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8.
NCSL Legisbrief ; 26(46): 1-2, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30562875

RESUMO

(1) Section 1332 of the Affordable Care Act (ACA) allows states to apply for reinsurance waivers--which can alter certain ACA requirements for health insurance plans--to help make coverage more affordable. (2) As of 2017, more than 10 million people were enrolled in a health insurance plan in the individual market. (3) To date, seven states have successfully adopted reinsurance programs at minimal cost to the state and have seen premiums reduced as much as 20 percent annually.


Assuntos
Controle de Custos/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Controle de Custos/legislação & jurisprudência , Custo Compartilhado de Seguro , Governo Federal , Humanos , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Risco Ajustado , Governo Estadual , Estados Unidos
9.
Artigo em Inglês | MEDLINE | ID: mdl-30551561

RESUMO

Background: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients' information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 (p < 0.001), ¥105.39 (p < 0.001) and ¥241.2 (p < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% (p < 0.001), 2.18 days (p < 0.001), and 1.5% (p < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 p < 0.001) and readmission rate growth (3.3% p < 0.001) and lower reimbursement fee reduction (¥150.16 p < 0.001) and length of stay growth (1.24 days p < 0.001) than those at the township level. Conclusions: Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients' economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.


Assuntos
Controle de Custos/normas , Eficiência Organizacional/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , China , Controle de Custos/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Modelos Econômicos , Qualidade da Assistência à Saúde/normas
13.
Manag Care ; 26(9): 8-9, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-29068301

RESUMO

States are facing unsustainable health care costs, and prescription drugs for Medicaid beneficiaries and state employees are the reason. From 2009 to 2013, the consumer price index (CPI) for prescription drugs increased about 11% vs. 8% for the overall CPI.


Assuntos
Custos de Medicamentos/legislação & jurisprudência , Regulamentação Governamental , Controle de Custos/legislação & jurisprudência , Maryland , Estados Unidos
14.
Fed Regist ; 82(188): 45511-4, 2017 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-28990743

RESUMO

The Health Resources and Services Administration (HRSA) administers section 340B of the Public Health Service Act (PHSA), known as the "340B Drug Pricing Program" or the "340B Program." HRSA published a final rule on January 5, 2017, that set forth the calculation of the ceiling price and application of civil monetary penalties. The final rule applied to all drug manufacturers that are required to make their drugs available to covered entities under the 340B Program. On August 21, 2017, HHS solicited comments on further delaying the effective date of the January 5, 2017, final rule to July 1, 2018 (82 FR 39553). HHS proposed this action to allow a more deliberate process of considering alternative and supplemental regulatory provisions and to allow for sufficient time for additional rulemaking. After consideration of the comments received on the proposed rule, HHS is delaying the effective date of the January 5, 2017, final rule, to July 1, 2018.


Assuntos
Custos de Medicamentos/legislação & jurisprudência , Controle de Custos/legislação & jurisprudência , Programas Governamentais/legislação & jurisprudência , Humanos , Legislação de Medicamentos/economia , Estados Unidos
15.
Value Health Reg Issues ; 13: 44-49, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29073987

RESUMO

Slovak law sets clear rules and timelines in the process of approving the price and reimbursement of drugs. During the last decade, the Ministry of Health adopted several cost-containment measures in the price and reimbursement policy. The most effective measures were the implementation of the external referencing of drug prices in 2008 and the reimbursement law in 2011. The new act introduced several regulations such as making stricter rules for the referencing of prices, setting cost per quality-adjusted life-year threshold, and defining new rules for the setting of reimbursements. On one side, implementation of these measures helped to achieve visible cost savings, but, on the other side, cost-containment policies have had some unintended consequences. In recent years, Slovakia has been facing a decreased availability of drugs because of parallel exports. As a result of the government's effort, Slovakia is the only country in the European Union that implemented a legal ban on the re-export of medicines. During the decade before 2011, many innovative drugs were included in the reimbursement system. Because of stricter legal conditions introduced in 2011, there has been a gradual shift in reimbursing innovative drugs from the standard reimbursement system to reimbursement by way of exceptions of health insurance companies. Recently, there has been an ongoing discussion on possible changes to the reimbursement law.


Assuntos
Comércio/legislação & jurisprudência , Política de Saúde , Mecanismo de Reembolso/legislação & jurisprudência , Avaliação da Tecnologia Biomédica , Comércio/economia , Controle de Custos/legislação & jurisprudência , Assistência à Saúde , Custos de Medicamentos/legislação & jurisprudência , Farmacoeconomia , Humanos , Mecanismo de Reembolso/economia , Eslováquia , Avaliação da Tecnologia Biomédica/organização & administração
16.
Value Health Reg Issues ; 13: 55-58, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29073989

RESUMO

BACKGROUND: The legal background of the current pharmaceutical pricing and reimbursement (P&R) setting in the Czech Republic is based on Act 48/1997. Since 2008, the P&R process has been coordinated by the State Institute for Drug Control, which is the main stakeholder in the decision-making process; marketing authorization holders and insurance funds (IFs) also participate. OBJECTIVES: To present a general overview of the current Czech health care system and its P&R principles. METHODS: The study used publicly available sources concerning health care, mainly acts related to public health care and public health care insurance, public notices related to P&R setting, and statistical data. RESULTS: Regulation covers P&R. The official price represents the highest exfactory price, which cannot be exceeded. It is calculated as the mean of the three lowest prices in the European Union reference basket. Reimbursement is based on the lowest price per daily dose across the whole European Union. For reimbursement, products can be clustered into jumbo groups (mutually interchangeable), stated by law. In each group, reimbursement is set at the lowest price of any substance within the group. For highly innovative drugs a temporary reimbursement can be granted for a period of 3 years. During the administrative proceeding, efficacy, safety, cost-effectiveness, and budget impact are assessed. The cost-effectiveness principles are aligned with the guidelines of the National Institute for Health and Clinical Care Excellence, preferring cost-utility analyses. The willingness-to-pay threshold has been implicitly set at 3 times the gross domestic product per capita. Products exceeding this threshold are subject to further risk-sharing negotiations. Budget impact is becoming increasingly important mainly for IFs. The IFs have recently introduced their own methodology, which allows only products with a budget impact in the range of CZK16 to CZK48 million (CZK = Czech koruna; ∼€600,000 to €1.8 million) to enter the system. Products exceeding this budget impact have to negotiate risk-sharing schemes, mainly further discounts and/or budget caps. CONCLUSIONS: The Czech pricing and reimbursement system is rather complex, taking into account clinical evidence, cost-effectiveness and budget impact. The strict regulations are a result of financial scarcity.


Assuntos
Comércio/legislação & jurisprudência , Controle de Custos/legislação & jurisprudência , Regulamentação Governamental , Preparações Farmacêuticas , Avaliação da Tecnologia Biomédica/métodos , República Tcheca , Assistência à Saúde , Política de Saúde , Humanos , Preparações Farmacêuticas/economia , Mecanismo de Reembolso/economia
17.
Health Aff (Millwood) ; 36(9): 1564-1571, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28874482

RESUMO

Provider market power is a powerful driver of high health care costs in the United States. Despite decades of antitrust litigation and regulatory interventions, the problem has worsened and threatens to undermine the benefits of market-based policies. A critical but neglected challenge for all health care reform proposals relying on market competition to address costs is finding effective tools to address the extant market power of dominant hospitals, hospital systems, and many specialty physician practices. This article analyzes the principal market-oriented approaches that have been used in the past and proposed for the future. It argues that antitrust law has an important but constrained role to play and has proved to be especially inept in dealing with extant market power. It finds serious deficiencies in the conduct decrees imposed by some courts and in open-ended regulatory regimes such as those established by Certificate of Public Advantage laws. Although not without administrative complications, policies that target providers who possess market power by capping prices may be the most effective means to control costs and retain the benefits of a competitive delivery system.


Assuntos
Leis Antitruste , Controle de Custos/métodos , Competição Econômica/legislação & jurisprudência , Marketing de Serviços de Saúde/economia , Comércio , Planos Médicos Alternativos , Controle de Custos/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Marketing de Serviços de Saúde/legislação & jurisprudência , Estados Unidos
19.
South Med J ; 110(4): 249-254, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28376520

RESUMO

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models. We conclude with suggestions for how to influence physician behavior through education and payment reform so that their behavior aligns with alternative care models to control spending in the future.


Assuntos
Controle de Custos/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Reembolso de Incentivo , Controle de Custos/legislação & jurisprudência , Educação Médica , Gastos em Saúde , Humanos , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/organização & administração , Padrões de Prática Médica , Reembolso de Incentivo/organização & administração , Estados Unidos
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