Reimbursement Research Papers - Academia.edu (original) (raw)

Financing health care system is of a major concern to countries all over the world. The Act of Parliament (Act 650) passed in 2003 health care financing and being implemented and supervised by the National Health Insurance Authority (NHIA). National Health Insurance Authority aimed to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential health care services without payment being required at the point of use. The efficiency and sustainability of the health care facilities depend on funding and timely disbursement of claims. It has been observed that, whilst health care facilities do comply with section 37 (7) of L.1 1809, the scheme has not been able to comply with section 38(1) of the L.1 1809. This leads to undue delays in reimbursement of funds to accredited institutions. This delays of reimbursement of claims by National Health Insurance Authority therefore has adverse effects on the financial management of health care facilities. It is therefore recommended that, Government should speed up on releasing funds to National Health Insurance Authority for payment of claims. Further research needs to be done to verify the findings among other groups of facilities, and explore comparative studies involving facilities from different industries. Future researchers should also develop measures of additional dimensions to find out if the premium charged on scheme members of NHIS is fair enough to pay claims and also suggest whether premium charged should be increased or maintained.

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- Management, Financial management, Reimbursement, National Health Insurance Authority

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- by Okan Özkan
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- DRG systems, Case-mix, Reimbursement

Changing the status of drugs from prescriptiononly to over-the-counter and removing them from reimbursement list has been used as a cost reduction measure by several third-party payers. In June 2006, the Turkish government, in an effort to curtail costs, removed many prescription drugs from the reimbursement list. This paper examines the effect of this policy on the expenditures for drugs that were removed from the reimbursement list and for their reimbursable alternatives that can be prescribed by physicians on patient request. To accomplish these goals, actual expenditures in four anatomical therapeutic chemical (ATC) groups were compared with expected expenditures in the absence of policy change for both removed and alternative drugs. The findings indicated that the expenditures on alternative drugs beyond expectations. In two of the four ATC groups involved in the study, the increase was large enough to wipe out the reduction in expenditures on the drugs removed from the reimbursement list.

- by Ozden Ali and +1
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- Health Policy, Cost-effectiveness, Reimbursement

Grutters et al recently investigated the role of early health economic modelling of health technologies by undertaking a secondary analysis of health economic modelling assessments performed by their group. Our commentary offers a broad perspective on the potential utility of early health economic modelling to inform health technology assessment (HTA) and decision-making around reimbursement of new health technologies. Further we provide several examples to compliment Grutters and colleagues’ observations.

- by Mihajlo (Michael) B Jakovljevic MD, PhD, MAE and +1
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- Pharmaceuticals, Cost, Reimbursement, Trend

Changing the status of drugs from prescription-only to over-the-counter and removing them from reimbursement list has been used as a cost reduction measure by several third-party payers. In June 2006, the Turkish government, in an effort to curtail costs, removed many prescription drugs from the reimbursement list. This paper examines the effect of this policy on the expenditures for drugs that were removed from the reimbursement list and for their reimbursable alternatives that can be prescribed by physicians on patient request. To accomplish these goals, actual expenditures in four anatomical therapeutic chemical (ATC) groups were compared with expected expenditures in the absence of policy change for both removed and alternative drugs. The findings indicated that the expenditures on alternative drugs beyond expectations. In two of the four ATC groups involved in the study, the increase was large enough to wipe out the reduction in expenditures on the drugs removed from the reimbursement list.

- by Ozden Ali
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- Turkey, Regulation, Qualitative Research, Public Health

This commentary considers the positive and negative consequences of early economic modelling and explores potential future directions. Early economic modelling offers device manufacturers an opportunity to assess the potential value of an innovation at an early stage of development. Early modelling can direct resources into potentially viable technologies and reduce investment in technologies with limited prospect of value. However, it is unclear whether early modelling is sufficiently specific to identify innovations with low value. It may be that early modelling is more useful for directing data gathering to reduce decision uncertainty. Early modelling is of primary benefit to the manufacturer and may have both positive and negative consequences for reimbursement processes that should be considered.

The article provides an estimate of capital investment costs for the stages of the breeding process. Once the full costs for each stage have been determined, the sum of the minimum funds required to carry out the entire breeding process has been calculated. This is 245.5 thousand AZN.
Given that the creation of the variety serves a specific purpose, there is a need to justify the method of deduction of costs incurred. Of all the available methods, the most advanced method is to cover the cost of deductions from the proceeds from the sale of seedlings. This method is possible as a result of obtaining copyright to the created variety. The variety created at low cost pays for itself by selling 613750 seedlings.

- by Azerbaijan Journal of Agrarian Studies and +1
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- Copyright, Reimbursement

Mileage Logs are used for tax deduction or corporate reimbursement purposes to document the amount of driving eligible for deduction or reimbursement. Anyone taking the IRS Standard Deduction for vehicle reimbursement is required to... more

- by Justi Taster
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- Tax Law, Business Taxation, Reimbursement

Background: Priority setting in publicly financed healthcare systems should be guided by ethical norms and other considerations viewed as socially valuable, and we find several different approaches for how such norms and considerations guide priorities in healthcare decision-making. Common to many of these approaches is that interventions are ranked in relation to each other, following the application of these norms and considerations, and that this ranking list is then translated into a coverage scheme. In the literature we find at least two different views on how a ranking list should be translated into coverage schemes: (1) rationing from the bottom where everything below a certain ranking order is rationed; or (2) a relative degree of coverage, where higher ranked interventions are given a relatively larger share of resources than lower ranked interventions according to some " curve of coverage. " Methods: The aim of this article is to provide a normative analysis of how the background set of ethical norms and other considerations support these two views. Results: The result of the analysis shows that rationing from the bottom generally gets stronger support if taking background ethical norms seriously, and with regard to the extent the ranking succeeds in realising these norms. However, in non-ideal rankings and to handle variations at individual patient level, there is support for relative coverage at the borderline of what could be covered. A more general relative coverage curve could also be supported if there is a need to generate resources for the healthcare system, by getting patients back into production and getting acceptance for priority setting decisions. Conclusion: Hence, different types of reasons support different deviations from rationing from the bottom. And it should be noted that the two latter reasons will imply a cost in terms of not living up to the background set of ethical norms. Implications for policy makers The results of this theoretical analysis could benefit policy makers by: • Showing that how priority setting and ranking of interventions are translated into coverage schemes will have implications for whether background ethical norms are implemented or not. • Providing theoretical models and reasons to develop coverage schemes for ranking lists that are in line with the central ethical norms and other considerations of the healthcare system. • Pointing to the fact that some coverage schemes and the associated reasons will be bought at the cost of not being able to fully implement the background ethical norms, that in essence there is an " ethical opportunity cost. " Implications for the public The implications for the public are of a more indirect nature, but the coverage schemes used will obviously affect the public. It has been argued that the extent to which the public should be involved in decision-making concerning priority setting, should primarily be involvement at a policy level. Being clear over how different policies concerning coverage schemes related to the background set of ethical norms and considerations (over which they would then also have an influence), will be important input to their decisions. In communication with the public concerning different rationing decisions, it might be important to be able to point to the fact that if they also condition their acceptance on some access to lower ranked interventions – this will be bought at the cost of actually fulfilling the background set of ethical norms. Abstract In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms' conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation. Citation: Askheim C, Heggen K, Engebretsen E. Politics and power in global health: the constituting role of conflicts: Comment on " Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health.