Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.434
Filtrar
1.
BMC Health Serv Res ; 22(1): 45, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-35000585

RESUMO

BACKGROUND: Much of spatial access research measures the proximity to health service locations. We advance this research by focusing on whether health service funding is within walkable reach of neighborhoods with high hardship. This is made possible by a new administrative data source: financial contracts data for those human services that are delivered by nonprofits under contract with the government. METHODS: In a prototypical spatial access study we apply a classic 2-step floating area catchment model for walkable network access to analyze 2018 data about contracted nonprofit health services funded by the Chicago Department of Public Health (CDPH). CDPH collected the data for the purpose of this study. RESULTS: We find that the common container approach of aggregating contract amounts by provider headquarter locations in a given area (ignoring satellite service sites) underestimates the share of funding that goes to Chicago neighborhoods with higher hardship. Once service sites and spatial access are taken into account, a larger share of CDPH funds was found to be within walkable reach of Chicago's high hardship areas. This was followed by low hardship areas (which could be driven by more headquarter locations there that do serve areas throughout the city). Medium hardship areas trail both, perhaps warranting closer attention. We explore these results by program type and neighborhood with a spatial decision support system developed for the health department. CONCLUSIONS: The typical approach for analyzing human service contracts based on headquarters is misleading -- in fact, we find that results are reversed when service sites and walkable access are taken into account. This prototype provides an alternative framework for avoiding these misleading results.


Assuntos
Contratos , Acesso aos Serviços de Saúde , Serviços de Saúde , Humanos , Características de Residência , Análise Espacial
2.
Rofo ; 193(11): 1360-1362, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34710932
3.
Radiology ; 300(3): 506-511, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34227885

RESUMO

Out-of-network (OON) balance billing, commonly known as surprise billing but better described as a surprise gap in health insurance coverage, occurs when an individual with private health insurance (vs a public insurer such as Medicare) is administered unanticipated care from a physician who is not in their health plan's network. Such unexpected OON care may result in substantial out-of-pocket costs for patients. Although ending surprise billing is patient centric, patient protective, and noncontroversial, passing federal legislation was challenging given its ability to disrupt insurer-physician good-faith negotiations and thus impact in-network rates. Like past proposals, the recently passed No Surprises Act takes patients out of the middle of insurer-physician OON reimbursement disputes, limiting patients' expense to standard in-network cost-sharing amounts. The new law, based on arbitration, attempts to protect good-faith negotiations between physicians and insurance companies and encourages network contracting. Radiology practices, even those that are fully in network or that never practiced surprise billing, could nonetheless be affected. Ongoing rulemaking processes will have meaningful roles in determining how the law is made operational. Physician and stakeholder advocacy has been and will continue to be crucial to the ongoing evolution of this process. © RSNA, 2021.


Assuntos
Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Radiologia/economia , Radiologia/legislação & jurisprudência , Contratos/economia , Contratos/legislação & jurisprudência , Dedutíveis e Cosseguros/economia , Financiamento Pessoal/economia , Humanos , Administração da Prática Médica/economia , Administração da Prática Médica/legislação & jurisprudência , Mecanismo de Reembolso/economia , Estados Unidos
4.
Environ Sci Pollut Res Int ; 28(43): 61707-61722, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34189690

RESUMO

To further reduce carbon emissions, supply chain members implement the low-carbon production process and use varieties of contracts to coordinate the channel. Considering the effect of emission reduction, this paper studies a two-echelon supply chain consisting of one manufacturer and one retailer. Two supply chain members dedicate to maximize profits by reducing their products' carbon emissions under two different contracts: the wholesale price contract and the consignment contract. The Stackelberg differential game is used, and the optimal strategies of emission reduction effort, wholesale, and retail price in the two situations are studied. The results show that the Pareto improvement for the whole supply chain can be reached under the consignment contract. However, the specific impacts on the retailer and the manufacturer are different. When consumers have a higher level of environmental awareness, the retailer tends to decrease her proportion of sales revenue under the consignment contract. At that time, choosing the wholesale price contract is more favorable for the retailer. However, as the retailer's proportion of sales revenue becomes lower, the proportion of revenue belonging to the manufacturer will increase. It would be better for the manufacturer to choose the consignment contract.


Assuntos
Carbono , Comportamento do Consumidor , Comércio , Contratos
5.
Am J Manag Care ; 27(6): 242-248, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34156217

RESUMO

OBJECTIVES: To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance: price, charge, cost, and length of stay. STUDY DESIGN: Retrospective observational study using administrative claims data matched with hospital characteristics from the American Hospital Association Annual Survey and the Healthcare Cost Reporting Information System. Data include a balanced panel of 1889 general acute care hospitals for the years 2011 to 2015. METHODS: Inpatient hospital commercial claims data from the Health Care Cost Institute were used to classify claims by contract type based on claim-line billed and allowed charges. Hospital-level performance measures-prices, charges, costs, and length of stay-were analyzed using linear regression models to identify the association of each measure with contract types. All measures were risk adjusted to control for differences in hospital case mix, and the regression specifications controlled for numerous hospital characteristics. RESULTS: Our estimate of the distribution of contract types in the data is similar to estimates using other methods. We find that discounted charges contracts are associated with higher prices and higher costs but not higher charges. Fixed-rate contracts are associated with lower prices as well as lower costs. CONCLUSIONS: Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.


Assuntos
Hospitais , Seguradoras , Contratos , Grupos Diagnósticos Relacionados , Custos de Cuidados de Saúde , Preços Hospitalares , Humanos , Estados Unidos
6.
BMC Health Serv Res ; 21(1): 598, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34162390

RESUMO

BACKGROUND: Patients with schizophrenia spectrum diagnoses have a poor prognostic outlook and rates of recovery. Inpatient care is common, but the decision to initiate such care is not solely up to the patient but also influenced by the healthcare providers. Recent ideas about shared decision-making however challenges this idea. Patient-Controlled Admissions (PCA) refers to a care model where a patient signs a contract that allows the decision for admission into inpatient care to be transferred onto the patient. METHODS: In Region Stockholm's public healthcare PCA was introduced to patients with schizophrenia spectrum diagnoses deemed to have the greatest care needs. Outcomes of a 12-month naturalistic within-group follow-up was analyzed using Wilcoxon signed-rank test. RESULTS: In total, 56 patients fulfilled the study's inclusion criteria, with between 20 to 42 patients having complete data and being able to analyze statistically, depending on the variable. Number of admissions, inpatient days, number of involuntary admissions, and involuntary admission days decreased, but only significantly so for inpatient days, p < .01 (a mean reduction of 11.5 days). Neither self-rated well-being, as assessed using the EQ5D-3L, or a clinician-administered rating of overall health status, the Clinical Global Impression Scale, demonstrated a significant change. CONCLUSIONS: The use of PCA points towards a trend in decreased hospitalization for patients with schizophrenia spectrum diagnoses, although this needs to be explored further in larger samples and over a longer follow-up.


Assuntos
Esquizofrenia , Contratos , Hospitalização , Humanos , Pacientes Internados , Admissão do Paciente , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Esquizofrenia/terapia
7.
PLoS One ; 16(6): e0252960, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34106997

RESUMO

This paper analyzes the option coordination problem of a fresh agricultural product supply chain under two supply chain structures, when the production cost and the loss rate are disrupted simultaneously. This paper provides the explicit option coordination conditions for the disrupted supply chain under two supply chain structures, and then explores the effects of the disruptions and supply chain structure on the option coordination conditions. The results suggest that it is unfavorable to apply the original coordinating contracts without disruptions to coordinate the disrupted supply chain. The coordination of the disrupted supply chain can be achieved with knowledge of the distribution of demand. In two coordinating contracts for the disrupted supply chain, the exercise price is still at the original level without disruptions while the option price deviates from the original level without disruptions. Moreover, the relationships of the coordination conditions in two supply chain structures depend on the value of the profit allocation coefficient. When the profit allocation coefficient exceeds (falls behind) a certain threshold, the option price is set at a higher (lower) value in the supplier-led supply chain structure than in the distributor-led supply chain structure, while the exercise price is set at a lower (higher) value in the supplier-led supply chain structure than in the distributor-led supply chain structure. Finally, the disrupted supply chain with any supply chain structure will perform better in the modified coordinating contracts than in the original coordinating contracts without disruptions.


Assuntos
Agricultura/organização & administração , Algoritmos , Comércio/economia , Contratos/economia , Custos e Análise de Custo , Abastecimento de Alimentos/economia , Comércio/métodos , Comportamento do Consumidor , Contratos/normas , Abastecimento de Alimentos/normas , Humanos
11.
Artigo em Inglês | MEDLINE | ID: mdl-33803666

RESUMO

The purpose of the study is to analyze the correlations between two clearly defined forms of non-standard employment (self-employment and mandate contract) and workers' health. The study also addressed such variables as gender, age, length of service, and the reason for employment (voluntary vs. non-voluntary). The research was carried out in Poland in 2020 using the CATI method (a telephone interviewing technique), and it covered a sample of 200 workers (100 self-employed and 100 working under a mandate contract). Most of the respondents declared that their form of employment did not affect their health. However, the statistical analysis showed significant differences in health status between the self-employed and those working on a mandate contract. Self-employed respondents experienced mental health impacts more often, whereas those working under a mandate contract more frequently declared that their physical health was affected. The length of service was only important for mental health, having a negative impact on it. The respondents' age and gender turned out to be statistically insignificant, which is in contradiction to many previous research findings. The inability to choose one's form of employment resulted in worse physical health. These findings demonstrate the importance of certain variables that were not prioritized in previous studies and emphasize the need to clearly define what non-standard and precarious forms of employment are, as well as revealing new correlations between the studied categories and providing directions for further research.


Assuntos
Emprego , Saúde do Trabalhador , Contratos , Nível de Saúde , Humanos , Polônia
12.
J Health Econ ; 77: 102423, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33838593

RESUMO

Prices negotiated between payers and providers affect a health insurance contract's value via enrollees' cost-sharing and self-insured employers' costs. However, price variation across payers is difficult to observe. We measure negotiated prices for hospital-payer pairs in Massachusetts and characterize price variation. Between-payer price variation is similar in magnitude to between-hospital price variation. Administrative-services-only contracts, in which insurers do not bear risk, have higher prices. We model negotiation incentives and show that contractual form and demand responsiveness to negotiated prices are important determinants of negotiated prices.


Assuntos
Seguradoras , Seguro Saúde , Contratos , Custo Compartilhado de Seguro , Humanos , Negociação
13.
Lima; Perú. Ministerio de Salud; 1 ed; 20210400. 12 p. ilus.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1281011

RESUMO

La publicación describe un conjunto de organizaciones que presta o hace los arreglos institucionales (Convenios, contratos u otros) para proveer una cartera de atención de salud equitativa e integral a una población definida. En una emergencia sanitaria nacional prolongada como la COVID-19 se requiere la prestación de los servicios para proveer atención a las necesidades prioritarias de la población activando los servicios esenciales en todo el país.


Assuntos
Atenção Primária à Saúde , Organizações , Convênios , Contratos , Política de Inovação e Desenvolvimento , COVID-19
15.
Plast Reconstr Surg ; 147(4): 680e-686e, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33776044

RESUMO

BACKGROUND: Restrictive covenants are common in contractual agreements involving physicians and need careful consideration to minimize potential conflict during the term of the contract and on physician departure from a group practice or hospital system. METHODS: A general overview of the different components of restrictive covenants is provided, including specific information related to noncompetes, nonsolicitations, and nondisclosure agreements. RESULTS: In general, states will uphold restrictive covenants if the elements of the noncompete are reasonable regarding geographic distance restrictions (e.g., <20 air miles), time restrictions (e.g., <2 years), and scope of services. However, states vary considerably in the interpretation of restrictive covenants. Other components of the contract, such as alternative dispute resolution (mediation and/or arbitration) and buy-out clauses (i.e., liquidated damages provisions), should be considered at the time the agreement is negotiated. CONCLUSIONS: States are balancing the protection of business interests with the protection of free trade. It is important that physicians seek counsel with an experienced health care attorney with respect to restrictive covenants in his or her specific state. A simple, well-written, and reasonable restrictive covenant can often help limit legal conflict and expense.


Assuntos
Contratos/legislação & jurisprudência , Emprego/legislação & jurisprudência , Médicos , Contratos/normas , Emprego/normas , Estados Unidos
16.
Ann Intern Med ; 174(6): 844-851, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33721520

RESUMO

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.


Assuntos
Emprego/ética , Ética Médica , Médicos/ética , Administração da Prática Médica/ética , Profissionalismo , Contratos/ética , Planos de Pagamento por Serviço Prestado , Humanos , Relações Médico-Paciente , Prática Privada/ética , Encaminhamento e Consulta/ética , Reembolso de Incentivo , Estados Unidos , Seguro de Saúde Baseado em Valor
17.
Soc Sci Med ; 276: 113844, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33773477

RESUMO

Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.


Assuntos
Serviços Terceirizados , Contratos , Humanos , Propriedade , Pesquisa Qualitativa , Apoio Social
18.
Plast Reconstr Surg ; 147(2): 331e-336e, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565841

RESUMO

SUMMARY: Plastic surgeons are increasingly choosing to practice as employed physicians: either in an academic position, a single-specialty or multispecialty group, or within a franchise-type business. Employment offers advantages with regard to immediate income, minimal investment in practice start-up costs, and easier access to prospective patients. Surgeons considering such employment must perform due diligence to determine whether the position offered is a good fit. Once the decision is made to offer the plastic surgeon a position, an employment contract is negotiated. It is imperative that all parties understand the provisions of the contract, so that there are no misunderstandings between the employer and employee for the duration of the term. This article introduces physician recruitment offers and employment contracting. The key components of a contract are described, and compensation options are explained. Negotiation of the contract is critical so that all aspects are understood and agreed on, and the responsibilities of all parties are delineated.


Assuntos
Contratos/estatística & dados numéricos , Emprego/organização & administração , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/organização & administração , Humanos
20.
Plast Reconstr Surg ; 147(3): 761-771, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620950

RESUMO

BACKGROUND: Plastic surgeons have been shown to be unprepared to negotiate their first employment contracts. Previous survey studies have attempted to assess plastic surgeons' first employment contracts to outline common pitfalls in contract negotiation. With this study, the authors aim to expand these previous studies and help plastic surgeons become prepared to negotiate their employment contracts. METHODS: A seven-question, cross-sectional survey was sent to attending-level surgeon members of the California Society of Plastic Surgeons, the American Society of Plastic Surgeons, the Texas Society of Plastic Surgeons, and the American Cleft Palate-Craniofacial Association. Questions investigated plastic surgeons' first contracts. Correlations were determined using a two-sample Wilcoxon rank sum test in an attempt to link these questions with overall satisfaction. RESULTS: From the 3908 distributed surveys, 782 (20 percent) responses were collected, and 744 were included for analysis. The majority of respondents were found to join a group-centered, private practice following residency. Surprisingly, 69 percent of surgeons did not use attorney assistance when negotiating their contract. Although greater than 70 percent of respondents reported a salary of $200,000 or less, satisfaction with one's contract was most strongly correlated with a salary of greater than $300,000 (p < 0.0001). However, only 12 percent of respondent surgeons were able to secure such a salary. CONCLUSIONS: This study examined the largest, most diverse plastic surgeon cohort to date regarding surgeons' first employment contract. Although the authors' findings indicate that certain factors should be prioritized when approaching a first employment contract, they ultimately recommend that all surgeons take into account their personal priorities and attempt to proactively define their terms of employment before signing a contract.


Assuntos
Contratos/economia , Emprego/economia , Negociação , Cirurgiões/psicologia , Cirurgia Plástica/economia , Estudos de Coortes , Contratos/legislação & jurisprudência , Estudos Transversais , Emprego/legislação & jurisprudência , Humanos , Imperícia/economia , Imperícia/legislação & jurisprudência , Salários e Benefícios/economia , Salários e Benefícios/legislação & jurisprudência , Cirurgiões/economia , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...