Medicare
Medicare

Author: Institute of Medicine

Publisher: National Academies Press

Published: 1990-02-01

Total Pages: 462

ISBN-13: 0309042305

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Health care for the elderly American is among our nation's more pressing social issues. Our society wishes to ensure quality health care for all older people, but there is growing concern about our ability to maintain and improve quality in the face of efforts to contain health care costs. Medicare: A Strategy for Quality Assurance answers the U.S. Congress' call for the Institute of Medicine to design a strategic plan for assessing and assuring the quality of medical care for the elderly. This book presents a proposed strategic plan for improving quality assurance in the Medicare program, along with steps and timetables for implementing the plan by the year 2000 and the 10 recommendations for action by Congress. The book explores quality of careâ€"how it is defined, measured, and improvedâ€"and reviews different types of quality problems. Major issues that affect approaches to assessing and assuring quality are examined. Medicare: A Strategy for Quality Assurance will be immediately useful to a wide audience, including policymakers, health administrators, individual providers, specialists in issues of the older American, researchers, educators, and students.

Medicare Laboratory Payment Policy
Medicare Laboratory Payment Policy

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2000-12-04

Total Pages: 261

ISBN-13: 0309183618

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Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

Medicare
Medicare

Author: Institute of Medicine

Publisher: National Academies Press

Published: 1990-02-01

Total Pages: 472

ISBN-13: 0309042380

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Volume II of Medicare: A Strategy for Quality Assurance provides extensive source materials on quality assurance, including results of focus groups with the elderly and practicing physicians, findings from public hearings on quality of care for the elderly, and many exhibits from site visits and the literature on quality measurements and assurance tools. The current Medicare peer review organization program and related hospital accreditation efforts are comprehensively described as background for the recommendations in Volume I of this report. Like the companion volume, this substantial book will be a valuable reference document for all groups concerned with quality of health care and the elderly.

Pricing the Priceless
Pricing the Priceless

Author: Joseph P. Newhouse

Publisher: MIT Press

Published: 2004-08-20

Total Pages: 282

ISBN-13: 9780262250573

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The health care industry differs from most other industries in that medical pricing is primarily administered by the government and private insurers and in that it uses several types of contracts. Providers may receive a fixed sum for all necessary services within a given period of time, for the necessary services to treat a given condition, or for each specific service. The industry is changing dramatically, offering many natural experiments to aid understanding of the economics of pricing for health care. In Pricing the Priceless, Joseph Newhouse explains the different pricing systems and how they affect resource allocation and efficiency, focusing on the efficiency of pricing. He also discusses larger issues of equity, fair distribution of burden, and social justice. Although most of the examples are American-based, the same issues arise in all medical care financing and delivery systems, and the theories and models are general enough to apply to many institutional contexts. The topics include Medicare, managed care, the contemporary integration of health insurance and medical care, the management of moral hazard and stinting, uncertainty and risk aversion, the demand for health insurance, agency relationships, information disparities, regulation, and supply-side and demand-side selection.