In October 2015, the third international Pharmaceutical Pricing and Reimbursement Information (PPRI) Conference was held in Vienna to foster discussion on challenges in pricing and reimbursement policies for medicines. The research presented highlighted that commonly used pharmaceutical pricing and reimbursement policies are not sufficiently effective to address current challenges. Conference p...

The current patient classification schemes used in case-mix reimbursement are not fully sensitive to variations in resource consumption that are associated with differential disease severity. Disease staging is a clinically based measure of severity that uses objective medical criteria to assess the stage of disease progression. Its availability in automated form increases its ease of implement...

As reimbursement continues to decline for diabetes management technologies and practice overhead continues to rise, it is becoming increasingly important to understand the current reimbursement environment for new technological innovations in diabetes care. The current environment demands a strong partnership among providers, key stakeholder groups, and industry to advocate for favorable coding...

The issue of third-party reimbursement also came up. “We hope the guidelines will help with reimbursement with some of these therapies by becoming standard practice,” Denlinger said. “But we don’t yet know.” Similarly, Philippe Spiess, M.D., genitourinary oncologist at H. Lee Moffitt Cancer Center in Tampa, Fla., and a member of NCCN’s bladder/penile cancer panel, said that uncertainty surround...

Psychologists in health care settings today find it increasingly difficult to obtain authorization and appropriate reimbursement for psychological assessments from 3rd party payers. Authorization and reimbursement denials often are based on allegations that empirical support for the utility and validity of psychological tests is nonexistent or limited. This article reviews a sample of the consi...

CT colonography has been shown to be an effective method to screen for colorectal cancer. However, at present, full endorsement and reimbursement for screening CT colonography, particularly by the US Preventive Services Task Force and CMS, respectively, are absent, so this screening option is infrequently used, and optical colonoscopy remains the de facto standard screening option. The authors ...

We provide novel insights into the effects of private information in automobile insurance. Our analysis is based on telematic data of insured cars which includes detailed information about driving behavior that is unobservable to the insurance company. We find that private information about driving behavior has significant and counteracting effects on the choice of third-party liability and fir...

This study explored the extent to which people with epilepsy and their families have choice and control over the management of their epilepsy and the support provided in the Australian disability sector. It measured the level of direct involvement in planning and recording of their epilepsy health-care needs and support required through the use of epilepsy management plans. An Australian online...

Do Walrasian markets function orderly in the presence of adverse selection? In particular, Is their outcome efficient when exclusive contracts are enforceable? This paper addresses these questions in the context of a Rothschild and Stiglitz insurance economy. We identify an externality associated with the presence of adverse selection as a special form of consumption externality. Consequently, ...

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.