CONTEXT Efforts to control medical expenses by emphasizing primary care and limiting specialty care may influence how physicians use informal or "curbside" consultation. OBJECTIVE To understand physicians' use of and beliefs about informal consultation. DESIGN Survey mailed in July 1997. PARTICIPANTS Of a random sample of Massachusetts general internists, pediatricians, cardiologists, ort...

OBJECTIVE To assess whether the model of service delivery affects the equity of the care provided across age groups. DESIGN Cross-sectional study. SETTING Ontario. PARTICIPANTS One hundred thirty-seven practices, including traditional fee-for-service practices, salaried community health centres (CHCs), and capitation-based family health networks and health service organizations. MAIN OU...

BACKGROUND Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines po...

Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. The authors estimate how well such adjusters predict annual medical expenditures among non-elderly adults. Both measures substantially improve on the variables currently used. If only health measures are added, 20-30 percent of the predictable variance is...

Feel lonely? What about reading books? Book is one of the greatest friends to accompany while in your lonely time. When you have no friends and activities somewhere and sometimes, reading book can be a great choice. This is not only for spending the time, it will increase the knowledge. Of course the b=benefits to take will relate to what kind of book that you are reading. And now, we will conc...

To actuaries and other financial professionals, risk adjustment means charging a premium or paying capitation in proportion to the expected costs of an individual or group. Most of the articles herein research exactly that topic. A few have a different view. Concerned with quality or performance indicators, they adjust for the variation in expected outcomes based on the variation in covered gro...

The most recent proposal by the Minister of Health to change healthcare financing aims to introduce a form of patient copay-ment for healthcare received, at 25% of GP costs for consultations, and more for secondary care. The objective is to encourage patients to take more responsibility for their own health and consult less often. This proposal is still in its early stage of political decision ...

In 2009, the methods for paying SHI-affiliated physicians in ambulatory care were changed. The era of capitation fees and strict budgeting is over. GPs and specialists are now paid on a capped fee-for-service basis, with a payment ceiling that is set for each doctor and adjusted for specialization, the number of cases and patient age. Instead of a floating-point fee schedule, a fee schedule wit...

BACKGROUND: Both private and public health care systems have embraced capitated reimbursement as a method of controlling costs. AIMS OF THE STUDY: This study explores the financial implications of using reimbursement models based on clinically based patient classification schemes to distribute funds for the treatment of mental health patients in the Department of Veterans Affairs (VA). METHODS:...