The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other pri...

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 qu...

Health care-related costs have been the focus of intense scrutiny in politics and in the media. However, public perception of physician reimbursement is poorly understood. The purpose of this study was to determine patient perception of physician reimbursement for 2 common hand surgery procedures: carpal tunnel release and open reduction and internal fixation of a distal radius fracture. Anonym...

PCV173 Are SPAniSh regionS imPlementing the nAtionAl therAPeutiC PoSitioning rePort (tPr) regArding new orAl AntiCoAgulAntS (noAC) in the SAme wAy? A CASe of regionAl VAriAbility in drug ACCeSS Rodriguez Barrios JM1, Pérez-Alcántara F2, Gonzalez-Juantey JR3, Avendaño C4, Suarez C5, López-Bastida J6, Barja de Soroa P1 1Daiichi-Sankyo, Madrid, Spain, 2OBLIKUE Consulting, Barcelona, Spain, 3Santia...

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates. You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare r...

BACKGROUND A shift in biochemical research towards drugs for rare diseases has created new challenges for the pharmaceutical industry, government regulators, health technology assessment agencies, and public and private payers. In this article, we aim to comprehensively review, characterize, identify possible trends, and explore reasons for negative reimbursement recommendations in submissions ...

The American College of Prosthodontists (ACP) has developed a classification system for partial edentulism based on diagnostic findings. This classification system is similar to the classification system for complete edentulism previously developed by the ACP. These guidelines are intended to help practitioners determine appropriate treatments for their patients. Four categories of partial eden...

Policymakers have focused primarily on increasing Medicaid reimbursement rates to increase physicians' participation in Medicaid, although physicians often complain of payment delays and other administrative burdens associated with Medicaid. Linking state-level data on average reimbursement times to the 2004-05 Community Tracking Study Physician Survey, this study examines how Medicaid reimburs...

We study the strategic interaction between the pricing decisions of a pharmaceutical firm and the reimbursement decisions of a government agency which grants reimbursement rights to patients for whom new drugs are most cost-effective. If the reimbursement decision precedes pricing, the agency only reimburses some patients if the drug's private and public health benefits diverge. This is, there ...

Reimbursement of commuting costs by employers has attracted little attention from economists. We develop a theoretical model of a monopsonistic employer who determines an optimal recruitment policy – in a spatial labour market with search frictions, and show that, in general, partial reimbursement of commuting cost will be an element of the recruitment policy. The empirical evidence we offer is...