Whether or not this is true, since the oft-referenced Institute of Medicine report leading to the enactment of the Nursing Home Reform Act in 1987 was published, Medicare and Medicaid skilled nursing facilities and nursing facilities, consumers, government and payers expect a continuing focus on quality, however defined, outcomes and resident autonomy and function. This has had a spillover effe...

This study compared palliative and non-palliative home care clients, services and providers, and described changes over a decade of health system reform (1991/92-2000/01). Complete individual-anonymous data from Alberta's home care database were analyzed. Over these 10 years, 7.0% of all home care clients were classified as palliative. The proportion of home care clients who were classified as ...

Despite prominent roles for employers and state regulation in the Clinton administration's Health Security Act, relatively little attention has been accorded to the impact of federal preemption of state legislation through the Employee Retirement Income Security Act (ERISA). As interpreted by the U.S. Supreme Court, ERISA permits state regulation of insured employee health plans but otherwise p...

Contractualization consists in the development and implementation of a documented agreement whereby one party (payer) provides compensation to the other party (provider) in exchange for a set of health services to a targeted population. We describe, through a case study, the history and the process of implementation of primary health care contractualization (since 1992) in Portugal, emphasizing...

The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likel...

INTRODUCTION For more than a decade, drug shortages have made headlines. Shortages also have forced P&T committees in many hospitals and health care delivery organizations to make contingency plans for providing safe and effective therapies when conventional and preferred drugs are not available. An article published in P&T in 2011 described several concerns associated with drug shortages and s...

BACKGROUND Studies show the great potential for self-management to improve health outcomes, yet it is carried out in a limited way by patients and providers. This study investigated the provider perspective of existing self-management support resources in a region of 1.2 million people. Participants included physicians, nurses, nurse practitioners, educators, and program managers. METHODS Qua...

OBJECTIVE To identify factors associated with the cost of treating high-cost Medicare beneficiaries. DATA SOURCES A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004-2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. STUDY DESIGN Using 12 months of claims data from 2005 to 2006, the sample was divided into pre...

With the reform of urban health delivery systems in China, concern has been growing about the effect of these changes on health care demand and utilization at basic-level health institutions, especially Community Health Services Centers (CHC). Using data from the fourth China National Health Services Survey (NHSS) that was conducted in 2008, the authors conducted a tracer illness study of urban...

Intense scrutiny of the American healthcare paradigm will alter the activities of patients, providers, and payors. Government reform and marketplace-driven managed care programs create uncertainty. Quality, access, and cost concerns also drive change. Quality is conformity to requirements, and specification of requirements creates policy debate. Variability in utilization creates an accountabil...