Costs sharing

Academic institutions should make substantial commitments (e.g., cost sharing and maintenance for instrumentation and facilities) to make additional outside investments in chemical engineering as effective as possible. This will be particrrlarly needed to justify additional funding for advanced instmmentation and computers needed for research and educatiom... 

B Foxman, RB Valdez, KN Lohr, GA Goldberg, JP Newhouse, RH Brook. The effect of cost sharing on the use of antibiotics in ambulatory care results from a population based randomized controlled trial. J Chron Dis 40(5) 429-437, 1987. 

Another interesting development in the USA is the recent passage of a law by the state of Maine for management of mercury in end-of-life CFLs [6], The law is intended to provide consumers with convenient recycling opportunities, with the costs shared by the lamp manufacturers and others (Box 1). 

Table 1.2 Cost sharing in the health systems of western European countries... 

Denmark None None Variable percentage rate of cost sharing (0-50%) applied on the basis of drug reference prices (RP). Drugs outside the MOH formulary are excluded from the coverage of die system... 

Germany None. Elat rate of co-payment for the first 14 days per year of hospitalization, after which there is no cost sharing of any sort Variable co-payment. RP system. No coverage is applied to those pharmaceuticals on public financing negative lists... 

None for public insurance, but varies in the case of private insurance Cost sharing, with a maximum annual contribution for all services as a whole Cost sharing... 

None for hospital stays. Combination of co-payment and percentage rate of cost sharing for specialist care and out-patient visits. Co-payment in diagnostic services. A maximum is set for the financial participation of the user None for category I in public hospitals. For the rest, co-payments are applied for the fust out-patient visit per episode, and there is a per diem co-payment for the first 10 days of hospitalization per year. Insurers buy free care for both public and private hospitals... 

None for in-patient care. Cost sharing was introduced in 1990 for public hospitals with regard to diagnostic procedures, hospital visits and spa treatments... 

Combination of daily deductibles per prescription and percentage rates of cost sharing up to a maximum level. Some medicines are completely free, while others are excluded from public coverage... 

Two percentage cost sharing rates, depending on the type of pharmaceuticals involved. Some pharmaceuticals are free, while others are excluded from pubhc coverage Percentage rates of sharing in the cost of pharmaceutical consumption. Positive list of pharmaceuticals with pubhc coverage... 

Switzerland Combination of annual deductibles and percentage cost-sharing rates Per diem co-payments for hospitalization User sharing in drug consumption costs, which varies between different health insurance schemes. Negative lists of medicines exclude consumption from public coverage... 

One way of discouraging excessive consumption, without cost sharing, is through pre-payment. The user advances the money, paying the provider, and is reimbursed at a later date after reclaiming. 

Table 7.1 Effects of cost sharing on financing, use and equity...

Pauly, M.V. and S.D. Ramsey (1999), Would you like suspenders to go with that belt An analysis of optimal combinations of cost sharing and managed care , Journal of Health Economics, 18, 443-58. 

Agreements with Farmaindustria for health care cost sharing in 1998, continuing those of 1995 and 1997 and raising them with annual contributions of 39 000 and 26 000 million pesetas for 1998 and 1999, 2001... 

Currently, physicians and patients determine the demand for pharmaceuticals and employers and insurers assume the risk and cost. As the price of new health care technologies escalates, payers will design and implement strategies to share risk and cost. Defined employer contributions, increased patient cost sharing, and benefit exclusions will be used to help control utilization and cost. In this environment, value-based assessments will be crucial to the adoption of any technological innovation. It is reasonable to expect public and private coverage for new therapies if evidence is provided regarding the costs and consequences of treatment. However, social and ethical dilemmas will certainly arise as therapies whose costs exceed their benefits are debated in the public arena. 

Cost Sharing. Most states impose cost sharing on patients in the form of copayments ranging from fifty-cents to five dollars. In 1996, 29 states and the District of Columbia had adopted prescription drug copayments for all... 

Soumerai, S., et al., "Determinants of Change in Medicaid Pharmaceutical Cost Sharing Does the Evidence Affect Policy " Milbank Q., 75, 11-34 (1997). 

Sales costs in the base currency are calculated applying the sales cost share rate on sales turnover. 

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