Medical care financing

Medical care, Cost of—United States. 2. Medical care—Finance—United States. I. World Bank. 

Another decision-making area in pharmaceutical policy is that of the financing of drags. An institution (be it pubhc or private) that finances medical care must decide first whether or not it will reimburse its insurees in the event of their consuming the product, and then what percentage of the price it will reimburse. 

As of 1998, the OMG was actively working toward such vertical standards in domains that include telecommunications, insurance, finance, and medical care. Microsoft has a less coordinated effort under its DNA project. Every project must invariably also define its own domain-specific standards. 

The investigator must remember that most clinical trial budgets derived in academic settings must conform to the Health Care Finance Administration s corporate compliance regulations. The regulations state that federal health care payers are responsible for covering only those resources that are medically necessary for the care of a patient. Taxpayer dollars (e.g.. Medicare) cannot be used to subsidize purely research activities, or for experimental or unproven medical therapies. 

Journal of Health Economics. Amsterdam Elsevier. Bimonthly. ISSN 0167-6296. Contains articles on the economics of health and medical care. Its scope includes the following topics production of health and health services demand and utilization of health services financing of health services cost-benefit and cost-effectiveness analyses and issues of budgeting and efficiency and distributional aspects of health policy. 

By law, Medicare does not cover any drugs administered outside of the hospital or a physician s office, and the program does not pay for clinical research (487). Furthermore, to be covered by Medicare, drugs must be reasonable and necessary, a criterion that the Health Care Financing Administration (HCFA) has interpreted. .. to exclude. .. those medical and health care services that are not demonstrated to be safe and effective by clinical evidence (487). HCFA has taken this to mean that experimental and investigational drugs are not covered. 

In spite of increased attention to quality, and efforts to provide safe medical care, adverse outcomes are still frequent in clinical practice (Leape, 94). Although some of the risk is related to the imderlying complexity of care and severity of illness in the patient population, a significant portion may be related to the structure of the system - most notably, the operational policies, incentive structures, and constraints imposed by third-parties who finance care. Any efforts to redesign the system, however, must be preceded by careful modeling and analysis to demonstrate exactly how the policies and features of the system influence risk. In this paper, we attempt to build models that demonstrate these system-level influences and how they dynamically shape risk in the healthcare... 

Prince, T. R., and Sullivan, J. A. (2000), Financial viability, medical technology, and hospital closures, J. Health Care Finance 26(4) 1-18. 

The UK NHS is financed primarily out of taxation and is available to all permanent residents. Most people are registered with a general medical practitioner (imder contract with the NHS and paid mainly on a capitation basis), who provides primary care and is the normal route of referral to hospital and specialist services, whether in the NHS or the private sector. A small minority of the population obtain some or all of their medical treatment privately, mainly through insurance schemes. 

There is not a bottomless pit of resources, says Phil Wadeson, finance director for the National Health Service unit that oversees hospitals and doctors offices in Liverpool. We reached the point a while ago where there is far more medical intervention than any health-care system can afford. ... 

Researchers and drug companies are interdependent. The pharmaceutical industry depends on scientists and clinicians for research, development, and marketing. Conversely, the medical profession depends on research that is largely financed by the pharmaceutical industry. While this interdependence often benefits industry, research, and patient care, conflicts of interest may arise in two main areas (1) drug research and development and (2) clinical education and product marketing. 

About the Author Dr. Bentley is an Associate Professor in the Department of Pharmacy Administration and Research Associate Professor in the Research Institute of Pharmaceutical Sciences at the University of Mississippi School of Pharmacy. He received a B.S. in pharmacy and an MBA from Drake University and an M.S. and Ph.D. in pharmacy administration from the University of Mississippi. In addition to statistics, Dr. Bentley s teaching interests focus on the organization, delivery, financing, and outcomes of health care. His research interests include understanding the role of pharmacy practice in how medications and the medication consumption experience affect quality of life, the use of quality-of-life measures as clinical tools, and empirical investigations of ethical issues in pharmacy and research. 

We have suggested that therapists must expand their interests and influence to other factors that have an impact on clinical care the patient s family, the clinic s organizational structure, the finances of therapy, and the physician-therapist-patient relationships. These factors can influence the outcome of therapy as much as the specific medication or specific psychotherapy techniques used. 

Medicare is an entitlement program and serves all eligible beneficiaries regardless of income or medical history Like Social Securify, Medicare is based on a system of social insurance. Medicare is composed of two programs. Medicare Part A covers inpatient care in hospitals and skilled nursing facilities. It also covers hospice care and some home health care. Part A is financed by a 1.45% payroll fax paid by bofh employees and employers (2.9% for self-employed persons). Currenf employers and employees pay for the health care of current Medicare beneficiaries, wifh the expectation that when they reach age 65 they will receive the same benefits. In the U.S., when people turn 65 years of age, they are automatically eligible for Medicare s Parf A, and they do not have to pay for the hospital insurance if they, or a spouse, paid Medicare taxes when they were working. 

Medicare Part B is a voluntary form of insurance, and beneficiaries choose whether to enroll in this part of Medicare. Parf B is financed parfly by a premium charged to the beneficiary ( 54/mo in 2002) and fypically is deducted from the beneficiary s Social Security check. The rest of Parf B funding comes from general federal fax revenues. Medicare Parf B helps cover physicians services, outpatienf hospifal care, and some ofher medical services not covered under Part A. Nearly 95% of Medicare beneficiaries choose to enroll in Part B because the federal government pays for 75% of the premium cost. Medicaid pays the Part B premium for low-income elderly. 

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