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This study’s aim was to examine the impact of pandemic emergency Home- and Community-Based Services (HCBS) payments on the continuity and security of people with intellectual and developmental disabilities (IDD). Using a multilevel logistic regression, we analyzed secondary Personal Outcome Measures interviews from 738 people with IDD (March 2020 through April 2022), and state pandemic emergency HCBS payment data from 16 states. The odds of people with IDD experiencing continuity and security during the pandemic increased by 3% for every 1% states increased their payment rates, and by 398% when states offered retainer payments. Increased reimbursement rates and retainer payments can help providers maintain operations and promote the continuity and security of people with IDD.

Recognizing the crisis the COVID-19 pandemic represents to the Home- and Community-Based Services (HCBS) service system and the health, safety, and quality of life of people with intellectual and developmental disabilities (IDD), states temporarily amended their HCBS programs to strengthen service delivery. States are able to temporarily amend their HCBS 1915(c) waiver programs by submitting Appendix K: Emergency Preparedness and Response Waivers to the Centers for Medicare and Medicaid Services (CMS). The aim of this study was to examine if, and how, states increased their reimbursement rates for HCBS IDD waiver services during the COVID-19 pandemic. To do so, we analyzed 294 Appendix Ks which amended HCBS 1915(c) waivers for people with IDD between the start of the pandemic and April 2022. During the pandemic, 34 states and the District of Columbia increased reimbursement rates for 2,435 services provided by 82 HCBS waivers for people with IDD. Increase in reimbursement rates ranged from 3.5% to 160.7%, with an average increase of 23.3%. States most frequently increased reimbursement for supports to live in one’s own home, residential habilitation, and health and professional services. In addition, 12 states and the District of Columbia offered one-time supplemental payments through 25 HCBS waivers for people with IDD. While increasing payments during the pandemic likely helped stabilize the HCBS service system during this period of crisis, what remains to be seen is how the IDD service system will function when this additional funding is discontinued.

Background Adjusting the health insurance reimbursement rate is essential to optimize the allocation of medical resources. This paper investigates the effect of health insurance reimbursement rates on middle-aged and elderly people’s choice of hospitals in China. Methods This study is conducted using the China Health and Retirement Longitudinal Study (CHARLS) database. This paper uses the widely used ordered logit model for estimation. We build three types of instrumental variables, Bartik instrumental variable, per capita financial income, and health risk perception bias, with the help of the propensity score matching method, aiming at the cleanest possible identification of causal relationship. Furthermore, we use a mediating effects model to investigate the specific mechanism by which the reimbursement rate influences patients’ choice of hospitals. Results Our findings reveal that the higher a hospital’s reimbursement rate, the more likely a patient is to choose to seek care. This paper further calculates the marginal effects based on the benchmark regression. For every 1% increase in health insurance reimbursement rates, the probability of patients choosing primary hospitals decreases by 5.75%, choosing secondary hospitals decreases by 1.47%, and choosing tertiary hospitals increases by 7.22%. According to mechanistic analysis, this paper reveals for the first time that health signals from medical checkups significantly impact patients’ health care choices. In addition, we discuss the heterogeneity of hospital choices by region, age, and health status. Conclusions The results mean that when individuals are faced with a multitude of hospitals and are overwhelmed with choices, some small institutional designs can act as a nudge to help policymakers achieve a desirable outcome. The government should fully utilize health insurance’s benefit adjustment role and implement a differentiated reimbursement strategy.

ObjectiveTo examine the association between reimbursement rates and the length of stay (LOS).DesignA retrospective cohort study.SettingThe study was conducted in Shenzhen, China by using health administrative database from 1 January 2015 to 31 December 2017.Participants6583 patients with acute myocardial infarction (AMI), 12 395 patients with pneumonia and 10 485 patients who received percutaneous coronary intervention (PCI) surgery.MeasuresThe reimbursement rate was defined as one minus the ratio of out-of-pocket to the total expenditure, multiplied by 100%. The outcome of interest was the LOS. Multilevel negative binomial regression models were constructed to control for patient-level and hospital-level characteristics, and the marginal effect was reported when non-linear terms were available.ResultsEach additional unit of the reimbursement rate was associated with an average of an additional increase of 0.019 (95% CI, 0.015 to 0.023), 0.011 (95% CI, 0.009 to 0.014) and 0.013 (95% CI, 0.010 to 0.016) in the LOS for inpatients with AMI, pneumonia and PCI surgery, respectively. Adding the interaction term between the reimbursement rate and in-hospital survival, the average marginal effects for the deceased inpatients with AMI and PCI surgery were 0.044 (95% CI, 0.031 to 0.058) and 0.034 (95% CI, 0.017 to 0.051), respectively. However, there was no evidence that higher reimbursement rates prolonged the LOS of the patients who died of pneumonia (95% CI, −0.013 to 0.016).ConclusionsThe findings indicate that the higher the reimbursement rate, the longer the LOS; and implementing dynamic supervision and improving the service capabilities of primary healthcare providers may be an important strategy for reducing moral hazard in low-income and middle-income countries including China.

Background The insurance reimbursement rate of medical cost affects the quality and quantity of health services provided in China. The nature of this relationship, however, has not been reliably described in the field of non-small cell lung cancer (NSCLC). The objective of the current study was to examine the impact of low reimbursement rates of medical costs on diagnosis, treatment and outcomes among patients with NSCLC. Methods We examined care of 2643 NSCLC patients and we divided the study cohort into a high reimbursement rate group and a low reimbursement rate group. The impact of reimbursement rates of medical costs on quality of care of NSCLC patients were examined using logistic regression and generalized linear models. Results Compared with patients insured with high reimbursement rate, patients insured through lower reimbursement rate programs were less likely to benefit from early detection and treatment services. Delayed detection was more common in low reimbursement group and they were less likely to be recommended for adjuvant chemotherapy, or to receive adjuvant chemotherapy and postoperative radiation therapy and they had lower odds to receipt chemotherapy response assessment. However, low reimbursement rate group had lower rate of in-hospital mortality and metastases. Conclusions Low reimbursement rate mainly negatively influenced the diagnosis and treatment of NSCLC. Reducing the gap in reimbursement rate between the three health insurance schemes should be a focus of equalizing access to care and improving the level of medical compliance and finally improving quality of care of NSCLC.

Historically, cooperative medical insurance and village doctors are considered two powerful factors in protecting rural residents’ health. However, with the central government of China’s implementation of new economic policies in the 1980s, cooperative medical insurance collapsed and rural residents fell into poverty because of sickness. In 2009, the New Rural Cooperative Medical Insurance (NRCMI) was implemented to provide healthcare for rural residents. Moreover, the National Basic Drug System was implemented in the same year to protect rural residents’ right to basic drugs. In 2013, a village doctor contract service was implemented after the publication of the Guidance on Pilot Contract Services for Rural Doctors. This contract service aimed to retain patients in rural primary healthcare systems and change private practice village doctors into general practitioners (GPs) under government management. Objectives: This study investigates the factors associated with rural residents’ contract behavior toward village doctors. Further, we explore the relationships between trust, NRCMI reimbursement rate, and drug treatment effect. We used a qualitative approach, and twenty-five village clinics were chosen from three counties as our study sites using a random sampling method. A total of 625 villagers participated in the investigation. Descriptive analysis, chi-squared test, t-test, and hierarchical logistic analyses were used to analyze the data. Results: The chi-squared test showed no significant difference in demographic characteristics, and the t-test showed a significant difference between signed and unsigned contract services. The results of the hierarchical logistic analysis showed that trust significantly influenced patients’ willingness to contract services, and the drug treatment effect and NRCMI reimbursement rate moderated the influence of trust. Conclusion: Our findings suggest that the government should aim to strengthen trust in the doctor–patient relationship in rural areas and increase the NRCMI reimbursement rate. Moreover, health officers should perfect the contract service package by offering tailored contract services or expanding service packages.

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns. Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need. The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.

To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals, the challenges it will face in achieving UC, and key reforms needed to overcome those challenges. It does so through a health financing lens, focusing on how resources are mobilized, pooled, and allocated, and how services are purchased. The report also examines the stewardship of financing that is, the organization, management, and governance of SHI as it has direct implications for achieving UC. The report ends by pulling together the recommendations in the form of an implementation road map.

Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.

Seit 1996 erfolgt in der Thoraxchirurgie eine Rechnungsstellung unter Berücksichtigung von Sonderentgelten (SE). Der Gesetzgeber geht davon aus, daß durch das SE die Operationskosten gedeckt sind und eine Absenkung des Pflegesatzes um 20 % gerechtfertigt ist. Zur Prüfung dieser Annahme führten wir eine Kostenanalyse thoraxchirurgischer Operationen durch. Für 5 verschiedene durch Sonderentgelte erfaßte Eingriffsarten, atypische Lungenresektion mit mehr als 3 entfernten Keilen (AR: n = 8), Lobektomie (LE: n = 8), Pneumonektomie (PE: n = 5), thoracoskopische atypische Resektion (VR: n = 6) und die Resektion eines Mediastinaltumors (MR: n = 3), wurden der Personal- und Sachbedarf sowie die Zeit der Operationssaalbereitstellung bei insgesamt 30 Fällen prospektiv dokumentiert. Anschließend erfolgte anhand vorgegebener Anhaltszahlen eine Kalkulation der Gesamtkosten der jeweiligen Operation. Die Kosten für eine LE lagen bei 9.927 DM um 4.904 DM höher als das entsprechende SE. Die Kosten einer PE betrugen 10.562 DM, einer VR 12.477 DM und einer MR 7.532 DM – sie lagen damit um 5.539 DM, 2.435 DM bzw. 1.907 DM über dem jeweiligen SE. Das SE für eine AR lag um 866 DM über den tatsächlichen Kosten von 6.922 DM. Nur bei einer kleinen Zahl thoraxchirurgischer Operationen kann von einer Kostendeckung durch das SE ausgegangen werden. Auch weiterhin müssen die Operationskosten zumindest anteilig aus dem Pflegesatz gedeckt werden.