Reimbursement, Incentive: A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.Physician Incentive Plans: Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders.Motivation: Those factors which cause an organism to behave or act in either a goal-seeking or satisfying manner. They may be influenced by physiological drives or by external stimuli.Insurance, Life: Insurance providing for payment of a stipulated sum to a designated beneficiary upon death of the insured.Employee Incentive Plans: Programs designed by management to motivate employees to work more efficiently with increased productivity, and greater employee satisfaction.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.Economic Competition: 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.Managed Competition: A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)United StatesInsurance, Health, Reimbursement: Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)Managed Care Programs: 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.Independent Practice Associations: A partnership, corporation, association, or other legal entity that enters into an arrangement for the provision of services with persons who are licensed to practice medicine, osteopathy, and dentistry, and with other care personnel. Under an IPA arrangement, licensed professional persons provide services through the entity in accordance with a mutually accepted compensation arrangement, while retaining their private practices. Services under the IPA are marketed through a prepaid health plan. (From Facts on File Dictionary of Health Care Management, 1988)Reward: An object or a situation that can serve to reinforce a response, to satisfy a motive, or to afford pleasure.Health Care Reform: 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.Health Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.Cost Control: 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)Fees and Charges: Amounts charged to the patient as payer for health care services.Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.Blue Cross Blue Shield Insurance Plans: Prepaid health and hospital insurance plan.Insurance: Coverage by contract whereby one part indemnifies or guarantees another against loss by a specified contingency.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.Insurance Claim Review: 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.Contract Services: Outside services provided to an institution under a formal financial agreement.Insurance Coverage: 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)Economics, Hospital: Economic aspects related to the management and operation of a hospital.Insurance Pools: An organization of insurers or reinsurers through which particular types of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts.Liability, Legal: Accountability and responsibility to another, enforceable by civil or criminal sanctions.Formularies as Topic: 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.Genetic Privacy: The protection of genetic information about an individual, family, or population group, from unauthorized disclosure.Preferred Provider Organizations: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients.Rate Setting and Review: A method of examining and setting levels of payments.Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Health Care Costs: 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.Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.Malpractice: Failure of a professional person, a physician or lawyer, to render proper services through reprehensible ignorance or negligence or through criminal intent, especially when injury or loss follows. (Random House Unabridged Dictionary, 2d ed)Trust: Confidence in or reliance on a person or thing.Cost Sharing: 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)Models, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Quality Assurance, Health Care: 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.Cost Allocation: 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.Health Benefit Plans, 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.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Health Maintenance Organizations: Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Antitrust Laws: Those federal and state laws, and their enforcement, that protect trade and commerce from unlawful restraints and monopolies or unfair business practices.Postal Service: The functions and activities carried out by the U.S. Postal Service, foreign postal services, and private postal services such as Federal Express.Drug 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).Deductibles and Coinsurance: 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.Privatization: Process of shifting publicly controlled services and/or facilities to the private sector.Practice Management, Medical: The organization and operation of the business aspects of a physician's practice.Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.National Health Programs: Components of a national health care system which administer specific services, e.g., national health insurance.Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Government Regulation: Exercise of governmental authority to control conduct.Negotiating: The process of bargaining in order to arrive at an agreement or compromise on a matter of importance to the parties involved. It also applies to the hearing and determination of a case by a third party chosen by the parties in controversy, as well as the interposing of a third party to reconcile the parties in controversy.Contracts: Agreements between two or more parties, especially those that are written and enforceable by law (American Heritage Dictionary of the English Language, 4th ed). It is sometimes used to characterize the nature of the professional-patient relationship.Capitation Fee: A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.Physicians: Individuals licensed to practice medicine.Meaningful Use: Using certified ELECTRONIC HEALTH RECORDS technology to improve quality, safety, efficiency, and reduce HEALTHCARE DISPARITIES; engage patients and families in their health care; improve care coordination; improve population and public health; while maintaining privacy and security.Salaries and Fringe Benefits: The remuneration paid or benefits granted to an employee.Centers for Medicare and Medicaid Services (U.S.): A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.Fee-for-Service Plans: 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)Drugs, Generic: Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Financing, Personal: Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Data Collection: 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.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Cost-Benefit Analysis: 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.State Government: The level of governmental organization and function below that of the national or country-wide government.Insurance, Liability: Insurance against loss resulting from liability for injury or damage to the persons or property of others.Commerce: The interchange of goods or commodities, especially on a large scale, between different countries or between populations within the same country. It includes trade (the buying, selling, or exchanging of commodities, whether wholesale or retail) and business (the purchase and sale of goods to make a profit). (From Random House Unabridged Dictionary, 2d ed, p411, p2005 & p283)Efficiency, Organizational: The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.Patient Protection and Affordable Care Act: An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.Choice Behavior: The act of making a selection among two or more alternatives, usually after a period of deliberation.Financing, Government: Federal, state, or local government organized methods of financial assistance.Fees, Medical: Amounts charged to the patient as payer for medical services.Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income.Health Facility Merger: The combining of administrative and organizational resources of two or more health care facilities.Medicaid: 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.Gatekeeping: The controlling of access to health services, usually by primary care providers; often used in managed care settings to reduce utilization of expensive services and reduce referrals. (From BIOETHICS Thesaurus, 1999)Financial Support: The provision of monetary resources including money or capital and credit; obtaining or furnishing money or capital for a purchase or enterprise and the funds so obtained. (From Random House Unabridged Dictionary, 2d ed.)Disclosure: Revealing of information, by oral or written communication.Patient Credit and Collection: Accounting procedures for determining credit status and methods of obtaining payment.Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.Gift Giving: The bestowing of tangible or intangible benefits, voluntarily and usually without expectation of anything in return. However, gift giving may be motivated by feelings of ALTRUISM or gratitude, by a sense of obligation, or by the hope of receiving something in return.Models, Economic: 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.Fee Schedules: A listing of established professional service charges, for specified dental and medical procedures.Economics: The science of utilization, distribution, and consumption of services and materials.Organizational Innovation: Introduction of changes which are new to the organization and are created by management.Genetics, Medical: A subdiscipline of human genetics which entails the reliable prediction of certain human disorders as a function of the lineage and/or genetic makeup of an individual or of any two parents or potential parents.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Financial Management, Hospital: The obtaining and management of funds for hospital needs and responsibility for fiscal affairs.Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.Orphan Drug Production: Production of drugs or biologicals which are unlikely to be manufactured by private industry unless special incentives are provided by others.Health Services Accessibility: 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.Physician's Practice Patterns: Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.Pharmacies: Facilities for the preparation and dispensing of drugs.Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond.American Recovery and Reinvestment Act: Public Law No: 111-5, enacted February 2009, makes supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009.Genetic Testing: Detection of a MUTATION; GENOTYPE; KARYOTYPE; or specific ALLELES associated with genetic traits, heritable diseases, or predisposition to a disease, or that may lead to the disease in descendants. It includes prenatal genetic testing.Attitude of Health Personnel: Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.Netherlands: 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.Reinforcement (Psychology): The strengthening of a conditioned response.MassachusettsSoutheastern United States: The geographic area of the southeastern region of the United States in general or when the specific state or states are not included. The states usually included in this region are Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, West Virginia, and Virginia.Token Economy: A practice whereby tokens representing money, toys, candy, etc., are given as secondary reinforcers contingent upon certain desired behaviors or performances.Risk Management: The process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability. (From Slee & Slee: Health care terms, 2d ed)Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services.Questionnaires: 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.Hospital-Physician Relations: Includes relationships between hospitals, their governing boards, and administrators in regard to physicians, whether or not the physicians are members of the medical staff or have medical staff privileges.Universal Coverage: Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.Attitude to Health: Public attitudes toward health, disease, and the medical care system.Health Services Needs and Demand: 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.CaliforniaIndividuality: Those psychological characteristics which differentiate individuals from one another.Interviews as Topic: Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.Conditioning, Classical: Learning that takes place when a conditioned stimulus is paired with an unconditioned stimulus.Economics, Behavioral: The combined discipline of psychology and economics that investigates what happens in markets in which some of the agents display human limitations and complications.SwitzerlandMedically Uninsured: Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (DIAGNOSTIC ERRORS), errors in the administration of drugs and other medications (MEDICATION ERRORS), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from MALPRACTICE in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Refusal to Participate: Refusal to take part in activities or procedures that are requested or expected of an individual. This may include refusal by HEALTH PERSONNEL to participate in specific medical procedures or refusal by PATIENTS or members of the public to take part in clinical trials or health promotion programs.Drug Prescriptions: Directions written for the obtaining and use of DRUGS.Patents as Topic: Exclusive legal rights or privileges applied to inventions, plants, etc.Drug Industry: 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.Electronic Health Records: Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient.Conditioning, Operant: Learning situations in which the sequence responses of the subject are instrumental in producing reinforcement. When the correct response occurs, which involves the selection from among a repertoire of responses, the subject is immediately reinforced.Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response.Ambulatory Care: 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.Flupenthixol: A thioxanthene neuroleptic that, unlike CHLORPROMAZINE, is claimed to have CNS-activating properties. It is used in the treatment of psychoses although not in excited or manic patients. (From Martindale, The Extra Pharmacopoeia, 30th ed, p595)Diffusion of Innovation: The broad dissemination of new ideas, procedures, techniques, materials, and devices and the degree to which these are accepted and used.Patient Satisfaction: 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.Investments: Use for articles on the investing of funds for income or profit.Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Practice Management: Business management of medical, dental and veterinary practices that may include capital financing, utilization management, and arrangement of capitation agreements with other parties.Outcome Assessment (Health Care): 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).Program Evaluation: 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.Altruism: Consideration and concern for others, as opposed to self-love or egoism, which can be a motivating influence.Financial Management: The obtaining and management of funds for institutional needs and responsibility for fiscal affairs.Primary Health Care: 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)Coercion: The use of force or intimidation to obtain compliance.Personnel Loyalty: Dedication or commitment shown by employees to organizations or institutions where they work.Professional Autonomy: The quality or state of being independent and self-directing, especially in making decisions, enabling professionals to exercise judgment as they see fit during the performance of their jobs.Group Purchasing: A shared service which combines the purchasing power of individual organizations or facilities in order to obtain lower prices for equipment and supplies. (From Health Care Terms, 2nd ed)Organizational Policy: A course or method of action selected, usually by an organization, institution, university, society, etc., from among alternatives to guide and determine present and future decisions and positions on matters of public interest or social concern. It does not include internal policy relating to organization and administration within the corporate body, for which ORGANIZATION AND ADMINISTRATION is available.Cost of Illness: 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.Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke.Appetitive Behavior: Animal searching behavior. The variable introductory phase of an instinctive behavior pattern or sequence, e.g., looking for food, or sequential courtship patterns prior to mating.Nucleus Accumbens: Collection of pleomorphic cells in the caudal part of the anterior horn of the LATERAL VENTRICLE, in the region of the OLFACTORY TUBERCLE, lying between the head of the CAUDATE NUCLEUS and the ANTERIOR PERFORATED SUBSTANCE. It is part of the so-called VENTRAL STRIATUM, a composite structure considered part of the BASAL GANGLIA.Physician-Patient Relations: The interactions between physician and patient.Behavior, Addictive: The observable, measurable, and often pathological activity of an organism that portrays its inability to overcome a habit resulting in an insatiable craving for a substance or for performing certain acts. The addictive behavior includes the emotional and physical overdependence on the object of habit in increasing amount or frequency.Databases, Factual: 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.Cooperative Behavior: 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)Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.Diagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.MaineFood: Any substances taken in by the body that provide nourishment.Ownership: 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.Chronic Disease: 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)Quality Improvement: The attainment or process of attaining a new level of performance or quality.Pharmacy Administration: The business and managerial aspects of pharmacy in its broadest sense.Models, Theoretical: 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.Cocaine-Related Disorders: Disorders related or resulting from use of cocaine.Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.Ethics: The philosophy or code pertaining to what is ideal in human character and conduct. Also, the field of study dealing with the principles of morality.Accountable Care Organizations: Organizations of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. Assigned means those beneficiaries for whom the professionals in the organization provide the bulk of primary care services. (www.cms.gov/OfficeofLegislation/Downloads/Accountable CareOrganization.pdf accessed 03/16/2011)Personnel Selection: The process of choosing employees for specific types of employment. The concept includes recruitment.Compensation and Redress: Payment, or other means of making amends, for a wrong or injury.Patient Selection: 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.Economics, Medical: 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.Delivery of Health Care, Integrated: 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)Rural Health Services: Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.Practice Guidelines as Topic: 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.Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure.Anticipation, Psychological: The ability to foresee what is likely to happen on the basis of past experience. It is largely a frontal lobe function.Decision Making, Organizational: The process by which decisions are made in an institution or other organization.GermanyState Medicine: 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.Social Responsibility: The obligations and accountability assumed in carrying out actions or ideas on behalf of others.Retrospective Studies: 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.Games, Experimental: Games designed to provide information on hypotheses, policies, procedures, or strategies.Hospital-Physician Joint Ventures: A formal financial agreement made between one or more physicians and a hospital to provide ambulatory alternative services to those patients who do not require hospitalization.Electronic Prescribing: The use of COMPUTER COMMUNICATION NETWORKS to store and transmit medical PRESCRIPTIONS.Conservation of Natural Resources: The protection, preservation, restoration, and rational use of all resources in the total environment.Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions.Game Theory: Theoretical construct used in applied mathematics to analyze certain situations in which there is an interplay between parties that may have similar, opposed, or mixed interests. In a typical game, decision-making "players," who each have their own goals, try to gain advantage over the other parties by anticipating each other's decisions; the game is finally resolved as a consequence of the players' decisions.Breathing Exercises: Therapeutic exercises aimed to deepen inspiration or expiration or even to alter the rate and rhythm of respiration.Organizational Objectives: The purposes, missions, and goals of an individual organization or its units, established through administrative processes. It includes an organization's long-range plans and administrative philosophy.Behavior, Animal: The observable response an animal makes to any situation.Health Facilities, Proprietary: Health care institutions operated by private groups or corporations for a profit.Reminder Systems: Systems used to prompt or aid the memory. The systems can be computerized reminders, color coding, telephone calls, or devices such as letters and postcards.Telephone: An instrument for reproducing sounds especially articulate speech at a distance. (Webster, 3rd ed)
BCBSMA has non-profit status as a health insurer and has 2.8 million policyholders, the largest number of any insurer in ... Enthoven AC (May 2011). "Reforming Medicare by reforming incentives". N. Engl. J. Med. 364 (21): e44. doi:10.1056/NEJMp1104427 ... Anonymous (January 2011). "An insurer adds a new twist to an old idea". Health Aff (Millwood). 30 (1): 62. doi:10.1377/hlthaff. ... permanent dead link] Robert Weisman (October 21, 2011). "After a rich severance deal, insurer issues refunds". The Boston Globe ...
Thus, the insured have a financial incentive to avoid making a claim. Moral hazard has been studied by insurers and academics; ... First, the agent may be risk-averse, so there is a trade-off between providing the agent with incentives and insuring the agent ... The agent may have an incentive to act inappropriately (from the viewpoint of the principal) if the interests of the agent and ... After selling the loans, the originators bore none of the risk so there was little to no incentive for the originators to ...
Allows the private insurers to sell benefits not medically necessary, such as cosmetic surgery benefits. Sets forth methods to ... Prohibits financial incentives between HMOs and physicians based on utilization. Establishes the USNHC Trust Fund to finance ... Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act ...
There is little that individual insurers can do to alter overall supply-and-demand conditions. But insurers can set up internal ... 7. Get smarter with underwriter and manager incentives. Incentives for key staff should be structured to reward efficient ... Insurers need to be prepared to walk away from markets when prices fall below a prudent, risk-based premium. 2. Invest in the ... Insurers must push for continuous improvement of these tools based on the latest science around issues such as climate change, ...
However, introducing improved incentives through a more competitive environment among providers and insurers has proved ... Some, such as the Netherlands, allow private for-profit insurers to participate. Almost every major country that has a publicly ... the rights of access to which are subject to contractual obligations between an insurer (or his sponsor) and an insurance ... have improved the microeconomic incentives facing providers. ...
Additionally, providing incentives to encourage appropriate use may address some concerns but could also inadvertently ... Policy could increase data use by incentivizing insurers and providers to increase population tracking, which improves outcomes ... To enforce compliance with regulations, the government can use incentives similar to those under the ACA for Medicare and ... The ACA has provided Medicare and Medicaid incentives to providers to adopt EHR's. Large healthcare institutions also have ...
In that situation, the insurer's interests conflict with the insured's interests, because the insurer has an incentive to not ... This option generally allows the insurer to insulate itself from a bad faith claim, in the sense that an insurer acts in good ... The standard judicial test is that an insurer must settle a claim if a reasonable insurer, notwithstanding any policy limits, ... However, writing such insurance is itself risky for insurers. The California Courts of Appeal have held that primary insurers ...
Eventually, the higher prices will push out all non-smokers and the insurer will also be unwilling to sell to smokers. No more ... Smokers will have greater incentives to buy insurance from that company and will purchase insurance in larger amounts than non- ... The insurer screens customers to distinguish high-risk individuals from low-risk individuals. For instance, medical insurance ... This increase means the insurer will spend more on policy payments, leading to losses. In response, the company may increase ...
... including imposing copayments on patients and limiting physician incentives to provide costly care. Insurers often compete by ... Insurers must cope with adverse selection which occurs when they are unable to fully predict the medical expenses of enrollees ... Insurers use several techniques to limit the costs of moral hazard, ... physician incentive to medicate without specialist referral. Evers et al. (2009) have suggested that improvements could be made ...
This incentive can lead to fraudulent practices such as billing insurers for treatments that are not covered by the patient's ... Though insurers try to fight fraud, some will pay suspicious claims anyway; settling such claims is often cheaper than legal ... The best that can be done is to provide an estimate for the losses that insurers suffer due to insurance fraud. The Coalition ... This allows fraudsters to make profits by destroying their property because the payment they receive from their insurers is of ...
Tanase's article noted that Japanese insurance companies, compared to their American counterparts, have much lower incentives ... payments to lawyers equalled 47 percent of the total personal injury benefits paid by liability insurers to third-party ... and also established compulsory loss-sharing arrangements among motor vehicle insurers. This made the insurance system more ...
The total set of risk factors used by insurers to rate their premiums can be divided in two subsets: the subset of risk factors ... The system of risk equalization plays a crucial role in order to reduce the incentives for risk selection in this new Dutch ... Then, the Subsidy Fund is called a Risk Equalization Fund (REF). An insurer receives a relatively large sum of subsidies by the ... See Health care in the Netherlands) Dutch insurers are not allowed to risk-rate their premiums. In practice, the sponsor often ...
This gives employers an incentive to report all claims to their insurers, rather than trying to pay for medical-only claims out ... The rating is a method used by insurers to determine pricing of premiums for different groups or individuals based on the group ... Errors in experience modifiers can occur if inaccurate information is reported to a rating bureau by a past insurer of an ... The experience rating approach uses an individual's or group's historic data as a proxy for future risk, and insurers adjust ...
The law prohibits insurers from capping their liability for a person's health care needs, a move which is expected to rectify ... Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they ... Private insurers in the UK only cover acute care from specialists. They do not cover generalist consultations, pre-existing ... Thus insurers with high payouts will receive more from the regulator than those with low payouts. ...
The Volpp study found that dieters with incentives were five times more likely to reach their goal. How incentives are ... Private medical insurer that rewards clients' employees for healthy behaviour with Vitality points for shopping. RedBrick ... Weight Wins (UK): Provides personal incentive plans via employers. Providers of health incentive programmes to corporate ... even when the incentive value was as high as $550. Among the current providers of weight loss incentives for consumers are: ...
With the launch of the FreedomPay Commerce Platform in 2009, its customers can now deliver those incentives in real time to ... Aetna, Inc., the world's largest insurer, acquired Intelihealth in 1999. The FreedomPay platform is a commerce solution ... Using that data FreedomPay launched a cloud-based platform as a service (PaaS) and a first generation incentives platform. This ... Users within the merchant-chosen distance can see active incentives within the mobile application, and apply them to their bill ...
Insurers have to offer a universal package for everyone over the age of 18 years, regardless of age or state of health - it's ... Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they ... Indeed, health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks ... Health insurers also monitored waiting times (which hospitals must publish), and assisted patients with finding the shortest ...
... "in part because there is no profit incentive for private insurers." Lightman also notes that the in-kind delivery system ... These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, health ... In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who ...
... they intended to give it only in exchange for referrals from members of the insurer - where a patient is given some advance ... incentive to choose them. Silent PPOs typically do not make referrals, but provide access to the discount after the service was ...
One of the goals of the bill is to "de-link research and development incentives from product prices" along with getting rid of ... Sanders believes that these bills will save private insurers, Medicaid, and other government assistance programs money. ... Offering a prize as opposed to a patent, according to Stiglitz, would address the lack of incentive for problems such as ... The nature of patents makes them an incentive so long as the product being invented is distributed to consumers through markets ...
... company in integrating aspects of behavioral economics into their insurance model and aligning incentives between the insurer ...
In this effort, insurers employ physicians to review the actions of other physicians and detect overuse. Utilization review has ... Fee-for-service is a large incentive for overuse because health care providers (such as doctors and hospitals) receive revenue ... Physicians' decisions are the proximate cause of unnecessary care, though the potential incentives and penalties they face can ... To protect themselves from legal prosecution physicians have an incentive to order clinically unnecessary tests, or tests of ...
Right to Shop is an FGA program that provides incentives for patients to shop for lower-cost, higher-value healthcare services ... into one comprehensive concept that allows patients to know the average price for their county from their insurer for specific ... Volunteer Care is a policy proposal that states should offer incentives to healthcare professionals (doctors, nurses, dentists ...
The fee-for-service (FFS) physician incentive structure makes it easier for SID to occur since it rewards the physician for ... As physician owned surgical centers and specialty hospitals increasingly use imaging services, insurers question the cost ... Jonathan Gruber and Maria Owings looked at the relationship between physician financial incentives and cesarean section ... physician incentives and practices. Increased levels and costs of technology, as well as changing practices and the lack of ...
... then there is little incentive for customers to claim, benefiting the insurer. Excess insurance (also known as excess reduction ...
Are you buying private medical insurance? Association of British Insurers *^ "N. generation surgery-centers to carry out ... Insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to ... Insurers are required to offer insurance to everyone, regardless of age or medical condition. They are not allowed to make a ... The law prohibits insurers from capping their liability for a person's health care needs, a move expected to reduce medically ...
CareFirst to give incentives to primary care physicians. Maryland Health commission approves insurers plan. ...
A long-awaited report on orphan drugs in Europe suggests incentives to pharma need change By Ed Silverman ... Pharmalittle: FDA approves another Duchenne muscular dystrophy drug; European orphan drug incentives questioned By Ed Silverman ... ALS patients losing time and hope as they wait for insurers to cover a pricey new drug. ... while critical of insurers, also refers to the underlying price that is causing problems for some patients. I have updated the ...
Mortage servicers perverse incentives Next Post » Newspaper self-cannibalization datapoint of the day ... The term of art for an insurer not paying an insureds medical bills is "rescission": the insurer rescinds the policy rather ... the insurer can get out of your insurance contract. Its particularly nasty in practice because the insurer does not ... In a Congressional hearing, the CEO of a health insurer admitted that he did not know what several of the conditions listed on ...
Health Reform Act that would allow behavioral health providers to receive federal incentive money to implement EHRs-incentives ... Behavioral health providers shorted by insurers November 30, 2017 Pages. *1. *2 ...
The insurance process was not easy back then with one insurer.. I must also say that Olive could probably ease up a bit on the ... First-Time Home Buyer Incentive Now Available. Steve Huebl. September 3, 2019. ... The fact that insurers today offer similar products is merely one perspective. It does not address the future consequences of ... The "private" insurers, Should be forging ahead wiht innovation and finetuning of their delivery instead of whining that things ...
Perverse incentives for the health insurers. Because of community rating, insurers have an incentive to attract the healthy and ... Perverse incentives for the health insurers. Because of community rating, insurers have an incentive to attract the healthy and ... Perverse incentives for employers. Self-insured companies (which employ about 75 percent of workers with health insurance) will ... Perverse incentives for employers. Self-insured companies (which employ about 75 percent of workers with health insurance) will ...
HHS to give out $333M in incentive payments to nursing homes. HHS will give out $333 million in incentive payments to nursing ... Insurers have taken significant financial hits on Affordable Care Act marketplace plans due to enrollees who have been sicker ... Insurers have strived to negotiate prices with pharmaceutical manufacturers, but these efforts can also alienate some consumers ... rather than focus solely on rising premiums as insurers go through rate request processes this summer, according to the article ...
BCBSMA has non-profit status as a health insurer and has 2.8 million policyholders, the largest number of any insurer in ... Enthoven AC (May 2011). "Reforming Medicare by reforming incentives". N. Engl. J. Med. 364 (21): e44. doi:10.1056/NEJMp1104427 ... Anonymous (January 2011). "An insurer adds a new twist to an old idea". Health Aff (Millwood). 30 (1): 62. doi:10.1377/hlthaff. ... permanent dead link] Robert Weisman (October 21, 2011). "After a rich severance deal, insurer issues refunds". The Boston Globe ...
Insurer offers incentive. BlueCross and BlueShield of Kansas joined the effort in 2013. The insurer offers incentives for ... The idea is that doctors will respond to financial incentives, benefiting the families under their care and the system as a ...
Require insurers to cover breast cancer treatment.. Rangel co-sponsored Breast Cancer Patient Protection Act Congressional ... Employer Incentive Program:. Employers providing drug coverage equal to or better than the Medicare coverage receive an ... Rangel co-sponsored limiting anti-trust lawsuits on health plans and insurers OFFICIAL CONGRESSIONAL SUMMARY: *Delineates the ... Limit anti-trust lawsuits on health plans and insurers.. ... incentive payment to maintain such coverage. Source: CPC Press ...
Require insurers to cover breast cancer treatment.. Nadler co-sponsored Breast Cancer Patient Protection Act Congressional ... Employer Incentive Program:. Employers providing drug coverage equal to or better than the Medicare coverage receive an ... Nadler co-sponsored limiting anti-trust lawsuits on health plans and insurers OFFICIAL CONGRESSIONAL SUMMARY: *Delineates the ... A pilot project would begin in 2010 in which Medicare would compete with private insurers to provide coverage for doctors and ...
Thus, the insured have a financial incentive to avoid making a claim. Moral hazard has been studied by insurers and academics; ... First, the agent may be risk-averse, so there is a trade-off between providing the agent with incentives and insuring the agent ... The agent may have an incentive to act inappropriately (from the viewpoint of the principal) if the interests of the agent and ... After selling the loans, the originators bore none of the risk so there was little to no incentive for the originators to ...
... have completed their joint review of 16 New Zealand life insurers. This review follows the regulators bank review published in ... Some insurers did little or nothing to assess a products ongoing suitability for customers.. • Sales incentives structures ... All 16 life insurers will receive individual feedback. By 30 June 2019, each insurer will need to report back to the regulators ... FMA and RBNZ report on life insurer conduct and culture. Tuesday, 29 January 2019, 1:53 pm. Press Release: Joint Media ...
... to align incentives for pharmacies and health insurers. WPQC currently comprises 187 pharmacies and 340 pharmacists accredited ... 8) The ASTHO learning collaborative required that state public health agencies partner with private health insurers to improve ... When patient, pharmacist, and payer incentives are aligned, sustainable programs with demonstrable benefits are created. ... Collaborative programs between pharmacists, public health, and health insurers contextualize and localize existing evidence ...
Insurers, employers offer incentives to promote healthful.... October 25, 2011. *U.S. employers expand health benefits coverage ...
Insurers, employers offer incentives to promote healthful.... October 25, 2011. *Shakeout Brings Financial Restraint. March 28 ... Humana, a Louisville, Ky.-based health insurer, said the Defense Department agreed to reopen bidding on a contract to provide ...
The marketing incentive percentage will remain the same. However, through a separate document the National Flood Insurance ... National Flood Insurance Program (NFIP); Assistance to Private Sector Property Insurers, Availability of FY2011 Arrangement. A ... private sector property insurers issue flood insurance policies Start Printed Page 42767and adjust flood insurance claims under ... The WYO insurers receive an expense allowance and remit the remaining premium to the Federal Government. The Federal Government ...
Dinallo could face resistance from banks that do not have significant exposure to the guarantors and thus have less incentive ... 4. Complexity due to differing situations at each insurer. Related to, but separate from point 1. is that each insurer has a ... Worrisome Signs for the Bond Insurer Bailout. Posted on January 24, 2008. by Yves Smith I hate to be a nay-sayer, and I want to ... He is empowered to deal only regarding MBIA (not certain if any of the smaller bond insurers are under his purview), and has no ...
After enrollment, the insurers have a perverse incentive to over-provide to the healthy (to keep the ones they have and attract ... After enrollment, the insurers have a perverse incentive to over-provide to the healthy (to keep the ones they have and attract ... Dont blame the insurers. They are doing the best they can, given the incentives created by Obamacare rules and regulations. ... Dont blame the insurers. They are doing the best they can, given the incentives created by Obamacare rules and regulations. ...
A New Approach to Exercise Incentives. Many health insurers offer rewards to incentivize exercise. Discovery Insurance, a South ... Incentives and physical activity: An assessment of the association between Vitalitys Active Rewards with Apple Watch benefit ... RAND researchers compared this program with one of Discoverys traditional wellness incentives. They found that it was linked ...
... the relationship between premiums and safety incentives; (3) roles of insurers, state agencies and third party administrators ... Workers compensation insurer risk control systems: Opportunities for public health collaborations. The purpose of this study ... The effectiveness of insurer-supported safety and health engineering controls in reducing workers compensation claims and ... Both state-based and private insurers were surveyed about the collection and use of industrial hygiene data for risk reduction ...
Quality and efficiency incentives are aligned across all insurers.. The FQHC/APCP model is testing effects on patient care and ... This program is also seeking agreements with other insurers, including commercial insurers and state Medicaid agencies, to join ... and implement quality and efficiency incentives that are aligned across all insurers. Participating payers provide practices ... 2 of 31 insurers discontinued participation in 2013, with no change in 2014.c, g. Participation. The number of FQHC medical ...
... the insurers really have a major incentive. Youre going to see a lot of direct-to-consumer advertising from insurers to young ... Theyre the ideal demographic for an insurer.. MARTIN: Many people might have seen that there have been some ads posted on ... Not only through outreach from the state exchanges and the White House, but also from insurers, from hospitals, from pharmacies ...
3. Perverse Incentives for Insurers. Problem: The ACA creates perverse incentives for insurers and employers (worse than under ... Top tags: Uncategorized / Policy / Startups / Policy/Politics / Quality / The ACA / Physicians / Health 2.0 / Pharma / Insurers ... 4. Perverse Incentives for Individuals. Problem: The ACA allows individuals to remain uninsured while they are healthy (paying ... Of course the part you miss, is the office staff time, hence money, it takes to deal with private insurers to get pre-approvals ...
Health insurers give people incentives to use mail order pharmacy. They charge lower co-payments and allow up to three months ... Recently, health insurers have even begun to refuse to pay for certain chronic medications if you dont get them from a mail ...
  • The Financial Markets Authority (FMA) and Reserve Bank of New Zealand (RBNZ) have completed their joint review of 16 New Zealand life insurers. (scoop.co.nz)
  • Life insurers have been complacent about considering conduct risk, too slow to make changes following previous FMA reviews and not sufficiently focused on developing a culture that balances the interests of shareholders with those of customers. (scoop.co.nz)
  • The regulators found extensive weaknesses in life insurers' systems and controls, with weak governance and management of conduct risks across the sector and a lack of focus on good customer outcomes. (scoop.co.nz)
  • Public trust in life insurers could be eroded unless boards and senior management transform their approach to conduct risk and achieve a customer-focused culture. (scoop.co.nz)
  • All 16 life insurers will receive individual feedback. (scoop.co.nz)
  • Life insurers can provide cash-flow through annuities for old-age financial requirements. (financialexpress.com)
  • The title of the '492 patent is "Providing Consumers With Incentives For Healthy Eating Habits," but when does a system move from merely a personal incentive for which one can opt in to a system that may be imposed by the government or an employer? (groklaw.net)
  • This strikes me as a good thing, not a bad thing, i.e., an employer providing incentives, such as rebates, to employees to live and eat healthier, since it still provides the employee the choice to opt in or opt out. (groklaw.net)
  • I'm much more worried about improper sharing of medical information with the employer, not the insurer. (metafilter.com)
  • Some insurers will offer a guaranteed issue to employer groups. (answers.com)
  • Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He'd use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. (californiahealthline.org)
  • Shady providers looking to cut corners have been known to unlawfully conduct MRIs without a doctor present, but bill insurers nonetheless. (nicb.org)
  • Since 2013, however, some of the largest deals were struck to help insurers expand up and down the health care value chain. (bcg.com)
  • The aim was to help insurers better deliver personalized, whole-person care, control rising health care spending, and give consumers more affordable plans and greater choice. (bcg.com)
  • Our solutions help insurers provide more precise policies while encouraging safer drivers and roadways. (sas.com)
  • Expanding into these markets allows insurers to access faster growth and diversify their portfolios in order to hedge risks more effectively. (bcg.com)
  • The present invention provides a method of providing a monetary incentive to a health care provider, typically a physician, responsible for treatment decisions of a patient with a condition during an episode of care. (google.com)
  • And, if the total treatment is less than the baseline value, then a monetary incentive can be provided to the provider based upon that episode of care. (google.com)
  • The research also stresses the relationship between monetary incentive schemes and individual behaviour as well as the influence of additional information schemes. (repec.org)
  • However, CMMI-rather than the state-is playing the major role in convening insurers to combine resources to provide care management fees to medical homes, provide data feedback on patient utilization, and implement quality and efficiency incentives that are aligned across all insurers. (kff.org)
  • Of course it would be possible, through economic incentives, to induce personnel to switch to mental health from some other health care field. (ncpa.org)
  • 2 Health insurers that support the medical home model typically provide monthly care management fees or other resources to the practice to support certain activities. (kff.org)
  • Recognizing that teen drivers are a special group, many auto insurers have programs that feature contracts between beginners and their parents, educational videos, online surveys, and practice driving logs to encourage safe habits. (iihs.org)
  • Are these incentive programs 'good for integrative practice? (healthy.net)
  • These statistics have prompted calls for expansions of mental health training by US medical schools, and for programmes that provide incentives for specialists to practice in underserved areas. (weforum.org)
  • Ultimately insurers need to take responsibility for whether customers are experiencing good outcomes from their products, regardless of how they are sold. (scoop.co.nz)
  • I spoke to one insurer and they said, an appeal can be filed but it doesn't mean it would ultimately be approved - it's their discretion. (healingwell.com)
  • With the right incentives and workflows in place, a primary care physician who can talk to a patient about the need to stop smoking could also provide basic mental health counselling and screen for suicide risk. (weforum.org)
  • Many of the concerns about the aggressive claims culture in the rest of the UK relate to the fact that they removed legal aid for personal injuries some years ago, and put in place incentives like success fees to encourage no-win no-fee arrangements with lawyers instead. (scotsman.com)
  • Does your insurer encourage a healthy lifestyle? (aegon.com)
  • Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs - ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee. (thehealthcareblog.com)
  • Mark Carney, Governor of the Bank of England, has referred to "the tragedy of the horizon": the impact of climate change is felt far in the future, while the costs are immediate, and thus we lack the right incentives to fix the problem. (bis.org)
  • Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.'s parked outside. (nytimes.com)
  • The hospitals have no incentive to keep costs down since most are not-for-profit entities. (wickedlocal.com)
  • The technology reduces medication errors, makes it easier for patients to obtain prescription medicine, saves time at doctors' offices and pharmacies, and increases compliance with insurers' preferences for certain medications to hold costs down. (fcw.com)
  • Oncologists and insurers have been devising new incentives for doctors to improve patient care while lowering costs. (reuters.com)
  • Since these insurers compete for customers, they have every incentive to keep costs low. (altoonamirror.com)
  • Bars insurers from offering incentives to doctors and hospitals to deny care. (votesmart.org)
  • In the latest experiment, UnitedHealth, the largest U.S. health insurer, gave participating doctors an upfront payment to cover a patient's full course of treatment, rather than reimburse them for each individual medical service such as chemotherapy. (reuters.com)
  • The program had hoped for the opposite effect, expecting that by ending payments for each chemotherapy treatment doctors would have less incentive to overuse it. (reuters.com)
  • However, parity legislation is more likely to make the current system worse, by imposing an arbitrary rule that would make it even more difficult for doctors, patients and insurers to find better ways of delivering health care. (ncpa.org)
  • In Scotland, although lawyers take on no-win no-fee cases, the payment incentives are less lucrative. (scotsman.com)
  • Here is basic economics: all of the dollars spent on services of questionable value, spent on services that patients could have easily afforded on their own, and spent on services that charge much more than what was necessary are dollars not available to insurers to pay for Ms. Wanderlich's brain scan. (forbes.com)
  • Requires insurers to allow patients to go to the nearest emergency facility, in case of an emergency, regardless of their coverage plan. (votesmart.org)
  • He's stepped back from that assessment (see " Pride in Workmanship Outweighs Incentives "), but there's no denying the lure of reward, as well as the converse aversion to penalty, in human interaction. (managedcaremag.com)
  • They will need to provide an action plan that the regulators will review, including how they will address incentives based on sales volumes for internal staff and commissions for intermediaries. (scoop.co.nz)
  • Here, a provider bills an insurer for an MRI, but did not provide the service. (nicb.org)
  • We believe that success in the current environment requires that insurers understand the key trends reshaping the industry and then make strategic choices about how-and, equally important, where-to operate. (bcg.com)
  • A participant on a winning team was eligible as follows: $50 if he or she met the goal (individual incentive), $50 only if all four team members met the goal (team incentive), or $20 if he or she met the goal individually and $10 more for each of three teammates that also met the goal (combined incentive). (springer.com)
  • In 2018, the Pharmacy Society of Wisconsin, the Wisconsin Division of Public Health, and NeuGen, a not-for-profit health insurer, piloted a pharmacist-led medication therapy management program for people with hypertension in partnership with 8 community pharmacies. (cdc.gov)
  • Health insurers give people incentives to use mail order pharmacy. (philly.com)
  • Incentives based on outcome, as opposed to incentives based on effort, are hugely controversial because weight loss is much easier for some people than for others. (slate.com)
  • The report also warned that access to justice south of the Border could be impaired by UK government proposals to switch whiplash claims between £1,000 and £5,000 to the small claims court, particularly for people who do not feel confident to represent themselves against insurers who will use legal professionals to contest claims. (scotsman.com)
  • You could even drill as far down as pharmacy incentives to make sure that a certain percentage of people who are on a certain drug, like a statin, actually receive the drug," says Boress. (managedcaremag.com)
  • Another major insurer excludes my gastro (so that's not an option for me) and the 3rd insurer has a 'step therapy' process and seems most likely to eventually approve the asacol at but almost double the premium. (healingwell.com)
  • We used claims' data gathered by a major Swiss health insurer, over a period of six years and involving 160 000 insured adults. (repec.org)
  • The premium has been determined based on annual premium data for defined coverages (liability, comprehensive and collision) from a major insurer. (edmunds.com)
  • In a Congressional hearing, the CEO of a health insurer admitted that he did not know what several of the conditions listed on his company's application were. (reuters.com)
  • By contrast, here there are more institutions, both the insurers and the parties potentially at risk, more uncertainty as to total liability and how it might play out over time, and a longer time frame for liquidation, assuming the insurers are put in run-off mode. (nakedcapitalism.com)
  • The term of art for an insurer not paying an insured's medical bills is "rescission": the insurer rescinds the policy rather than pay the bills. (reuters.com)
  • In the first year of implementation, AQCs resulted in medical cost savings in all participating provider groups, but the incentives that BCBSMA paid to providers are estimated to have made up for the savings. (wikipedia.org)
  • Calls for claims to be reviewed by external review boards and independent medical specialists to determine whether an insurer should have paid for a particular service and what compensation they may owe to the patient. (votesmart.org)
  • Some companies or their insurers legally avoid paying injury claims, while their injured undocumented workers lose their jobs, get arrested, face jail and deportation, and must pay their own medical bills. (sun-sentinel.com)