Payment practices

In a short final synthesis, we briefly discuss the political implications of the various different regulation schemes and the present heterogeneity of Europe as regards co-payment practices. 

High transaction costs, fragmented processing, and inefficient payment practices, increase the provider s cost. Batch processing of transactions, such as billing and wholesale pricing, is a major cause of such inefficiency. Providers submit claims to payers for settlement. The amount not covered by the payers is... 

In practical terms, a company can foUow the trends ia its markets on a monthly or quarterly basis. Changes ia customer patterns ia terms of quantities, grades, or payment alert management to seek causative factors and take appropriate action. 

The patentee should develop and implement a poHcy for auditing its patent portfoHo in the process of paying maintenance fees to the U.S. PTO. This practice should also be used to justify the further payment of aimuities to foreign national patent offices. Maintenance fees and aimuities can constitute a substantial portion of funds expended in the protection of patents over a year s time. Further, without a tangible, real commercial value or advantage stemming from the patent, there may be Htde justification for maintaining the patent over its last five years of life. 

In considering either multiple payments or cash into and out of a company, the present values are additive. For example, at 6 percent interest, the present value of receiving both 1,000 in one year and 1,000 in three years would be 943.40 + 839.62 = 1,783.06. Similarly, if one were to receive 1,000 in one year, and pay 1,000 in 3 years the present value would be 943.40 - 839.62 = 103.78. It is common practice to compare investment options based on the present-value equation shown above. We may also apply one or all of the following four factors when comparing investment options Payback Period Internal Rale of Return Benefit-to-cost Ratio and Present Value of Net Benefit. But as we will see later, it is rate of return that is usually the most enlightening when considering an investment. 

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission on Accreditation of Healthcare Organizations has also incorporated these standards into their accreditation reviews of health care facilities. 

Let us return to Figure 7.1. When a deductible (D) is fixed, one of two things can happen either it is more than the amount the patient would spend if he or she were not insured, given the market price (P0), or it is less. If the deductible is greater than this expenditure (P0 <90), then the relevant demand function for the patient is that of 100 per cent co-payment, that is, in practice it is as if it he or she were not insured. However, if the deductible does not exceed this figure, then the relevant demand function becomes that which corresponds to... 

In order to evaluate the practical effects of co-payment it is essential to have access to quantifications of elasticities. The fourth section of this chapter deals with this. It is far from straightforward to obtain reliable estimates of the elasticities of demand for pharmaceuticals with respect to co-payment and price. Distinctions must be made between active ingredients, brands and generics, and between essential and non-essential drags, and substitution elasticities must be taken into account. 

To sum up, in Europe we have an enormous variety of types and formulas of co-payment, which have developed gradually over time and allow us to draw some conclusions with regard to their effectiveness. In practice, the percentage of pharmaceutical expenditure borne by patients varies greatly for different countries and therapeutic groups.20... 

More recently, large databases have been used to estimate the effect of drug co-payment in the USA under different insurance schemes.10 The conclusion reached is that there is a significant interaction effect between the behaviour of demand and prescriber incentives. Thus, larger prescription drug copayments are associated with lower expenditure when the doctor does not share the financial risk of the cost of the drugs (that is, practises in an independent practice association) but this effect is barely perceived in managed care models in which the doctor has incentives for cost containment. 

However, the extensive and varied experience undergone in Europe and its trend towards greater participation by the user in the financing of pharmaceuticals does not seem to have made any substantial contribution to cost containment. Practically all European countries use drag co-payment with the imphcit objective of making the user jointly responsible for the cost, but not as an essential source of revenue for the public health care system, nor has it proved to be a political instrument with the ability to contain costs or substantially improve efficiency. 

There are several areas where a therapeutic relationship can typically go wrong and cause ethical concerns. The first area of concern has to do with finances. Since counseling and therapy often involve payment, it is important to try to divorce therapy as much as possible from the financial aspects of the business of therapy. However, this is not always possible, especially if you are in private practice and you are your own accountant, too A rule of thumb is this If you cannot treat a client without bias because bills are not being paid, then you have no business treating the client any longer. A therapeutic referral must be made. There is no possible way that you can give your best effort to a client when you are sore about not getting paid. 

The Code of Professional Responsibility of the American Bar Association, Disciplinary Rule 2-108, provides in part that a lawyer shall not be a party to or participate in a partnership or employment agreement with another lawyer that restricts the right of a lawyer to practice law after the termination of a relationship created by the agreement, except as a condition to payment of retirement benefits. DR 4-101 provides for the protection of confidences and secrets of a client presumably forever unless disclosure is necessary under conditions set forth in the fine print, as, for example, to collect his fee. Interestingly, DR 2-106 (B) (2) provides that the determination of a reasonable fee includes "the likelihood, if apparent to the client, that the acceptance of the particular employment will preclude other employment by the lawyer. A lawyer cannot serve both sides in a dispute, and taking one client may later bar lucrative employment. 

Donations to charities made by companies in return for health professionals attendance at company stands at meetings or offered as rewards for completing and returning quiz cards in mailings and suchlike are not unacceptable under this clause provided that the level of donation for each individual is modest, the money is for a reputable charity and any action required of the health professional is not inappropriate. Any donation to a charity must not constitute a payment that would otherwise be unacceptable under the Code. For example, it would not be acceptable for a representative to pay into a practice equipment fund set up as a charity as this would be a financial inducement prohibited under Clause 18.1. Donations to charities in return for representatives gaining interviews are also prohibited under Clause 15.3 of the Code. 

Measures of cost used in existing cost-effectiveness analysis of drugs done from a societal perspective are wrong. But we do not know how to reconcile theoretically correct analysis with proper and practical pricing and payment policies. 

However, differences between the care provided to patients in the trial and that provided to patients in this group may be due as much to secular trends in the provision of medical care as they are to the adoption of a study protocol. For example, length of stay in the United States has decreased since the early 1980s, due in part to the implementation of the Medicare Prospective Payment System. Thus, historical cohorts from earlier periods may have had longer lengths of stay as inpatients than is currently seen in clinical practice. These data may suggest a protocol-induced decrease in length of stay when one actually does not exist. 

Any systematic records that Forman might have kept in the 1580s have not survived, but his records of disputes about payments for his services in his diary throughout this decade partially document his medical practices.Likewise, he used examples in his treatises and notes that date from the early 1580s... 

The chemical supplier does not incur any financial losses from the reduced quantity of chemicals sold. Now the company sells the effect of the chemicals. By making its specific know-how available - in practice this is often an unpaid service - the supplier refines its product, for which it is now suitably remunerated. The chemical supplier gets a share of the profit and the lower the volume of chemicals used, the higher the profit it derives from the project. Its payment is based on "number of pieces chemically treated, cleaned m2", etc. 

Accreditation to ISO/IEC 17025 or GLP is becoming a standard approach to creating a quality system (chapter 9). Note that accreditation, as such, is not part of the VAM principles, but it is one of alternative quality systems (see chapter 1). Like any quality system, accreditation only fulfills its purpose if implemented properly. Some laboratories have done the minimum to achieve accreditation, and then take the view that having paid for their accreditation payment of the annual fee will then suffice. This practice is evidenced when accredited laboratories perform no better in testing rounds than experienced laboratories without accreditation (see chapter 5). 

The defendant, a physician, was indicted for violating section 2 of the Harrison Narcotics Act by selling 500 tablets of heroin to a known addict, such sale not being part of any legitimate medical practice. The Harrison Act required that forms be filed with the government for any such nonmedical distribution of controlled drugs other provisions required payment of an excise tax. 

Owing to large cash deficiency in the energy sector a critical situation is predicted for the following winter (2003/2004) to cover the supply of electricity and natural gas to the industry and households. The main risk factors are non-payment and continuing practices of administrative interference in commercial activities... 

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