medicare Part B, private supplemental insurance, or Medicare+ Choice premiums) are not counted as out-of-pocket costs to the individual who pays them. (
  • Available solutions, if embraced by policymakers, could reduce such cost sharing with very little impact on premiums. (
  • Because I believe the unfunded cost-sharing subsidy liabilities are going to be shifted to the "silver" Exchange plans (in the form of higher premiums), which at the end of the day, means the unfunded cost-sharing liabilities are going to borne by the government, not the consumer. (
  • Stopping cost-sharing reduction (CSR) payments to insurers under the Affordable Care Act (ACA), as President Trump has repeatedly threatened, would drive up federal marketplace subsidy costs, raise premiums, cause more insurers to withdraw from the marketplaces, and increase the number of uninsured next year, the Congressional Budget Office (CBO) found today. (
  • Stopping CSR payments would raise federal budget deficits by $6 billion in 2018 and $194 billion over the next ten years, relative to current law, due to increased costs for the ACA's premium tax credits for low- and moderate-income people to offset their rising premiums (see below). (
  • As both CBO and the Kaiser Family Foundation expect, if the CSR payments stop, marketplace insurers would likely cover the upfront cost of providing CSRs by raising their premiums just for silver plans by about one-fifth in 2018. (
  • The increased federal costs for premium tax credits (due to higher silver-level premiums) would more than offset the savings from stopping the CSR payments, CBO finds - particularly for people with somewhat higher incomes who either don't qualify for CSRs or receive only modest assistance. (
  • National Health Law Program Legal Director Jane Perkins and Senior Policy Analyst David Machledt discuss cost-sharing, the portions of medical bills that are payed by the enrollee, and premiums in the context of Medicaid. (
  • This webinar covers the relative impacts of cost-sharing and premiums on access to care at different income levels, the legal requirements that limit Medicaid cost-sharing, the important litigation on Medicaid cost-sharing at the time of recording (including Section 1115 Demonstration cases), and tips for advocates working in this policy area. (
  • The Deficit Reduction Act of 2005 (DRA) established a new section 1916A of the Act, which gives states additional flexibility, allowing for alternative premiums and cost sharing, beyond what is allowed under section 1916 of the Act, for somewhat higher income beneficiaries. (
  • Alternative premiums and cost sharing imposed under section 1916A of the Act, cannot exceed five percent of family income. (
  • EnRoute, Erie Insurance's commercial telematics program, makes it easy for business auto insurance customers to share their driving data and thereby potentially lower business auto premiums and reduce driving risk. (
  • According to news reporting originating from Washington , District of Columbia , by VerticalNews correspondents, research stated, "Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. (
  • PARIS-Auto makers Renault SA of France and Nissan Motor Co. of Japan are accelerating efforts to wring costs out of their shared operations, installing a new management structure and increasing their target for cost savings by 2016. (
  • Our map shows, by state, how much help CSRs provide lower-income people with their out-of-pocket health care costs, based on 2016 data. (
  • AUSTIN, Texas , April 1, 2020 /PRNewswire/ -- Sendero Health Plans, the community-based non-profit health maintenance organization serving the Austin -area, announced today that the company's Board of Directors voted to waive all costs to its members for treatment of COVID-19 with in-network providers. (
  • Blue Cross and Blue Shield of Illinois, the state's largest health insurer, announced Thursday it is waiving cost-sharing for members for treatment of COVID-19. (
  • This brief provides details of the benefit and cost-sharing rules that will govern the coverage available under health reform to these newly eligible adults Medicaid beneficiaries, and it identifies key considerations for state policymakers making Medicaid benefit design choices. (
  • The analysis shows median out-of-pocket spending as a share of Medicare beneficiaries' income increased between 1997 and 2005, from 11.9 percent to 16.1 percent. (
  • What Share of Beneficiaries' Total Health Care Costs Does Medicare Pay? (
  • The extent to which Medicare pays for the costs of beneficiaries' health care is a central issue in health policy. (
  • To illustrate how Medicare's share varies across different populations, information is presented on expenditures for selected groups of beneficiaries (i.e., those not in institutions and those not in Medicare+Choice plans). (
  • The data show that, overall, Medicare paid for about half of beneficiaries' total health care costs in 2000. (
  • Personal health care expenditures include the costs of health care goods and services purchased directly by beneficiaries or paid by a third party on behalf of beneficiaries. (
  • Compared to those age 65 and older, Medicare beneficiaries under age 65 had a higher share of expenditures paid by Medicaid. (
  • To improve healthcare price and quality transparency, Mercer recommends Congress require hospitals and health insurers to give cost information to patients and beneficiaries before they receive care. (
  • The Center for Medicare Advocacy's National Medicare Advocates Alliance provides Medicare advocates with a collaborative network to share resources, best practices, and developments of import to Medicare beneficiaries throughout the country. (
  • When Medicare beneficiaries face higher cost sharing, hospitalizations go up, not down , especially for those with chronic illnesses. (
  • Such alternative cost sharing may be targeted to specific groups of beneficiaries and payment may be required as a condition of providing services. (
  • Under the authority granted under sections 1916(a)(3) and (b)(3) of the Act for the Secretary to define nominal cost sharing, at § 447.52(b) we propose to revise the maximum amount of nominal cost sharing for outpatient services, which may be imposed on beneficiaries with incomes below 100 percent of the FPL. (
  • Mercer's recommendations respond to Alexander's Dec. 11, 2018, letter asking healthcare experts how to curb costs for taxpayers, employers and families. (
  • After several years of no or very small increases, Social Security benefits will increase by 2.0 percent in 2018 due to the Cost of Living Adjustment. (
  • As a result, the share of the nation's population living in areas with no marketplace insurers would rise to 5 percent in 2018, up from less than 0.5 percent under current law. (
  • These costs represent actual expenditures above and beyond what a department is already spending on their operations. (
  • Allowable cost sharing expenditures (i.e. (
  • Although the uninsured had slightly shorter stays and lower hospitalization costs, patients with public insurance such as Medicare or Medicaid, which pay less than the cost of care, had longer than average stays and higher costs. (
  • The state's second largest health insurer, UnitedHealthcare, announced Tuesday it was waiving patient out-of-pocket costs for COVID-19 treatment through May 31, covering it for all fully-insured commercial, Medicare Advantage and Medicaid plans. (
  • While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. (
  • Since 2014, when the Affordable Care Act's health insurance marketplaces opened and states were able to expand Medicaid eligibility under the law, the rate of growth in out-of-pocket spending has slowed and the share of Americans reporting medical bill problems and cost-related delays has declined. (
  • That is likely because Medicaid requires no cost-sharing or premium payments for individuals with household incomes below 133 percent of the federal poverty level. (
  • More U.S. employers are using employee cost sharing in their prescription drug programs, according to Buck Consultants' Prescription Drug Benefit Survey , completed in July 2009. (
  • In an attempt to control costs, many employers and insurers have adopted incentive-based formularies, in which drugs are placed in different tiers. (
  • Coinsurance, in which consumers pay a fixed percentage of a prescription's costs, is attractive to employers because, unlike fixed co-payments per prescription, coinsurance rates keep pace with rising drug costs. (
  • As employers understand that providing effective, available health care is an investment in human capital that will pay off in real dollars by decreasing overall health-related costs, they may want to rethink their approach to measuring and investing in employee health and productivity," said Jack Mahoney, MD, medical director at Pitney Bowes, in an IBI press release. (
  • Mercer's response focuses on cost-control strategies and other reforms to help employers continue providing health benefits to more than 181 million Americans. (
  • Over the last decade, employers and other providers of health insurance have shifted more costs onto patients due to a multitude of factors that includes the rising cost of healthcare services. (
  • A common discussion with this cost-shifting trend is the steady increase in consumer premium payments, as employee premium contributions have increased 83% since 2006 (compared with a 54% increase for employers over the same period). (
  • GASB 78 narrows the scope of GASB 68 by excluding pensions provided to employees of state or local governmental employers through cost-sharing multiemployer defined benefit pension plans meeting certain criteria. (
  • In an effort to alleviate their rising health care costs, employers have sought to share more of these expenses with their workers. (
  • Study findings will inform policymakers and employers about the personal health and financial implications of imposing higher levels of cost-sharing. (
  • Crashes cost employers billions of dollars annually in medical care, lost productivity, legal expenses and property damage," says ERIE's Leo Heintz, vice president, Commercial Products. (
  • 1 , 2 On a per-capita basis, this amounts to $7,400 spent per person per year and to employers' costs of more than $9,300 for annual family coverage. (
  • Sometimes cost sharing forms are mixed, such as assessing coinsurance for a service up to a maximum amount, or assessing coinsurance or copayment for a service, whichever is higher. (
  • c) When the out-of-pocket cost for a covered Part D drug under a Part D sponsor's plan benefit package is less than the maximum allowable copayment, coinsurance or deductible amounts under paragraphs (a) and (b) of this section, the Part D sponsor may only charge the lower benefit package amount. (
  • Insurance for prescription drugs is characterized by two types of cost-sharing: flat copayments and variable coinsurance. (
  • Similarly, under copayments, moving from the 25th percentile to the 75th percentile of cost sharing results in a significantly lower shift into the non-compliance state compared with coinsurance. (
  • They definitely imply that there is no simple but correct way to move from findings of a typical cost effectiveness study to saying what the coinsurance rate should be for a non-poor population. (
  • They also imply that the cost effectiveness of a treatment cannot be properly determined unless coinsurance is set at the optimal level. (
  • Results Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. (
  • Conclusions Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. (
  • In addition, Trump directed the U.S. Department of Health and Human Services to end the cost-sharing reduction payments (CSRs) to health insurers required under the ACA effective immediately. (
  • On average, the CSRs reduce people's out-of-pocket costs by roughly $1,100 per person. (
  • Insurers design the CSR plans to fit federal standards, and the federal government reimburses each health insurer that provides CSRs for the estimated costs of reducing the amounts that they'd otherwise charge under the standard silver plan. (
  • In some states, far higher shares of residents receive CSRs. (
  • with decreasing marginal costs, the agents impose a positive externality on each other (see example below). (
  • The FAQ says that the agencies recognize that plans may utilize multiple service providers, such as major medical TPAs and pharmacy benefit managers, which may impose different levels of cost-sharing. (
  • NSF Program Officers are not authorized to impose or encourage mandatory cost sharing unless such requirements are explicitly included in the program solicitation. (
  • If higher cost sharing harms sicker patients and doesn't even save money, insurers and public programs then might want to reconsider how they impose it. (
  • Under the statute, states may impose cost sharing at higher than nominal levels for nonexempt individuals with incomes at or above 100 percent of the FPL. (
  • Plans are required to offer preventive benefits, and they cannot impose cost-sharing on these benefits (including contraceptive coverage, which has lowered out-of-pocket spending for many newly insured women). (
  • Although the types of interventions, measures, and populations studied varied widely, we were able to identify relatively clear relationships between cost sharing, adherence, and outcomes. (
  • But the cost of testing pales in comparison to that of an inpatient hospital stay for treatment, which Congress didn't address. (
  • Some inpatient cost shares will change each fiscal year October 1 - September 30 . (
  • If this work proceeds satisfactorily, a second phase will be proposed to assess the effect of cost-sharing on emergency room visits, inpatient hospitalization, and mortality. (
  • We are not proposing a change but are considering alternatives for the maximum allowable cost sharing related to an inpatient stay because this is a relatively high cost for very low income people and not a service that consumers have the ability to avoid or prevent. (
  • Forestry cost share programs under the Tennessee Agricultural Enhancement Program (TAEP) and Southern Pine Beetle Initiative (SPBI) were developed to promote long term investments in Tennessee's forests by providing cost share incentives to qualifying landowners and forest industry. (
  • OCCSP provides cost share assistance to producers and handlers of agricultural products who are obtaining or renewing their certification under the National Organic Program (NOP). (
  • Certified operations may receive up to 75 percent of their certification costs paid during the program year, not to exceed $750 per certification scope. (
  • Expenses used as cost sharing in any other sponsored program. (
  • In accounting, cost sharing or matching means that portion of project or program costs not borne by the funding agency. (
  • If the award is federal, only acceptable non-federal costs qualify as cost sharing and must conform to other necessary and reasonable provisions to accomplish the program objectives. (
  • To understand the importance of the House's challenge, one needs to understand the cost sharing reduction program found in section 1402 of the ACA ( 42 U.S.C. § 18071 ). (
  • But the cost sharing reduction program changes this. (
  • Even those earning 250% of federal poverty level get a little boost from the cost sharing reduction program: they get a policy that may have "Silver" printed on it but that in fact has been modified to provide 27% average cost sharing rather than 30% average cost sharing. (
  • Well over half of Obamacare purchasers ( about 57% in 2015 ) get at least some form of cost sharing reduction through this program. (
  • Moreover, here there is no doubt but that Congress decided, at least after the ACA was enacted, to refuse to pay for the cost sharing reduction program. (
  • The Wabash River Enhancement Corporation continues to accept applications for our cost-share program. (
  • This cost-share program will provide up to 75% of the total cost for urban and agricultural projects focused on improving water quality in the Region of the Great Bend of the Wabash River wateshed. (
  • Learn more about our cost-share program online at . (
  • Eight organizations, including the AHA, today urged Congress to fund the cost-sharing reduction program for certain individuals purchasing health coverage through the Health Insurance Marketplaces. (
  • In the Medicare program, increases in cost sharing by a supplemental insurer can exert financial externalities. (
  • Watch as Lory Willard explains how residents and businesses can participate in the City of Raleigh's Stormwater Quality Cost Share Program, which offers funding for installing affordable and sustainable stormwater management options that reduce pollution to Raleigh's streams and lakes. (
  • Criteria for considering voluntary committed cost sharing and any other program policy factors may be used to determine who may receive a Federal award must be explicitly described in the notice of funding opportunity. (
  • For other funding agencies, voluntary Cost Sharing commitments must be supported by a well justified plan that aligns with the goals of the research or education program and clearly demonstrates the value added by the voluntary cost share commitment. (
  • USDA reimburses organic producers up to 75 percent of the cost of organic certification, but only about half of the nation's organic operations currently participate in the program," said FSA Administrator Val Dolcini. (
  • USDA is making changes to increase participation in the National Organic Certification Cost Share Program (NOCCSP) and the Agricultural Management Assistance Organic Certification Cost Share Program, and at the same time provide more opportunities for organic producers to access other USDA programs, such as disaster protection and loans for farms, facilities and marketing. (
  • Shares of the company, whose board also authorized an additional $3 billion share buyback program, were up 2.5% at $55.50 in extended trading on Tuesday. (
  • If proposed Medicare legislation would decrease prescription drug use (e.g., by increasing cost sharing), it increases its estimate of overall Medicare spending to account for higher hospitalization costs the program would have to finance. (
  • Click here for funding available in each Cost Share Program. (
  • The conventional model for the use of cost effectiveness analysis for health programs involves determining whether the cost per unit of effectiveness of the program is better than some socially determined maximum acceptable cost per unit of effectiveness. (
  • A common view that cost sharing should vary inversely with program cost effectiveness is shown to be incorrect. (
  • The council Tuesday approved a cost-sharing agreement on the program. (
  • Grant funding is provided by USDA's National Organic Certification Cost-Share Program. (
  • For more information on cost-share program guidelines or to apply, visit or call OEFFA directly at (614) 262-2022. (
  • By reducing barriers to high-value treatments (through lower costs to patients) and discouraging low-value treatments (through higher costs to patients), health systems that incorporate the concepts of V-BID can improve patient outcomes," it says. (
  • Proponents argue that this approach promotes doctor-patient communication, enhances patient satisfaction, improves health outcomes, and even may lower cost. (
  • The decision on whether or not to introduce cost sharing arrangements is largely a political one and many factors (e.g. accessibility, equity, clinical outcomes) have to be taken into account, apart from economic results. (
  • Our news editors obtained a quote from the research from Natl Pharmaceuticals Council , "Cost sharing may have unintended consequences on treatment adherence and health outcomes. (
  • Increasing patient cost sharing was associated with declines in medication adherence, which in turn was associated with poorer health outcomes. (
  • A related question, if we assume that cost sharing affects adherence, is whether decreased adherence leads to poorer health outcomes. (
  • Only ten percent of individuals with clinical SA disorders receive any treatment, and almost half who forgo treatment point to accessibility and cost constraints as barriers to care. (
  • Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. (
  • Legal barriers also limit sharing. (
  • Barriers that hinder the alignment of care and patient cost sharing exist. (
  • Have you done your ACA affordability cost-share homework for the 2021 health plan year? (
  • Malaysian Transport Minister Liow Tiong Lai told a news conference in Canberra that the two countries would evenly split the costs of the new search phase, estimated at up to A$52 million ($48.65 million). (
  • So it is important here that we would like to thank Australia for leading this search and we have so far committed and spent about A$15 million and we are also going to match the Australians in the tender cost for the search," he said. (
  • Microsoft's search engine gained only a small increase in market share. (
  • Indeed, Christina Warren, writing for Mashable , predicted that if current trends continue, Bing will hold a greater share of the US search market that Google within a year. (
  • Microsoft attributed the cost increase to the Yahoo search agreement and increasingly expensive traffic acquisition - which Blodget noted was only two different ways of saying the same thing. (
  • If you haven't heard it, the software giant claims that it's sending what appears to be good money after bad to buy search share because once they've gained a large enough number of queries, their keyword prices for their advertising will rise to profitable levels and they'll stop losing money. (
  • When you put Yahoo's and Bing's shares of the US search market together, you get 30 percent. (
  • Watson explained that "when the burden of cost sharing falls too heavily on the patient," it forces them to make "impossible decisions" between their financial health and their physical health. (
  • Jonas A. de Souza, MD, MBA, assistant professor of medicine at the University of Chicago, concurred that benefits must be redesigned to alleviate the out-of-pocket cost burden on patients. (
  • If we take the last two major disease outbreaks, BSE and foot-and-mouth, for British agriculture to share the cost burden, which was enormous, we would have to have had control of the cause. (
  • I would argue that sharing energizes and shapes a community, whether we share ideas, the burden, or credit. (
  • The high-cost burden means we have less to invest in wages, benefits, and in growing our businesses - and our employees have less to spend on housing, education, and other priorities for their families. (
  • For example, patients with rheumatoid arthritis may be required to fail low-cost generic treatments before obtaining coverage for a higher-tier tumor necrosis factor alpha inhibitor for which they would have a larger financial burden. (
  • If this assumption is met and if the links between uninterrupted medication use and future disease burden and costs are established, a greater value should be attained in the pharmacy benefit, along with, perhaps, a positive return on investment-particularly in conditions for which pharmaceuticals play a crucial role in effective disease management. (
  • Of particular interest is the question of whether cost sharing or other cost-containment techniques that shift the financial burden to patients lead to decreased adherence. (
  • It should also be noted that cost sharing commitments reduce the University's facilities and administrative rate (indirect cost rate) as it is considered a part of the research base when calculating the rate. (
  • This time & effort report is the University's means of verifying that cost sharing was performed as promised and commitments were met. (
  • Cost sharing commitments must be considered carefully as they have broad implications for the University. (
  • He also discussed the possibility of implementing dynamic benefit design, such as different OOP costs for the same drug based on its benefit for the patient's specific condition. (
  • This study identified 5 guiding principles to determine when it was more (or less) acceptable for patients with the same or similar conditions to have different OOP costs. (
  • Starting March 20, USDA will provide a uniform, streamlined process for organic producers and handlers to apply for organic cost share assistance either by mail or in person at USDA offices located in almost every rural county in the country. (
  • Historically, many state departments of agriculture have obtained grants to disburse reimbursements to those producers and handlers qualifying for cost share assistance. (
  • Once certified, producers and handlers are eligible to receive reimbursement for up to 75 percent of certification costs each year up to a maximum of $750 per certification scope-crops, livestock, wild crops and handling. (
  • Approximately $11.5 million is available nationwide for organic certification cost-share assistance, making certification more accessible for certified producers and handlers. (
  • The savings from increased cost sharing accrue mostly to the supplemental insurer, while the costs of increased hospitalization accrue mostly to Medicare. (
  • Although Medicare provides important coverage for hospital, physician, and other services, its cost-sharing requirements are sometimes substantial. (
  • A 2010 study by the Harvard economist Amitabh Chandra and colleagues found that when cost sharing for physician visits and prescription drugs goes up, so does overall Medicare spending. (
  • Most Obamacare Plans' Cost Sharing Is Too High to Be HSA-Compatible. (
  • How we fund that cost is subject to a separate biosecurity levy consultation with our farmers, which farmers will receive information about in early 2019," says Mr van der Poel. (
  • The move makes Sendero the first area affordable care act health plan to waive cost-sharing for treatment and comes as the company also recently waived copayments for in-network doctor visits and lab costs to screen for the disease. (
  • Since all cost sharing (mandatory & voluntary) must be fully documented, the PI must include and certify effort towards the project that was not directly charged, on their monthly time & effort report. (
  • In benefit packages that include mandatory generic substitution, members who choose brand drugs over their generic equivalents generally must pay the generic co-payment plus the full difference in cost between the brand and generic drugs. (
  • In these cases, the University follows its long-standing practice of meeting published mandatory cost sharing requirements for targeted programs. (
  • These generally sell for considerably more than Silver policy, in part precisely because the insurer pays for 80% of costs on average rather than the Silver 70% and in part because of "induced demand": people who buy Gold policies tend to have higher medical expenses than people who buy Silver. (
  • When developing budgets which include committed cost sharing, every effort should be made to list expenses the University already covers, such as faculty salary or tuition, as the cost shared items. (
  • The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. (
  • For women who do decide to get pregnant without a partner in the picture, how much does the whole process cost - before all the usual expenses of a baby kick in? (
  • If these tools are implemented effectively, they can decrease costs by reducing the moral hazard of health insurance and by causing patients to realize the true cost of medications through their higher out-of-pocket expenses. (
  • Cost sharing may also vary by the type of service, such as office visits, hospitalizations, or prescription drugs. (
  • The new law further forces insurers to cover related hospital and physician visits at no cost. (
  • A 2012 study showed that higher cost sharing reduces spending on physician visits and drugs, but can increase hospital spending . (
  • Cost sharing could be reduced specifically for drugs and visits meant to address chronic conditions. (
  • Many plans sold in the marketplaces also offer a small number of primary care visits without cost-sharing. (
  • While the cost of prescription drug coverage varies widely, 30 percent, or the largest group of respondents, said pharmacy benefits represent between 11 percent and 15 percent of total health care costs," says Jacobs. (
  • This is down from last year's survey, when the largest group indicated their drug benefits made up between 16 percent and 20 percent of total health care costs. (
  • Develop should-cost models to learn about total supply chain costs, supplier economics and cost-reduction opportunities. (
  • Cost sharing is a commitment made by the University towards the total cost of a sponsored project. (
  • Cost sharing effort is included in the calculation of total committed effort. (
  • So if you split that halfway, each family is looking at a total cost of around $8/hour. (
  • So if there are three agents whose demands are 3 and 6 and 10, then the total cost is $100. (
  • where D is the total demand: D := ∑ i Demand ( i ) {\displaystyle D:=\sum _{i}{\text{Demand}}(i)} Several cost-sharing solutions have been proposed. (
  • The district and the board still have not determined what items the referendum could include or what its total cost could be. (
  • According to Haynes' analysis, only 60 percent of the total reappraisal cost occurs in the fourth year. (
  • The second-highest four-year total costs amount to $93,272 and $67,786 for East Ridge and Soddy-Daisy, respectively. (
  • Total costs fell to $2.59 billion from $3.09 billion. (
  • Congress specified that for a plan to be HSA-compatible, it must have a deductible that is no lower than the minimum set in law, and a limit on total out-of-pocket costs that is no higher than the maximum set in law. (
  • When an award budget incorporates voluntary cost share into total project costs, it becomes a binding commitment and the institution must include it in financial reporting to the sponsor. (
  • Under the new pricing, two lines will cost a total of $90 per month ($40 for 2GB bucket plus $25 access charge for each device). (
  • Barclays Bank loaned a total of £100m of Shared Appreciation Mortgages, and so the average size of each of their loans would have been about £33,333. (
  • These payments are supposed to roughly make them whole for the extra cost sharing the insurers assume. (
  • An £870,000 IT project to share driver data between the DVLA and motor insurers is floundering over who will bear the costs, according to MPs. (
  • The project, which cost £870,000 between 2009 and August 2011, has run up against the buffers of cost negotiations between the government and insurers , roads minister Michael Penning told the House of Commons on Thursday . (
  • Some 18 months ago I made a speech to the insurers and said, 'We will give you this [data-sharing] facility. (
  • The Association of British Insurers (ABI), which is the main insurer's body dealing with the government over the IADD project, said the project was ongoing, but had encountered difficulties over who would bear costs. (
  • The ACA requires the federal government to reimburse insurers for the cost, which CBO estimates at about $7 billion a year. (
  • Under the ACA, as we've explained , insurers are entitled to these CSR payments, just as eligible people are entitled to the lower cost-sharing charges they provide. (
  • Blue Cross and Blue Shield of Illinois has joined a growing list of health insurers waiving member costs for treatment of COVID-19. (
  • Last month, Blue Cross and Blue Shield of Illinois was among a number of health insurers to announce they would waive COVID-19 testing costs. (
  • Health insurers Cigna and Humana previously announced they would waive cost-sharing for COVID-19 treatments. (
  • Trump's executive order would give Americans the option of buying lower-cost health insurance, but also could usher back the bare-bones insurance options that the Affordable Care Act was designed to eliminate. (
  • The Affordable Care Act has rightfully focused attention on innovations like these designed to improve health and reduce the rate of growth in medical costs over time. (
  • Any major IT project is a major piece of work with major cost implications. (
  • These results have implications for the effectiveness of the 2008 Federal Mental Health Parity and Addiction Equity Act in increasing SA treatment admissions and promoting cost-sharing. (
  • Cost-sharing subsidy. (
  • 42 CFR § 423.782 - Cost-sharing subsidy. (
  • Look, I am by no means applauding the decision to cancel the cost-sharing subsidy payments. (
  • The second piece of evidence comes from the Congressional Budget Office (CBO), and CBO's report analyzing the impact of a decision to cancel the cost-sharing subsidy payments. (
  • What I find most interesting about the CBO report is this: If you have been an advocate of increasing the premium subsidy amounts so as to help low- and middle-income people better afford health insurance, cancelling the cost-sharing subsidy payments actually HELPS these consumers. (
  • As a result, CBO expects that overall federal marketplace subsidy costs would grow significantly over both the short and long term, raising federal deficits. (
  • The survey reveals that 76 percent of respondents use employee cost sharing as a utilization management tool, up substantially from 51 percent in 2008. (
  • For individuals with family income above 150 percent of the FPL, per section 1916A(c) of the Act, cost sharing for non-preferred drugs may not exceed 20 percent of the cost the agency pays for the drug. (
  • To learn more about organic certification cost share, please visit or contact a local FSA office by visiting . (
  • Plan enrollees receiving services from providers that do not participate in plan networks often face higher cost sharing and may be responsible for charges that exceed the plan's allowable amounts. (
  • Reuters) - American Express Co ( AXP.N ) warned of higher operating costs this year as the credit card issuer spends heavily on rewards programs to attract customers in an increasingly crowded market, sending its shares down 2.5% on Friday. (
  • Patients who preferred not to delegate decisions to their doctors-those who wanted to work with their caregivers to reach decisions-spent about 5 percent more time in the hospital and incurred about 6 percent higher costs. (
  • When patients face higher cost sharing for prescription drugs, they tend to cut back on them. (
  • In response to this higher cost sharing, hospital spending grew substantially for the sickest patients. (
  • However, these enrollees are exposed to substantial out-of-pocket cost risk with little evidence that this risk exposure will incentivize higher-value health care decisions, meaning they are essentially playing the game blindfolded with one hand tied behind their back. (
  • Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration. (
  • Little is known about stakeholders' views on the acceptability of greater patient cost sharing if the individual patient characteristics lead to the higher-cost treatments. (
  • Panelists felt it was least acceptable for patients to have greater OOP costs if the use of the higher-cost treatment was due to biological reasons such as step therapy (6 = unacceptable, 9 = neutral, 2 = acceptable) or diagnostic results (5 = unacceptable, 10 = neutral, and 2 = acceptable). (
  • Five guiding principles emerged from the discussion: When patients have tried lower-cost therapies unsuccessfully, the benefits of higher-cost treatments were certain and significant, the cost difference between treatments was aligned with improved benefits, and penalties due to bad luck were mitigated, then cost-sharing differences should be minimized but not eliminated. (
  • If we hadn't moved to eradication, the alternative - to do nothing and let this disease spread throughout our stock - would have been a serious challenge and the costs higher, estimated at $1.3 billion. (
  • This year, plan sponsors are clearly focused on controlling costs in response to budget cuts," says Michael Jacobs, a principal and national clinical practice leader at Buck Consultants. (
  • TAEP cost share is available for sign-up year-round, while SPBI sign-up period is between May 1 to May 31. (
  • The maximum cost share for all TAEP practices is up to $15,000 per participant per year. (
  • The maximum cost share for all SPBI practices is up to $15,000 per participant per year. (
  • Net income in the fourth quarter was $416 million, or 91 cents per share -- up from $384 million, or 85 cents per share, a year earlier. (
  • In Germany, renewable energy support costs have risen this year to 20.4 billion euros from 1.9 billion euros a decade ago, energy association BDEW said, but industry, which uses most of the energy, doesn't shoulder its fair share of those costs. (
  • The district's plan for building repairs alone could cost an average taxpayer $45 a year over 15 years, according to estimates in a draft survey. (
  • Costs for potential work could be spread out over 15 years at a cost of about $45 a year for a taxpayer with a $100,000 home, according to district estimates. (
  • If 30 percent of those patients chose to share decision making rather than delegate that role to their doctors, it would mean $8.7 billion of additional costs per year, according to the study. (
  • I have seen my share of health care increase every year since I've had an employer based plan. (
  • The company's net income rose to $1.91 billion, or $1.68 per share, for the second quarter ended June 30, from $1.80 billion, or $1.32 per share, a year earlier. (
  • For example, with an anti-obesity drug, to track and trial that drug over a year "would be a tremendous cost. (
  • Nearly 6 million enrollees, or 57%, qualify for the cost-sharing payments this year, according to the most recent data from the Department of Health and Human Services. (
  • South Korean media have reported that the Trump administration has sought a fivefold increase to about $5 billion a year by including funding for the deployment of bombers and other strategic assets in addition to the traditional labor costs. (
  • It will not prevent a fall in earnings for the half year to December 31 with the company expecting earnings before interest and tax (EBIT) of $250 million - less several million dollars in one-off restructuring costs - compared to $309.7 million for the prior first half. (
  • Note: If full F&A is allowed by the sponsor and the PI receives permission to waive recovery , the amount unrecovered becomes voluntary committed cost share. (
  • The latest decision by a health insurer to waive cost-sharing comes as COVID-19 continues to spread, with about 267,000 confirmed cases and nearly 7,000 deaths in the U.S. as of Friday afternoon, according to Johns Hopkins University, which is tracking the disease globally. (
  • Yet, because of the high cost sharing associated with their medications, Fletcher and Jody have faced profound difficulty accessing the treatments prescribed for them. (
  • This trend is especially troubling for patients living with a blood cancer diagnosis, since available treatments typically consist of high-priced specialty drugs and other cost-intensive healthcare services. (
  • His organization helps patients navigate their high out-of-pocket (OOP) costs and provides financial assistance that allows 90% of recipients to initiate or stay on their cancer treatments. (
  • HealthLat ( ) has introduced a patent-pending service where individuals who have undergone medical treatments make significant earnings by sharing experiences with others seeking first-hand personalized information. (
  • Americans always want the most up-to-date information about treatments - preferably from reliable and comparable sources who have already tried it, says Johnson Chen, a founder of HealthLat and previously a senior in the health care sector of Deloitte Consulting, We re meeting their needs and putting money back in the pocket of those willing to share. (
  • According to the authors, the findings are significant because this is one of the first studies to find success in value-based insurance design, which is intended to promote the use of services or treatments that provide high benefits relative to cost and, alternatively, to discourage the use of services whose benefits do not justify their cost. (
  • Do increased patient cost sharing and formulary restrictions reduce pharmaceutical use and costs? (
  • Our results suggest that encouraging patients to be more involved will not, alone, reduce costs. (
  • The cost sharing problem occurs also in voluntary form of cooperation, for example, if one wants to reduce the cost in transport or the building and operating cost of water, gas, or telecommunication networks. (
  • In fact, CBO eventually expects a greater share of people in that income range (between 200 and 400 percent of the federal poverty line) to buy marketplace coverage than under current law, due to the larger premium credits, which would then reduce the number of uninsured over time. (
  • In order to make it easier for states to utilize existing flexibilities to reduce non-emergency use of the ED, at § 447.54(a) we propose to allow cost sharing of up to $8 for non-emergency use of the ED no waiver will be required. (
  • I was wondering if someone tried an idea to share their extra lines with other folks to reduce costs for both? (
  • Accordingly, the University provides only the minimum amount of cost sharing necessary to meet sponsors' requirements and discourages voluntary committed cost sharing. (
  • UM strongly discourages cost sharing unless required. (
  • Forest industry practitioners, such as loggers and sawmill owners, are eligible to receive a 50% cost share reimbursement for funds spent. (
  • Participants may receive 75 to 90 percent reimbursement for their project based on available funding and project cost. (
  • Brown's objective is to maximize sponsor cost reimbursement to support the continued growth of the research enterprise. (
  • Application fees, inspection costs, fees related to equivalency agreement/ arrangement requirements, travel/per diem for inspectors, user fees, sales assessments and postage are all eligible for a cost share reimbursement from USDA. (
  • To assess the impact of changes in employee cost-sharing on the use, cost, and quality of preventive and therapeutic care, the project investigators will examine medical claims and personnel data at two or three St. Louis firms for up to 70,000 employees and dependents. (
  • Evidence indicates that once cost sharing exceeds $100, adherence to prescribed medications begins to drop off significantly, 4,5 likely due to the trade-off between paying for medical care and the prospect of damaging the family's financial stability. (
  • Risk Sharing and Transactions Costs: Evidence from Kenya's Mobile Money Revolution ," American Economic Review , American Economic Association, vol. 104(1), pages 183-223, January. (
  • While other States have yet to publicly announce how they are going to make their insurance carriers deal with the unfunded cost-sharing liabilities, there is ample evidence that most if not all States will choose to require their carriers to add a surcharge to "silver" Exchange plans ONLY, just like California did. (
  • This study provides evidence that reducing cost-sharing can improve the ability of patients with chronic illness to take the medications they need to stay in good health," said Commonwealth Fund President Karen Davis. (
  • Risk-sharing networks and insurance against illness ," CSAE Working Paper Series 2002-16, Centre for the Study of African Economies, University of Oxford. (
  • 3 Placing a drug in a specialty tier allows the plan to charge patients a percentage of a drug's list price rather than a fixed dollar amount and simultaneously prevents a patient from accessing Medicare's cost-sharing appeals process. (
  • Brown University does not typically Cost Share on a voluntary basis. (
  • Health care coverage typically includes member cost sharing which are costs directly paid by member to help lower the monthly costs of premium. (
  • As health care is typically the second or third biggest cost in our budgets as manufacturers, something needs to change. (
  • Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. (
  • Sam Xanders, a spokesman for the ICC staff, said its concern is to estimate how much of the expense caused by Byron cost overruns and delays should be borne by Edison customers and how much should be taken on by shareholders. (
  • Of specific concern to blood cancer patients are benefit designs that increase the portion of drug costs borne by consumers. (
  • Under the federal Uniform Guidance of 2014, it states: "Under Federal research proposals, voluntary committed cost sharing is not expected. (
  • The National Science Foundation (NSF) directly instructs proposers that "Unless required by NSF inclusion of voluntary committed cost sharing is prohibited and Line M on the proposal budget will not be available for use by the proposer. (
  • Voluntary Committed: The Uniform Guidance states that voluntary committed cost sharing is not expected for federal research proposals ( 2 CFR 200.306 ) and cannot be used as a factor during the merit review of applications or proposals. (
  • The cost-sharing amounts reported here are for covered workers using in-network services. (
  • Such cost sharing is limited to "nominal" amounts. (
  • The rapid growth of high-deductible health plans (HDHP) has been driven in part owing to a belief that cost-sharing obligations (ie, having skin in the game ) will encourage health insurance enrollees to shop for health care. (
  • The most common target cost-sharing range is 11 percent to 20 percent of claim costs (used by 39 percent of respondents). (
  • While 73 percent of respondents cited are taking advantage of low-cost generic pricing offered by retail pharmacy chains as a high priority, only 26 percent require their mail service provider to match these low-cost retail generic prices. (
  • The cost share amount is based on 50 percent of the participant's eligible cost, not to exceed the maximum per unit. (
  • The cost share amount is based on 50 percent of the participant's documented cost. (
  • forecast lower margins than some investors hoped for, reflecting the costs of its growth strategy, and shares of the world's largest online retailer plunged 8.5 percent. (
  • Amazon shares traded at $168.75, down 8.5 percent, following the earnings report, after rising more than 5 percent to end at $184.45 on Nasdaq Thursday. (
  • A common example of voluntary cost sharing is when a PI commits a percent of effort to the project in the budget without any corresponding request for funding. (
  • RWE npower, the British unit of German utility RWE (GER:RWE), said it expected the share of commodity prices as a component of energy bills to drop to 35 percent in 2020, down from 50 percent three years ago. (
  • Danish households, for example, pay Europe's highest electricity bills at around 31 euro cents per kilowatt-hour because more than half of the cost, or 55 percent, is made up of taxes, according to a report into energy bills by VaasaETT energy research group. (
  • German households use only 26 percent but bear 36 percent of this cost, or 7.4 billion euros. (
  • Cost sharing is a split of provider costs between the insurance company and the customer and can represent 70 percent / 30 percent with the insurance company paying the larger portion of health care costs until an annual maximum is reached for the member. (
  • Over the same period of time, Google's share of the same market went from 65.7 percent to 65.4 percent, while Ask's share dropped from 3.1 percent to an even 3 percent. (
  • So I first outline the simple and correct application of a decision rule to treatment choices based on cost effectiveness in the "binary coverage" setting, when insurance either covers 100 percent of the cost of a given type of care or leaves it entirely uncovered, and the extra welfarist approach is taken. (
  • Current rules permit cost sharing for institutional care, up to 50 percent of the cost for the first day of care, for individuals with incomes below 100 percent of the FPL. (
  • Section 1916A provides that states may establish cost sharing for nonexempt services, other than drugs and ED services, up to 10 percent of the cost paid by the state for such services, for individuals with incomes between 100 and 150 percent of the FPL. (
  • To provide additional flexibility to states, and to further encourage the use of preferred drugs, we are proposing to define nominal for this purpose so as to allow cost sharing of up to $8 for non-preferred drugs for individuals with income equal to or less than 150 percent of the FPL or who are otherwise exempt from cost sharing. (
  • 1 About 53 percent of Americans without health coverage have trouble paying their medical bills, while another 20 percent of those with coverage also struggle to meet health costs. (
  • In August only 2 percent of electricity was produced through coal and its financial cost is increasingly ruling it out. (
  • As announced in May, 68 percent of the costs are funded by government and the remaining 32 percent is split between dairy and beef farmers. (
  • Of the 32 percent of costs, the dairy sector will meet 94 percent of the costs of the programme, and beef 6 percent. (
  • Payments will be up to 75 percent of an individual producer's certification costs, with a maximum of $750 per certification scope (crops, livestock, handling, wildcrops). (
  • Sony made the affected batteries for Dell, and has confirmed it will share the expense of recalling the 4.1m laptop batteries worldwide. (
  • If F&A on cost share is an allowable expense per sponsor terms and conditions, then all cost share, except third party, is assessed F&A as appropriate for the activity to accurately reflect the institutional contribution. (
  • TAEP Best Management Practices Cost Share is an incentive for timber harvesting or wood using industries to avoid or minimize negative environmental and water quality impacts, resulting from timber harvesting. (
  • To begin the panel discussion, he turned to another patient advocate, Samantha Watson, MBA, founder and CEO of the Samfund, who explained the impacts of cost sharing from the perspective of the patient. (
  • The Boards of DairyNZ and B+LNZ supports the panel's view that the funding split represents a reasonable allocation for the costs of the Mycoplasma bovis response, considering the relative economic size of the two sectors, the risk of infection and the potential clinical impacts weighted by the farm-gate revenue for milk and beef of M. bovis on the respective sectors. (
  • However, the panel felt it was too difficult to determine these costs and settled on likely clinical impacts instead. (
  • Voluntary uncommitted cost sharing commonly results from cost overruns on a project or from PI effort exceeding the amount proposed. (
  • Cost overruns of more than $3 billion in the construction of Commonwealth Edison Co.`s Byron nuclear power facilities were the fault of the federal Nuclear Regulatory Commission and, to a lesser extent, Edison`s lack of construction monitoring, according to an independent audit released Monday. (
  • The report by Arthur D. Little Inc., a consulting firm based in Cambridge, Mass., was carried out under an Illinois Commerce Commission order to determine responsibility for long delays and cost overruns in construction of the Byron 1 and 2 plants. (
  • The wide variation in costs across physicians and hospitals implies considerable opportunity for enrollees to save money by switching to lower-cost providers. (
  • However, prior studies using health insurance claims data indicate these savings are primarily owing to decreased use of care and not because HDHP enrollees are switching to lower-cost providers. (
  • Limited prior work has assessed attitudes toward price shopping among HDHP enrollees and whether they were more likely to consider costs when seeking care. (
  • This paper examines the unanswered question of how cost effectiveness analysis should be performed and interpreted when insurance coverage can involve non-negligible cost sharing. (
  • They warned this could increase health care disparities as empowered and engaged groups, who already are more likely to receive care, gain resources through shared decision making while the national movement toward accountable care organizations increases the pressure for cost reduction. (
  • Increases in cost and schedule were caused by continually increasing NRC safety and construction requirements and the resulting underestimation of costs and schedule by Commonwealth Edison,`` the report said. (
  • Thursday night, as the Nationals were choking in Game 5, President Trump announced that the Administration would stop making the cost-sharing reduction payments to those insurance carriers who are still selling health plans through the ACA Exchanges. (
  • Non-grandfathered health plans are required to cover some services, such as preventive care, without cost sharing. (
  • These include care management, disease management and low-cost generic pricing programs offered by retail pharmacy chains. (
  • In health care, cost sharing occurs when patients pay for a portion of health care costs not covered by health insurance. (
  • Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? (
  • In a nanny share, instead of being in a day care with a bunch of other babies, you'll have one person splitting his or her attention between two babies. (
  • Covering health care requires writing about the cost of care. (
  • After all, cost control is one of the primary concerns behind health care reform. (
  • Focusing closely on costs leads health systems to use a one-size-fits-all approach to cost sharing, and requiring consumers to pay more for needed services may have a perverse effect of becoming a barrier to care, he explains. (
  • Conversely, VBID encourages a more clinically nuanced approach to financial incentives that involves setting consumers' out-of-pocket costs for health care services and medications to motivate patients to do what research proves will help keep them healthy. (
  • For people with modest incomes, high cost-sharing can present an enormous barrier to accessing necessary medical care. (
  • The result that everyone would have liked, that patients who are more engaged in their care do better and cost less, is not what we found in this setting," said study author David Meltzer, MD, PhD, associate professor of medicine, economics and public policy at the University of Chicago. (
  • They found that provider incentives were not the only predictors of care costs. (
  • Several aspects of 'HEALTH CARE SPPECIFICCS' will resolve many of the problems of ACA once the Republicans control a larger share of the US Senate, at whatever time that may occur. (
  • Mercer suggests Congress build on this success by modernizing HSA standards - for example, to allow predeductible care delivery through cost-effective options like worksite clinics and telemedicine and to create HSA-qualifying HDHP safe-harbor plan designs that allow predeductible coverage of drugs and services for people with chronic conditions. (
  • Mercer notes that much of today's healthcare data doesn't help consumers make cost-effective decisions for quality care. (
  • Consumers effectively get a discount on the cost of their medical care whenever they can avoid paying tax on the money used to purchase that care. (
  • Panelists from diverse vantage points in the cancer care landscape discussed the effects of cost sharing on patients in a discussion at the 5th annual Patient-Centered Oncology Care® meeting. (
  • He compared cancer care to an iceberg, with financial issues like cost sharing being at the tip. (
  • The idea that cost sharing could be used as both a tool and a barrier was reinforced by de Souza, who suggested providing incentives to patients for preventive services or palliative care while also discouraging low-value care. (
  • In that case, a lot of the legwork and decisions about value-based care need to be made behind the scenes," she said, so that when patients are presented with their options, they are not making decisions based on cost. (
  • The growth in health care spending is slowing down, and one reason might be that cost sharing is rising. (
  • Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down. (
  • When applied indiscriminately, cost sharing can hurt the sicker patients by prompting them to delay or avoid the preventive care they need. (
  • If reduced cost sharing is targeted at the preventive and maintenance care and the medications that patients with chronic illnesses need, value-based insurance could save money. (
  • Charging sicker patients the same as healthy ones for the drugs and preventive care they need ultimately costs more. (
  • Cost Shares for Care in the U.S. (
  • You'll pay a cost share based on the type of care provider you see (network vs. non-network). (
  • Note: You may have separate costs for additional services when receiving home health care. (
  • Increased cost sharing does NOT make better health care shoppers. (
  • Realizing that IT integration could result in cost-savings, workflow efficiencies and improve patient care, UCHealth is now utilizing Philips to consolidate and standardize its health IT systems across the entire hospital enterprise. (
  • Previous studies ranked our state the worst or near worst when it comes to high health care costs. (
  • Evaluating Cost Sharing Measures in Public Primary Units in Greece: Cost Sharing Measures in Primary Care. (
  • The mission of this paper is to investigate the economic viability and the workload imposed on nurses of the introduction of a cost sharing mechanism (€5/visit) in public primary health care units. (
  • Studies from Natl Pharmaceuticals Council Update Current Data on Managed Care (Does a One-Size-Fits-All Cost-Sharing Approach Incentivize Appropriate. (
  • According to the news editors, the research concluded: "Policies that facilitate the alignment of patient cost sharing with appropriate care are needed. (
  • High-growth services comprise the key targets for reform efforts by payers, purchasers, and other cost-conscious stakeholders within the health care system. (
  • This may be the result of many expensive brand medications moving off-patent and being replaced by lower-cost generics. (
  • Cost sharing for medications presents a serious access barrier for many blood cancer patients. (
  • In the past 4 years alone, Part D plans have shifted 50% more drugs onto their specialty tiers,3 subjecting many patients relying on those medications to thousands of dollars in additional cost sharing. (
  • Patient OOP costs can affect the use of both inappropriate and appropriate medications. (
  • If Spraddle Creek Road requires work to handle logging trucks, the cost is estimated at between $20,000 and $25,000 per mile. (
  • In all of these incentive-based formularies, savings result from shifting members' drug use to generics or preferred brands, for which the health plans have negotiated favorable rates, and by increasing patients' cost sharing. (
  • In the videos below, patients and families share their personal experiences of fear and frustration. (
  • Since the 1980s, doctors and patients have been encouraged to share decision making. (
  • Yet, a hospital-based study found that patients who want to participate in their medical decisions end up spending more time in the hospital and raising costs of their hospital stay by an average of $865. (
  • Patients who want to be more involved do not have lower costs. (
  • Patients with the most education had lower costs than those with the least education, the study found. (
  • She argued that the disconnect between patients and resources indicates a much larger problem- that the OOP costs affecting patients' treatment decisions are not acknowledged by the current system. (
  • Acknowledging that charitable assistance can be difficult for patients to navigate, Klein said that a bigger issue is actually the ineffectiveness of cost sharing. (
  • Alvarnas suggested that cost sharing could be used to improve the system by directing patients toward preferred pathways and prioritizing efficient drugs. (
  • Shrank agreed that cost sharing at its core is meant to work as a barrier, but that an alternative approach to value could instead reward patients for adhering to their treatment regimens, so "all of those pieces can fit into a rich, value-based contracting design. (
  • Watson routed the discussion back to the patient's point of view, saying that patients newly diagnosed with cancer may not be ready to discuss cost and value-rather, they may be more concerned with their chances of survival. (
  • A number of studies document the adverse effects of cost sharing on sicker patients. (
  • reducing cost sharing for healthier patients does not save money. (
  • I show that the ideal level of "interior" cost sharing depends on whether consumer values are assumed to be relevant, on how much consumer values really vary, and most especially on whether the extent of variation in expected effectiveness across patients is perceived by patients but cannot be known by the insurer. (
  • The paper, 'Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients,' is in the May 27, 2013, issue of JAMA Internal Medicine . (
  • Madison, WI October 09, 2007 Healthcare costs for patients can go down. (
  • In contrast, panelists felt it was more acceptable for patients to pay greater OOP costs when treatment choice was based on preferences to avoid a side-effect risk (1 = unacceptable, 3 = neutral, and 13 = acceptable) or the route/frequency of administration (1 = unacceptable, 1 = neutral, and 15 = acceptable). (
  • Consideration should be given to fully exempt high-risk patients from drug cost sharing. (
  • In theory, these steps should deter the overuse of nonessential therapies and should direct patients toward taking drugs that offer a therapeutic benefit at a lower cost, thus maximizing value. (

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