BACKGROUND Continuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors' focus on value-based...

OBJECTIVE The goal was to elicit perspectives of selected health insurance plan medical or quality improvement directors regarding factors related to coverage and reimbursement and perceptions of financing as a barrier to child and adolescent immunization. METHODS Medical or quality improvement directors from 20 plans selected by America's Health Insurance Plans were invited to complete an on...

Anemia is common in patients with advanced chronic kidney disease (CKD). Though erythropoiesis-stimulating agents (ESAs) have been strongly endorsed in guidelines, it is of particular financial interest. Recently, the reimbursement of ESAs in non-dialytic patients was started by the Korean National Health Insurance System. Thus, we investigated the impact of the reimbursement of ESAs on the ane...

As we discussed in Chapter 1, the federal government gives each state flexibility in establishing its own Medicaid reimbursement methods and rates for nursing home services. While the five states examined all use prospective, facility-specific reimbursement methods, the way each state has designed its reimbursement system varies significantly. The combination of historical, facilityspecific cos...

BACKGROUND In Belgium, regulations restrict the reimbursement of statins to patients with total serum cholesterol above 250 mg/dl (6.41 mmol/l) after a three-month lipid-lowering diet. We investigated the possible impact of these regulations on characteristics of Belgian patients receiving a lipid-lowering drug. DESIGN From 1998 to 2000, standard questionnaires on coronary risk factors and tr...

This article examines the interaction between the demand for deductible insurance and the demand for the asset that can be insured. A model where the decision-maker can choose both the insurance level and the amount of the risky asset to hold in the portfolio is used. Allowing simultaneous determination of the demand for an asset and the level of the deductible alters the comparative statics of...

Standard models of political competition do not differentiate between parties and the candidates selected by those parties, nor between electoral competition and competition between parties for support and influence among the public. This paper introduces a framework that distinguishes between parties and their candidates, creating roles for both the importance of a party’s power (size) and of ...

Between 1978 and 1993, the number of persons receiving disability benefits under either the Supplemental Security Income program or the Old-Age, Survivors, and Disability Insurance program increased more than 43 percent--from 4.7 million to 6.7 million. In 1993, 4.08 percent of the U.S. resident population aged 18-64 were receiving a disability benefit under one or both of the programs, compare...