the purposes of our study were to identify a drug entry process, collect, and prioritize criteria for selecting drugs for the list of basic health insurance commitments to prepare an “evidence based reimbursement eligibility plan” in iran.the 128 noticeable criteria were found when studying the health insurance systems of developed countries. four parts (involving criteria) formed the first que...

background: except in emergency cases, all patients should be seen first by a primary healthcare physician who decides whether a referral to secondary care is necessary. the present study examined the reasons for patient self-referral to specialists. methods: a random sample of 1036 individuals was selected from people attending public outpatient clinics and specialists’ offices in the private ...

A Fresh Look at Regional Health Spending Variation Almost all research on health care spending variation has focused on Medicare, hampering full understanding of what drives variations. Key differences exist between employer-sponsored health insurance and Medicare, making it critical to examine spending variation among privately insured people and not assume that patterns observed in Medicare a...

BACKGROUND Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear. METHODS AND RESULTS Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were cat...

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fra...

Key findings. (1) Adjusted premiums in the individual market in states with prior approval authority combined with loss ratio requirements were lower in 2010-2013 than premiums in states with no rate review authority or file-and-use regulations only. (2) Adjusted premiums declined modestly in prior approval states while premiums increased in states with no rate review authority or with file-and...

background: with the increased range of medical insurance coverage in china, the proportion of medical expenditure shouldered by individuals is declining. the problem is the rapidly growing scale of medical expenditures challenges the sustainability of medical insurance funds. methods: this study used the heckman selection model, survival analysis, and ordered probit model to evaluate the effec...

The first three years of the Affordable Care Act’s Health Insurance Marketplaces have been tumultuous ones, with rapid entry and exit of insurers and recent spikes in premiums. As concerns mount about the stability and viability of the Marketplaces, this brief provides some insight into the forces behind the headlines and presents six options for policymakers to consider.

health insurance “across state lines” are often promoted to address the challenges of high health insurance costs and a lack of choice among insurers and have been a core component of alternative health reform proposals since the mid-2000s. Critics, however, argue that across state lines proposals would lead to deregulation and a “race to the bottom” where health insurers relocate to the states...