Leaders of health insurance companies, hospital systems, and physician organizations believe that when Medicare and Medicaid reduce payment rates to hospitals or physicians, these providers respond by raising prices to private insurers to offset a portion of the loss in revenue. This would mean that payment reductions in public programs contribute to increasing premiums for private insurance. B...

This paper explores the extent to which third-party reimbursement dictates occupational therapy practice. A literature review was used to examine the history and meaning of reimbursement in regard to occupational therapy. It was found that the profession has altered its definition, practice, management, ethics, and professional response as a result of changes in reimbursement. Reimbursement pol...

Managed health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the to...

INTRODUCTION: Cost-analysis research can influence healthcare policies and practice patterns. There are three major perspectives in cost analysis research: the third-party payer, the hospital, and societal. Cost-analysis research has inherent bias depending on the chosen cost perspective. Subsequent conclusions based on cost-analysis research can change based on the perspective used.1 These per...

In this work we study a dynamics of tax evasion. We considered fully-connected population divided in three compartments, namely honest payers, evaders and susceptibles, class that is composed by payers can become evaders. consider contagion model where the transitions among compartments are governed probabilities. Such probabilities represent possible interactions indiviudals, as well governmen...

We address the question of how a third-party payer (e.g. an insurer) decides what providers to contract with. Two different mechanisms are studied and their properties compared. A first mechanism consists in the thirdparty payer setting up a bargaining procedure with both providers. The second mechanism is the so-called “any willing provider” where the third-party payer announces a contract and...

OBJECTIVES We estimated national and state-level potential medical care cost savings achievable through modest reductions in the prevalence of several diseases associated with the same lifestyle-related risk factors. METHODS Using Medical Expenditure Panel Survey Household Component data (2003-2005), we estimated the effects on medical spending over time of reductions in the prevalence of dia...