75 FR 60066 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-29

... of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY... (ATPA) to provide for duty and quota-free treatment for certain textile and apparel articles imported... articles assembled in ATPDEA beneficiary countries from regional fabric and components. More specifically...

78 FR 59917 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary Sub...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-30

... of Apparel Articles Assembled in Beneficiary Sub-Saharan African Countries From Regional and Third... quota-free treatment for certain textile and apparel articles imported from designated beneficiary sub... apparel articles wholly assembled in one or more beneficiary sub-Saharan African countries from fabric...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

3 CFR 8997 - Proclamation 8997 of June 27, 2013. To Modify Duty-Free Treatment Under the Generalized System of...

Code of Federal Regulations, 2014 CFR

2014-01-01

... determined pursuant to section 502(d) of the 1974 Act, that it is appropriate to suspend Bangladesh's... Bangladesh's status as a beneficiary developing country under the GSP, I have determined that it is... of the 1974 Act, do proclaim that: (1) The designation of Bangladesh as a beneficiary developing...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... textile components cut to shape in the United States. 10.26 Section 10.26 Customs Duties U.S. CUSTOMS AND... ingredients; articles assembled in a beneficiary country from textile components cut to shape in the United... assembled in a beneficiary country in whole of textile components cut to shape (but not to length, width, or...

78 FR 21002 - Andean Trade Preference Act (ATPA), as Amended: Request for Public Comments Regarding Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... countries. The original ATPA allowed Bolivia, Ecuador, Colombia, and Peru to be considered as beneficiary... November 25, 2008, the President determined that Bolivia no longer satisfied the eligibility criteria related to counternarcotics and suspended Bolivia's status as a beneficiary country for purposes of the...

76 FR 59663 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary Sub...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... of Apparel Articles Assembled in Beneficiary Sub-Saharan African Countries From Regional and Third... Acceleration Act of 2004, Pub. L. 108-274; Division D, Title VI, section 6002 of the Tax Relief and Health Care... beneficiary sub-Saharan African countries. Section 112(b)(3) of TDA 2000 provides duty- and quota-free...

19 CFR 10.196 - Cost or value of materials produced in a beneficiary country or countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... country where it is tanned to create nonperishable “crust leather”. The tanned product is then imported... tanned to create nonperishable “crust leather”. The tanned skin is then imported directly into the U.S... composed is not wholly the growth, product, or manufacture of a beneficiary country and (2) the tanning...

19 CFR 208.2 - Definitions applicable to this part.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INVESTIGATIONS WITH RESPECT TO COMMERCIAL AVAILABILITY OF TEXTILE FABRIC AND YARN IN SUB-SAHARAN AFRICAN COUNTRIES § 208.2 Definitions applicable to this part. (a) Beneficiary sub-Saharan African country. The term “beneficiary sub-Saharan African country” means those countries so designated by the President under 19 U.S.C...

42 CFR 413.202 - Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted...

Code of Federal Regulations, 2011 CFR

2011-10-01

... kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. 413.202... (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. An OPO's total costs for all kidneys is reduced by the costs associated with procuring kidneys...

42 CFR 413.202 - Organ procurement organization (OPO) cost for kidneys sent to foreign countries or transplanted...

Code of Federal Regulations, 2010 CFR

2010-10-01

... kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. 413.202... (OPO) cost for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. An OPO's total costs for all kidneys is reduced by the costs associated with procuring kidneys...

19 CFR 10.232 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the CBERA which the President also has designated as a beneficiary country for purposes of... by the President or his designee, published in the Federal Register, that the beneficiary country has... entered into by the United States, Canada, and Mexico on December 17, 1992. Preferential tariff treatment...

75 FR 19669 - Andean Trade Preference Act (ATPA), as Amended: Request for Public Comments Regarding Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-15

... eligible Andean countries. In Proclamation 7616 of October 31, 2002, the President designated Bolivia... President determined that Bolivia no longer satisfies the eligibility criteria related to counternarcotics and suspended Bolivia's status as a beneficiary country for purposes of the ATPA and ATPDEA. In a June...

19 CFR 10.178a - Special duty-free treatment for sub-Saharan African countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... specifically determines, after public notice and comment, will not cause material injury to watch or watch band... insular possessions; (2) Certain electronic articles; (3) Certain steel articles; (4) Footwear, handbags... “Materials produced in a beneficiary developing country or members of the same association” should read...

19 CFR 10.178a - Special duty-free treatment for sub-Saharan African countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... specifically determines, after public notice and comment, will not cause material injury to watch or watch band... insular possessions; (2) Certain electronic articles; (3) Certain steel articles; (4) Footwear, handbags... “Materials produced in a beneficiary developing country or members of the same association” should read...

19 CFR 10.178a - Special duty-free treatment for sub-Saharan African countries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... specifically determines, after public notice and comment, will not cause material injury to watch or watch band... insular possessions; (2) Certain electronic articles; (3) Certain steel articles; (4) Footwear, handbags... “Materials produced in a beneficiary developing country or members of the same association” should read...

19 CFR 10.178a - Special duty-free treatment for sub-Saharan African countries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... specifically determines, after public notice and comment, will not cause material injury to watch or watch band... insular possessions; (2) Certain electronic articles; (3) Certain steel articles; (4) Footwear, handbags... “Materials produced in a beneficiary developing country or members of the same association” should read...

19 CFR 10.178a - Special duty-free treatment for sub-Saharan African countries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... specifically determines, after public notice and comment, will not cause material injury to watch or watch band... insular possessions; (2) Certain electronic articles; (3) Certain steel articles; (4) Footwear, handbags... “Materials produced in a beneficiary developing country or members of the same association” should read...

78 FR 16908 - Determinations Under the African Growth and Opportunity Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... STATES TRADE REPRESENTATIVE Determinations Under the African Growth and Opportunity Act AGENCY... substantial progress toward implementing and following, the customs procedures required by the African Growth... lesser developed beneficiary sub-Saharan African country. In Proclamation 7350 (October 2, 2000), the...

The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access

PubMed Central

2012-01-01

Background The reform of pharmaceutical policy can often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a legislative amendment that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only two orders of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda have been exported. Future use of the regime appears unlikely. This research aimed to examine the politics of CAMR. Methods Parliamentary Committee hearing transcripts from CAMR's legislative development (2004) and legislative review (2007) were analysed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analysed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR. Results In 2004, policy debates in Canada were dominated by two themes: intellectual property rights and the TRIPS Agreement. The right to medicines as a basic human right and CAMR's potential impact on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. Conclusions The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access. PMID:22472291

The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access.

PubMed

Esmail, Laura C; Kohler, Jillian Clare

2012-04-03

The reform of pharmaceutical policy can often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a legislative amendment that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only two orders of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda have been exported. Future use of the regime appears unlikely. This research aimed to examine the politics of CAMR. Parliamentary Committee hearing transcripts from CAMR's legislative development (2004) and legislative review (2007) were analysed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analysed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR. In 2004, policy debates in Canada were dominated by two themes: intellectual property rights and the TRIPS Agreement. The right to medicines as a basic human right and CAMR's potential impact on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.

Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements

NASA Astrophysics Data System (ADS)

Spiteri, Arian; Nepalz, Sanjay K.

2006-01-01

Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

77 FR 1549 - Generalized System of Preferences (GSP): Notice of the Results of the 2010 GSP Annual Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-10

... OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE Generalized System of Preferences (GSP): Notice...-free importation of eligible articles when imported from designated beneficiary developing countries... review and the recommendation of the U.S. Trade Representative, President Obama removed one product...

19 CFR 10.195 - Country of origin criteria.

Code of Federal Regulations, 2011 CFR

2011-04-01

... cost or value of the material produced in a beneficiary country or countries, plus the direct costs of... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.195 - Country of origin criteria.

Code of Federal Regulations, 2014 CFR

2014-04-01

... cost or value of the material produced in a beneficiary country or countries, plus the direct costs of... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.195 - Country of origin criteria.

Code of Federal Regulations, 2013 CFR

2013-04-01

... cost or value of the material produced in a beneficiary country or countries, plus the direct costs of... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.195 - Country of origin criteria.

Code of Federal Regulations, 2012 CFR

2012-04-01

... cost or value of the material produced in a beneficiary country or countries, plus the direct costs of... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., production, manufacture, or assembly of the specific merchandise under consideration. Such costs include, but are not limited to: (1) All actual labor costs involved in the growth, production, manufacture, or... specific merchandise or are not related to the growth, production, manufacture, or assembly of the...

Maternal healthcare financing: Gujarat's Chiranjeevi Scheme and its beneficiaries.

PubMed

Bhat, Ramesh; Mavalankar, Dileep V; Singh, Prabal V; Singh, Neelu

2009-04-01

Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. General Provisions Generalized System of Preferences § 10.178 Direct costs of...

76 FR 29008 - Caribbean Basin Economic Recovery Act: Impact on U.S. Industries and Consumers and on Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-19

...: Impact on U.S. Industries and Consumers and on Beneficiary Countries; Notice of public hearing and opportunity to submit comments in connection with the 20th report on the economic impact of the Caribbean...: Notice. SUMMARY: Section 215 of the CBERA (19 U.S.C. 2704) requires the Commission to report biennially...

19 CFR 10.206 - Value content requirement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... countries, plus the direct costs of processing operations performed in a beneficiary country or countries...)(1) of this part. Any cost or value of materials or direct costs of processing operations...) combining or packaging operations, or mere dilution with water or mere dilution with another substance that...

78 FR 26392 - Caribbean Basin Economic Recovery Act: Impact on U.S. Industries and Consumers and on Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

...: Impact on U.S. Industries and Consumers and on Beneficiary Countries, 21st Report AGENCY: United States... connection with the 21st report. SUMMARY: Section 215 of the CBERA (19 U.S.C. 2704) requires the Commission to report biennially to the Congress and the President by September 30 of each reporting year on the...

19 CFR 10.253 - Articles eligible for preferential treatment.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Footwear not designated on December 4, 1991, as eligible articles for the purpose of the Generalized System... material which is the product of any country with respect to which HTSUS column 2 rates of duty apply; and... materials produced in an ATPDEA beneficiary country or countries, plus the direct costs of processing...

19 CFR 10.253 - Articles eligible for preferential treatment.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Footwear not designated on December 4, 1991, as eligible articles for the purpose of the Generalized System... material which is the product of any country with respect to which HTSUS column 2 rates of duty apply; and... materials produced in an ATPDEA beneficiary country or countries, plus the direct costs of processing...

77 FR 70473 - Child Labor, Forced Labor, and Forced or Indentured Child Labor in the Production of Goods in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

... Production of Goods in Foreign Countries and Efforts by Certain Countries To Eliminate the Worst Forms of...'s individual advancement toward eliminating the worst forms of child labor during the current... beneficiary country's implementation of its international commitments to eliminate the worst forms of child...

3 CFR 8618 - Proclamation 8618 of December 21, 2010. To Take Certain Actions Under the African Growth and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... designated the Democratic Republic of Congo (DRC) as an eligible sub-Saharan African country pursuant to... “Democratic Republic of Congo” from the list of beneficiary sub-Saharan African countries. (3) In order to...

Mapping Stormwater Retention in the Cities: A Flexible Model for Data-Scarce Environments

NASA Astrophysics Data System (ADS)

Hamel, P.; Keeler, B.

2014-12-01

There is a growing demand for understanding and mapping urban hydrological ecosystem services, including stormwater retention for flood mitigation and water quality improvement. Progress in integrated urban water management and low impact development in Western countries increased our understanding of how grey and green infrastructure interact to enhance these services. However, valuation methods that account for a diverse group of beneficiaries are typically not made explicit in urban water management models. In addition, the lack of spatial data on the stormwater network in developing countries makes it challenging to apply state-of-the-art models needed to understand both the magnitude and spatial distribution of the stormwater retention service. To fill this gap, we designed the Urban InVEST stormwater retention model, a tool that complements the suite of InVEST software models to quantify and map ecosystem services. We present the model structure emphasizing the data requirements from a user's perspective and the representation of services and beneficiaries. We illustrate the model application with two case studies in a data-rich (New York City) and data-scarce environment. We discuss the difference in the level of information obtained when less resources (data, time, or expertise) are available, and how this affects multiple ecosystem service assessments that the tool is ultimately designed for.

Equity in the financing of social security for health in Chile.

PubMed

Bitran, R; Mu?oz, J; Aguad, P; Navarrete, M; Ubilla, G

2000-01-01

Real public health spending has more than doubled since 1990, raising concerns about the targeting of public subsidies. This study examined the degree of equity in the financing of FONASA, the public insurer, which in 1995 covered 8.6 million beneficiaries, or 62% of the country's population. Study results, covering calendar year 1995, indicated that (1) government health subsidies were well-targeted, with about 90% reaching the indigent and 8% going to other, low-income beneficiaries; (2) only 2.5% of government subsidies leaked to higher-income, non-beneficiaries of FONASA (people covered by private insurers known as ISAPRES, otherwise covered, or without any coverage); (3) overall, FONASA's contributing beneficiaries (i.e. the indigent aside) self-financed their health benefits, although higher-income beneficiaries were providing significant cross-subsidies to low-income ones, making the internal financing of FONASA somewhat progressive; (4) the indigent received the highest amount of annual net benefits per capita, followed by low-income beneficiaries; and (5) the evasion of FONASA's payroll tax was pervasive, although public providers delivered care on an equal basis irrespective of the patients' contributions to FONASA. FONASA's finances would improve significantly if affiliation to health social security by both dependent and independent workers was made compulsory.

When elders choose: Which factors could influence the decision-making among elderly in the selection of health tourism services?

PubMed

Tomasović Mrčela, N; Borovac, J A; Vrdoljak, D; Grazio, S; Tikvica Luetić, A; Tomek-Roksandić, S

2015-12-01

Elderly beneficiaries (age 65+) exhibit specific characteristics that influence the distribution of health tourism market. High incidence of multiple morbidities and functional disability are hallmarks in this age group. For these reasons, elderly population requires different elements and diverse spectrum of services within health tourism, in comparison to younger beneficiaries. Thus, differences would occur within heterogeneous elderly population itself. A preliminary study that we conducted showed that the level of functional independence was one of the significant factors that guided decision-making among elderly beneficiaries when it came to their health tourism-related choices. Results suggested that beneficiaries recognized and appreciated the effect of the natural remedies and attractions available at the given destination. Maritime and continental health tourism are two different entities commonly selected by elderly beneficiaries for therapeutic purposes. We propose that the climate conditions, geographical location and availability of regional natural remedies are the key factors to why different services were elected by different groups of elderly. The model of Croatia, an established country in the field of health tourism was utilized for this purpose. Differences in the diagnostic categories of beneficiaries are expected due to effects of marine (sea, Mediterranean climate) and continental (thermal water, healing mud) health tourism. In addition, multitudes of mutually intertwined factors affect decision-making process among elderly regarding their health tourism choices. Such factors include the scale of preferences (with special emphasis on well-being and health), leisure opportunities, marketing influences, cost (price) and the availability/diversity of health tourism services within the particular region. Moreover, individual psychosocial and physical characteristics, disabilities and other debilitating conditions, examined in our preliminary study, significantly contributed to the decision-making scheme. We shouldn't disregard sociodemographic and cultural preferences among elderly as potential factors. Confirmation of our hypothesis could change the usual approach towards the group of elderly beneficiaries (65+) in the health tourism domain. This approach is often largely based on chronological age criteria exclusively. The contents of this manuscript could serve as a blueprint for the development of comprehensive and sustainable health tourism strategies worldwide. Copyright © 2015 Elsevier Ltd. All rights reserved.

Neoliberalism as a class ideology; or, the political causes of the growth of inequalities.

PubMed

Navarro, Vicente

2007-01-01

Neoliberalism is the dominant ideology permeating the public policies of many governments in developed and developing countries and of international agencies such as the World Bank, International Monetary Fund, World Trade Organization, and many technical agencies of the United Nations, including the World Health Organization. This ideology postulates that the reduction of state interventions in economic and social activities and the deregulation of labor and financial markets, as well as of commerce and investments, have liberated the enormous potential of capitalism to create an unprecedented era of social well-being in the world's population. This article questions each of the theses that support such ideology, presenting empirical information that challenges them. The author also describes how the application of these neoliberal policies has been responsible for a substantial growth of social inequalities within the countries where such policies have been applied, as well as among countries. The major beneficiaries of these policies are the dominant classes of both the developed and the developing countries, which have established worldwide class alliances that are primarily responsible for the promotion of neoliberalism.

Patient access to pharmaceuticals: an international comparison.

PubMed

Cohen, Joshua; Faden, Laura; Predaris, Susan; Young, Brian

2007-09-01

We have identified eight sub-dimensions of patient access to pharmaceuticals: marketing approvals, time of marketing approval, coverage, cost sharing, conditions of reimbursement, speed from marketing approval to reimbursement, extent to which beneficiaries control choice of their drug benefit, and evenness of the availability of drugs to the population. For a sample of commonly used best-selling drugs in the United States (US), we measured these eight access sub-dimensions across four health systems: France, the Netherlands, the United Kingdom (UK), and the US. Although the US approved between 15 and 18% more drugs than the other three countries, the US was slower than France and the UK to approve drugs licensed in all four countries. The percentage of drugs covered is approximately the same for all four countries. For covered drugs, we observe the least cost sharing by patients in the Netherlands. The Netherlands imposes conditions of reimbursement on a much larger percentage of drugs. France seems to be the slowest in respect of speed from marketing approval to reimbursement. The US is the most flexible in terms of the extent to which beneficiaries control their choice of drug benefit but it is the least universal in terms of evenness of the availability of drugs to the population. Our study confirms the frequently cited problems of access in European countries: lag between marketing approval and reimbursement, and inflexibility in respect of the extent to which beneficiaries control their choice of drug benefit. At the same time, our study confirms, qualitatively, different kinds of access problems in the US: relatively high patient cost sharing for pharmaceuticals, and wide variation in coverage.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... merchandise: (1) All actual labor costs involved in the growth, production, manufacture or assembly of the... the growth, production, manufacture, or assembly of the merchandise, such as administrative salaries... costs either directly incurred in, or which can be reasonably allocated to, the growth, production...

19 CFR 10.191 - General.

Code of Federal Regulations, 2011 CFR

2011-04-01

... articles for purposes of the CBI on January 1, 1994, as the CBI was in effect on that date. (ii) Footwear... analog, if such watches or watch parts contain any material which is the product of any country with... two or more beneficiary countries and to all materials incorporated in an article which have been...

19 CFR 10.191 - General.

Code of Federal Regulations, 2012 CFR

2012-04-01

... articles for purposes of the CBI on January 1, 1994, as the CBI was in effect on that date. (ii) Footwear... analog, if such watches or watch parts contain any material which is the product of any country with... two or more beneficiary countries and to all materials incorporated in an article which have been...

19 CFR 10.191 - General.

Code of Federal Regulations, 2013 CFR

2013-04-01

... articles for purposes of the CBI on January 1, 1994, as the CBI was in effect on that date. (ii) Footwear... analog, if such watches or watch parts contain any material which is the product of any country with... two or more beneficiary countries and to all materials incorporated in an article which have been...

19 CFR 10.191 - General.

Code of Federal Regulations, 2014 CFR

2014-04-01

... articles for purposes of the CBI on January 1, 1994, as the CBI was in effect on that date. (ii) Footwear... analog, if such watches or watch parts contain any material which is the product of any country with... two or more beneficiary countries and to all materials incorporated in an article which have been...

75 FR 1589 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

...-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric... for duty- and quota-free treatment for certain textile and apparel articles imported from designated...) of the amended ATPA provides duty- and quota-free treatment for certain apparel articles assembled in...

76 FR 1137 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

76 FR 66915 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

77 FR 59913 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-month cap...

Information and communication technologies and health in low income countries: the potential and the constraints.

PubMed Central

Chandrasekhar, C. P.; Ghosh, J.

2001-01-01

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide. PMID:11584733

Impact of Thailand universal coverage scheme on the country's health information systems and health information technology.

PubMed

Kijsanayotin, Boonchai

2013-01-01

Thailand achieved universal healthcare coverage with the implementation of the Universal Coverage Scheme (UCS) in 2001. This study employed qualitative method to explore the impact of the UCS on the country's health information systems (HIS) and health information technology (HIT) development. The results show that health insurance beneficiary registration system helps improve providers' service workflow and country vital statistics. Implementation of casemix financing tool, Thai Diagnosis-Related Groups, has stimulated health providers' HIS and HIT capacity building, data and medical record quality and the adoption of national administrative data standards. The system called "Disease Management Information Systems" aiming at reimbursement for select diseases increased the fragmentation of HIS and increase burden on data management to providers. The financial incentive of outpatient data quality improvement project enhance providers' HIS and HIT investment and also induce data fraudulence tendency. Implementation of UCS has largely brought favorable impact on the country HIS and HIT development. However, the unfavorable effects are also evident.

The effectiveness of international development assistance from American organizations to deaf communities in Jamaica.

PubMed

Wilson, Amy T

American organizations bringing assistance to deaf people in developing countries unintentionally create relationships of dependency or oppression rather than relationships of support. Using qualitative methods, the author examined the effectiveness of development assistance provided to the Jamaican Deaf community by two American churches, one American nongovernmental organization, and one U.S. federal agency. Documents were reviewed and observations were made. Interviews were conducted with more than 60 deaf and hearing people involved with the American organizations, the Jamaican organizations, and deaf Jamaican beneficiaries. The author concludes that the Jamaican Deaf community was often excluded in planning, designing, or evaluating programs, and was unsatisfied with the American assistance it received. Results also indicate that the American organizations were poorly prepared to work with the Deaf community. Suggestions for American organizations wishing to strengthen and empower deaf people through development assistance in developing countries are proposed.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations performed in...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... specific merchandise, including fringe benefits, on-the-job training, and the cost of engineering..., engineering, and blueprint costs insofar as they are allocable to the specific merchandise and; (4) Costs of... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations performed in...

[Laws relevant to international missions of health cooperation].

PubMed

Scaroni, E; Riccardo, F; De Rosa, A G; Russo, G; Pacini, A; Nardi, L; Pacifici, L E

2007-01-01

Both medical doctors and humanitarian operators engaged in health relief or development missions abroad, are called to respect the general principles of international law, that is to say, customary law that is legally compulsory for the International Community and rules deriving from Treaties and International Conventions. Humanitarian operators have to observe also the rules and regulations of the hosting country. They have to respect all rules applying to their humanitarian action and they have to take responsibility towards beneficiaries and donors alike.

19 CFR 10.176 - Country of origin criteria.

Code of Federal Regulations, 2012 CFR

2012-04-01

... amended (19 U.S.C. 2467(2)), plus the direct costs of processing operations performed in the beneficiary... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.176 - Country of origin criteria.

Code of Federal Regulations, 2010 CFR

2010-04-01

... amended (19 U.S.C. 2467(2)), plus the direct costs of processing operations performed in the beneficiary... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.176 - Country of origin criteria.

Code of Federal Regulations, 2014 CFR

2014-04-01

... amended (19 U.S.C. 2467(2)), plus the direct costs of processing operations performed in the beneficiary... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.176 - Country of origin criteria.

Code of Federal Regulations, 2013 CFR

2013-04-01

... amended (19 U.S.C. 2467(2)), plus the direct costs of processing operations performed in the beneficiary... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

19 CFR 10.176 - Country of origin criteria.

Code of Federal Regulations, 2011 CFR

2011-04-01

... amended (19 U.S.C. 2467(2)), plus the direct costs of processing operations performed in the beneficiary... juice by adding water to orange juice concentrate; and (G) Diluting chemicals with inert ingredients to...

3 CFR 8741 - Proclamation 8741 of October 25, 2011. To Take Certain Actions Under the African Growth and...

Code of Federal Regulations, 2012 CFR

2012-01-01

...’Ivoire (Côte d’Ivoire), the Republic of Guinea (Guinea), and the Republic of Niger (Niger) meet the..., Guinea, and Niger as eligible sub-Saharan African countries and as beneficiary sub-Saharan African countries. 5. Côte d’Ivoire, Guinea, and Niger each satisfy the criterion for treatment as a “lesser...

Focusing on Success: Examples of How the Universal Service Fund Is Helping Improve Connectivity across the Country

ERIC Educational Resources Information Center

Universal Service Administrative Company, 2008

2008-01-01

This report includes examples of how Universal Service Fund support is used by beneficiaries across the country. Included in this version are approximately 140 success stories of how the Universal Service Fund is helping to improve connectivity in the United States. This report is updated quarterly, as Universal Service Administrative Company…

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

[Availability of physicians in Chile at the year 2004].

PubMed

Román, Oscar; Acuña, Miguel; Señoret, Miriam

2006-08-01

The number of physicians available in a given country, their efficiency, quality and specialization is of utmost epidemiological importance. To evaluate the availability of physicians in Chile. The information about the number of physicians in Chile up to the year 2004, was obtained from the Ministry of Health, national universities and the register of immigrant physicians since 1950. The total number of physicians licensed to practice was 25,542, of whom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004. The greater impact in the increment of available physicians was given by the immigration of professionals and by the increase in the number of physicians graduated from national universities, mainly from the new private universities. Forty two percent of physicians work at public services and 61% of these are certified specialists. The regional distribution of general practitioners and basic specialists is adequate. Along the country, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 and the general practitioner/beneficiary ratio is 2.3/10,000. The national information of available physicians, especially in the private sector, should be improved. Immigration of physicians should be regulated, maintaining validation examinations and a National Medical Test to assess medical proficiency should be instituted.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed

Desmond, Katherine A; Rice, Thomas H; Leibowitz, Arleen A

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Development of a Medicare Beneficiary Comprehension Test: Assessing Medicare Part D Beneficiaries' Comprehension of Their Benefits

PubMed Central

Aruru, Meghana V.; Salmon, J. Warren

2013-01-01

Background Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by consumer health plans and healthcare providers that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, may have cognitive problems, and may not have a true understanding of managed care. They are more likely than younger persons to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare. Objective To develop a Medicare Beneficiary Comprehension Test (MBCT) to evaluate Medicare beneficiaries' understanding of Part D plan concepts, as presented in the 2008 Medicare & You handbook. Methods A 10-question MBCT was developed using a case-vignette approach that required beneficiaries to read portions of the Medicare & You handbook and answer Part D–related questions associated with healthcare decision-making. The test was divided into 2 sections: (I) insurance concepts and (II) utilization management/appeals and grievances to cover standard terminology, as well as newer utilization management and appeals and grievances procedures that are unique to Part D. The test was administered to 100 beneficiaries at 2 sites—a university geriatrics clinic and a private retirement facility. Beneficiaries were tested for cognition and health literacy before being administered the test. Results The mean score on the MBCT was 3.5 of a maximum of 5, with no statistical difference found between both sites. Ten faculty members and 4 graduate students assessed the content validity of the instrument using a 4-point Likert rating rubric. The construct validity of the instrument was assessed using a principal components analysis with varimax rotation. The principal components analysis yielded 4 factors that were labeled as “Plan D concepts,” “managed care/utilization management,” “cost-sharing,” and “plan comparisons.” The factor analysis indicated that the test is multidimensional and did measure the construct. Conclusions Medicare beneficiaries' understanding of Part D may play a key role in the management of their drug use and health and the associated outcomes. The MBCT and its pending revisions can be administered to beneficiaries with differing health outcomes. Medicare beneficiaries are often faced with several pieces of information involving a complex array of choices amidst bewildering plan options. It is crucial that beneficiaries and/or their family members involved in the decision-making process understand the plan benefits to truly make an informed decision. As the number of Medicare beneficiaries increases over the coming years with the baby boomers, it becomes even more imperative that the elderly have improved access to treatments that can achieve desirable outcomes. Measuring comprehension by Medicare beneficiaries may be an initial step toward understanding more complex issues, such as treatment adherence, decision-making, and, ultimately, trends in healthcare utilization and outcomes. PMID:24991375

Legislation on violence against women: overview of key components.

PubMed

Ortiz-Barreda, Gaby; Vives-Cases, Carmen

2013-01-01

This study aimed to determine if legislation on violence against women (VAW) worldwide contains key components recommended by the Pan American Health Organization (PAHO) and the United Nations (UN) to help strengthen VAW prevention and provide better integrated victim protection, support, and care. A systematic search for VAW legislation using international legal databases and other electronic sources plus data from previous research identified 124 countries/territories with some type of VAW legislation. Full legal texts were found for legislation from 104 countries/territories. Those available in English, Portuguese, and Spanish were downloaded and compiled and the selection criteria applied (use of any of the common terms related to VAW, including intimate partner violence (IPV), and reference to at least two of six sectors (education, health, judicial system, mass media, police, and social services) with regard to VAW interventions (protection, support, and care). A final sample from 80 countries/territories was selected and analyzed for the presence of key components recommended by PAHO and the UN (reference to the term "violence against women" in the title; definitions of different types of VAW; identification of women as beneficiaries; and promotion of (reference to) the participation of multiple sectors in VAW interventions). Few countries/territories specifically identified women as the beneficiaries of their VAW legislation, including those that labeled their legislation "domestic violence" law ( n = 51), of which only two explicitly mentioned women as complainants/survivors. Only 28 countries/territories defined the main forms of VAW (economic, physical, psychological, and sexual) in their VAW legislation. Most highlighted the role of the judicial system, followed by that of social services and the police. Only 28 mentioned the health sector. Despite considerable efforts worldwide to strengthen VAW legislation, most VAW laws do not incorporate the key recommended components. Significant limitations were found in the legislative content, its application, and the extent to which it provided women with integrated protection, support, and care. In developing new VAW legislation, policymakers should consider the vital role of health services.

Beneficiaries' perceptions of new Medicare health plan choice print materials.

PubMed

Harris-Kojetin, L D; McCormack, L A; Jaël, E M; Lissy, K S

2001-01-01

This article presents findings from a study involving seven focus groups with aged and disabled Medicare beneficiaries in the Kansas City area regarding their impressions of a pilot version of the Medicare & You 1999 handbook and the Medicare Consumer Assessment of Health Plans Study (CAHPS) survey report. Beneficiaries generally had positive reactions to both booklets and viewed the handbook as an important reference tool. Based on the findings, we present policy recommendations for the development and dissemination of Medicare health plan information to beneficiaries.

The social and economic impact of biofortification through genetic modification.

PubMed

De Steur, Hans; Demont, Matty; Gellynck, Xavier; Stein, Alexander J

2017-04-01

Genetic modification (GM) has been advocated as an alternative or complement to micronutrient interventions such as supplementation, fortification or dietary diversification. While proof-of-concept of various GM biofortified crops looks promising, the decision tree of policy makers is much more complex, and requires insight on their socio-economic impacts: Will it actually work? Is it financially sound? Will people accept it? Can it be implemented in a globalized world? This review shows that GM biofortification could effectively reduce the burden of micronutrient deficiencies, in an economically viable way, and is generally well received by target beneficiaries, despite some resistance and uncertainty. Practically, however, protectionist and/or unscientific regulations in some developed countries raise the (perceived) bar for implementation in target countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

76 FR 68039 - Federal Acquisition Regulation; Successor Entities to the Netherlands Antilles

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-02

...] RIN 9000-AM11 Federal Acquisition Regulation; Successor Entities to the Netherlands Antilles AGENCIES..., successor political entities remain eligible as beneficiary countries. On October 10, 2010, Curacao and Sint... been revised to replace ``Netherlands Antilles'' with the five separate successor entities-- Bonaire...

Relative importance of attributes of drug benefit plans: Thai civil servants' perspective.

PubMed

Ngorsuraches, Surachat; Wanishayakorn, Tanatape; Tanvejsilp, Pimwara; Udomaksorn, Siripa

2013-01-01

The drug benefit plan of Thailand's Civil Servant Medical Benefit Scheme (CSMBS) must be amended to control increasing costs; to that end, it is important to gather the views of beneficiaries before making changes to the benefit plan. To examine the relative importance of attributes of drug benefit plans from the perspective of CSMBS beneficiaries. Attributes and levels adopted from focus group discussions and a preliminary survey were used to develop a questionnaire concerning hypothetical drug benefit plans. A convenience sample of 650 CSMBS beneficiaries in Songkhla province was asked to rate the drug benefit plans. To determine the beneficiaries' decision models, judgment analysis was used. Policy-capturing analysis was used to examine the beneficiaries' preferences, and cluster analysis was conducted to explore the variability among judgment plans. Judgment policy insight was also examined. The results of the study showed that the beneficiaries weighed on cost-sharing as their most important attribute. The results remained unchanged, although only data from the beneficiaries who used the compensatory model were analyzed. The results of the cluster analysis showed that the largest cluster of beneficiaries weighed mostly on the cost-sharing attribute. The judgment policy insight results not only supported the finding that most beneficiaries focused on the cost-sharing attribute but also revealed that they might have the least understanding of how the formulary attribute affected beneficiaries' decision making. Cost-sharing was the most important attribute for the CSMBS beneficiaries. This study indicated that a possible preferred drug benefit plan should have no cost-sharing, permit access only to drugs listed in a closed formulary, allow beneficiaries to obtain 3 months of drugs, and allow them to obtain drugs from either a community pharmacy or a government hospital. Copyright © 2013 Elsevier Inc. All rights reserved.

European training network on full-parallax imaging (Conference Presentation)

NASA Astrophysics Data System (ADS)

Martínez-Corral, Manuel; Saavedra, Genaro

2017-05-01

Current displays are far from truly recreating visual reality. This requires a full-parallax display that can reproduce radiance field emanated from the real scenes. The develop-ment of such technology will require a new generation of researchers trained both in the physics, and in the biology of human vision. The European Training Network on Full-Parallax Imaging (ETN-FPI) aims at developing this new generation. Under H2020 funding ETN-FPI brings together 8 beneficiaries and 8 partner organizations from five EU countries with the aim of training 15 talented pre-doctoral students to become future research leaders in this area. In this contribution we will explain the main objectives of the network, and specifically the advances obtained at the University of Valencia.

Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor.

PubMed

Barber, Sarah L

2010-08-01

Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for >or=6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.

19 CFR 10.206 - Value content requirement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in any beneficiary country as defined in § 10.202(a) in the production or manufacture of a new or... incurred in the growth, production, or manufacture of the material, including general expenses; (B) An..., production, manufacture, or assembly of the specific merchandise under consideration. Such costs include, but...

77 FR 47910 - Andean Trade Preference Act (ATPA): Notice Regarding the 2012 Annual Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... eligible Andean countries. The original Act allowed only Bolivia, Ecuador, Colombia, and Peru to be...). In Proclamation 8323 of November 25, 2008, the President determined that Bolivia no longer satisfies the eligibility criteria related to counternarcotics and suspended Bolivia's status as a beneficiary...

77 FR 24555 - Andean Trade Preference Act (ATPA), as Amended: Request for Public Comments Regarding Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

...., provides trade benefits for eligible Andean countries. The original Act allowed only Bolivia, Ecuador... Bolivia no longer satisfies the eligibility criteria related to counternarcotics and suspended Bolivia's... Congress, the President did not determine that Bolivia satisfies the requirements set forth in section 203...

78 FR 1296 - Agency Information Collection Activities: Proposed Request and Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-08

... collection techniques or other forms of information technology. Mail, email, or fax your comments and... Statement Regarding Farming Activities of Person Living Outside the U.S.A.--0960-0103. When a beneficiary or... respondent's country of residence. Respondents are Social Security recipients engaged in farming activities...

JICA support of NGO project succeeds.

PubMed

2000-05-01

In 1997, the Japan International Cooperation Agency (JICA) started the Community Empowerment Program (CEP) to directly help people at the grassroots level in developing countries. It was created to directly benefit people in developing countries by improving their livelihood and welfare. Under the program, model projects are implemented together with local nongovernmental organizations (NGOs). The Capacity Building for Sustainable Reproductive Health Care Project in Jessore District in Bangladesh, is a pioneer of JICA and NGO cooperation under CEP, and it aims to develop the capacity of service providers to deliver sustainable reproductive health (RH) services in rural areas through community involvement. To achieve this, training for community health promoters (CHPs) is provided to enable them to deliver an Essential Services Package (ESP) of integrated health and RH services to rural beneficiaries. So far, a total of 125 people have been trained, including 75 CHPs, 10 health assistants, and 40 family welfare assistants. Midterm evaluation of the project indicated that the project had pioneered the development of 17 ESP modules and has established the strong potential to link with government programs for future sustainability.

75 FR 82069 - Ethyl Alcohol for Fuel Use: Determination of the Base Quantity of Imports

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

...: Determination of the Base Quantity of Imports AGENCY: United States International Trade Commission. ACTION... establish the ``base quantity'' of imports of fuel ethyl alcohol with a zero percent local feedstock requirement that can be imported from U.S. insular possessions or CBERA-beneficiary countries. The base...

Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

DTIC Science & Technology

2017-01-01

delivery of health care that would be more accessible and less expensive than operating two federal medical centers serving VA and DOD beneficiaries in...departments—including DOD’s operational readiness mission—by integrating services previously provided by the former North Chicago VA Medical Center...1VA beneficiaries include veterans of military service and certain dependents and survivors. DOD beneficiaries include active duty

Using measures of wellbeing for impact evaluation: Proof of concept developed with an Indigenous community undertaking land management programs in northern Australia.

PubMed

Larson, Silva; Stoeckl, Natalie; Jarvis, Diane; Addison, Jane; Prior, Sharon; Esparon, Michelle

2018-05-05

Combining insights from literature on the Theory of Change, Impact Evaluation, and Wellbeing, we develop a novel approach to assessing impacts. Intended beneficiaries identify and rate factors that are important to their wellbeing, their satisfaction with those factors now, and before an intervention. Qualitative responses to questions about perceived changes and causes of change are linked to quantitative data to draw inferences about the existence and/or importance of impact(s). We use data from 67 Ewamian people, in a case study relating to Indigenous land management, to provide proof of concept. 'Knowing that country is being looked after' and 'Having legal right/access to the country' were identified as important to wellbeing, with perceptions that Native Title determination, declared Indigenous Protected Area and associated land management programs have had a significant and positive impact on them. Further method testing might determine the utility of this approach in a wide range of settings.

Genomic Medicine Without Borders: Which Strategies Should Developing Countries Employ to Invest in Precision Medicine? A New "Fast-Second Winner" Strategy.

PubMed

Mitropoulos, Konstantinos; Cooper, David N; Mitropoulou, Christina; Agathos, Spiros; Reichardt, Jürgen K V; Al-Maskari, Fatima; Chantratita, Wasun; Wonkam, Ambroise; Dandara, Collet; Katsila, Theodora; Lopez-Correa, Catalina; Ali, Bassam R; Patrinos, George P

2017-11-01

Genomic medicine has greatly matured in terms of its technical capabilities, but the diffusion of genomic innovations worldwide faces significant barriers beyond mere access to technology. New global development strategies are sorely needed for biotechnologies such as genomics and their applications toward precision medicine without borders. Moreover, diffusion of genomic medicine globally cannot adhere to a "one-size-fits-all-countries" development strategy, in the same way that drug treatments should be customized. This begs a timely, difficult but crucial question: How should developing countries, and the resource-limited regions of developed countries, invest in genomic medicine? Although a full-scale investment in infrastructure from discovery to the translational implementation of genomic science is ideal, this may not always be feasible in all countries at all times. A simple "transplantation of genomics" from developed to developing countries is unlikely to be feasible. Nor should developing countries be seen as simple recipients and beneficiaries of genomic medicine developed elsewhere because important advances in genomic medicine have materialized in developing countries as well. There are several noteworthy examples of genomic medicine success stories involving resource-limited settings that are contextualized and described in this global genomic medicine innovation analysis. In addition, we outline here a new long-term development strategy for global genomic medicine in a way that recognizes the individual country's pressing public health priorities and disease burdens. We term this approach the "Fast-Second Winner" model of innovation that supports innovation commencing not only "upstream" of discovery science but also "mid-stream," building on emerging highly promising biomarker and diagnostic candidates from the global science discovery pipeline, based on the unique needs of each country. A mid-stream entry into innovation can enhance collective learning from other innovators' mistakes upstream in discovery science and boost the probability of success for translation and implementation when resources are limited. This à la carte model of global innovation and development strategy offers multiple entry points into the global genomics innovation ecosystem for developing countries, whether or not extensive and expensive discovery infrastructures are already in place. Ultimately, broadening our thinking beyond the linear model of innovation will help us to enable the vision and practice of genomics without borders in both developed and resource-limited settings.

Incentives for Better Performance in Health Care

PubMed Central

Abduljawad, Asaad; Al-Assaf, Assaf F.

2011-01-01

Incentives for better performance in health care have several modes and methods. They are designed to motivate and encourage people to perform well and improve their outcomes. They may include monetary or non-monetary incentives and may be applied to consumers, individual providers or institutions. One such model is the Pay-for-Performance system. In this system, beneficiaries are compared with one another based on a set of performance indicators and those that achieve a high level of performance are rewarded financially. This system is meant to recognise and primarily to reward high performers. Its goal is to encourage beneficiaries to strive for better performance. This system has been applied in several countries and for several recipients and settings. Early indications show that this system has had mixed effects on performance. PMID:21969891

Social Security Protection of Women: Prospects for the 1990's.

ERIC Educational Resources Information Center

Hoskins, Irene

1992-01-01

Social security systems in many countries must serve different populations of women, both as beneficiaries and as insured workers. As more women are acquiring their own social security rights, it is unclear what jobs they will have, what the benefits will be, what family responsibilities they will have, and what social policies will affect their…

Overview of the Programme TEMPUS IV, 2007-2013: Information for Future Applicants and Beneficiaries

ERIC Educational Resources Information Center

European Union, 2010

2010-01-01

TEMPUS is a European Union funded Programme which supports the modernisation of higher education in the Partner Countries in Eastern Europe, Central Asia, the Western Balkans and the Mediterranean region, mainly through university cooperation projects. It also aims to promote the voluntary convergence of the higher education systems in the Partner…

The Talented Arab Girl: Between Tradition and Modernism

ERIC Educational Resources Information Center

David, Hanna; Khalil, Mahmood

2009-01-01

Since Israel's independence in 1948 Arab females were the main beneficiaries of the law of mandatory education. Arab women aged 65+ have, on average, less than one year of formal education. Their granddaughters, aged 18-24, have about 12.5 years of schooling--a number that increases each year. As in many Arab countries, Arab girls in Israel tend…

15 CFR 2007.1 - Information required of interested parties in submitting requests for modifications in the last...

Code of Federal Regulations, 2011 CFR

2011-01-01

... duty-free treatment under the GSP have on competition and the business of the interest on whose behalf..., total quantity, value and trends in exports; (8) Information on exports to the United States in terms of... beneficiary countries and trends in their production and promotional activities; (9) Analysis of cost...

15 CFR 2007.1 - Information required of interested parties in submitting requests for modifications in the last...

Code of Federal Regulations, 2010 CFR

2010-01-01

... duty-free treatment under the GSP have on competition and the business of the interest on whose behalf..., total quantity, value and trends in exports; (8) Information on exports to the United States in terms of... beneficiary countries and trends in their production and promotional activities; (9) Analysis of cost...

Opening a dialog: communicating with retirees about Medicare+Choice.

PubMed

Maeyer, M M; Marlowe, J F

1999-01-01

In October 1998, the Health Care Financing Administration sent information to 38 million Medicare beneficiaries in five pilot states, consisting of a comprehensive handbook entitled Medicare and You. The purpose of the handbook is to clarify new options under Medicare+Choice to participants. Such clarification is bound to initiate contact by Medicare beneficiaries to former employers/unions. This article addresses employers' need to develop a communication strategy for beneficiaries and suggests a methodology and possible questions that may arise.

Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries

PubMed Central

Reschovsky, James D; Hadley, Jack; Saiontz-Martinez, Cynthia B; Boukus, Ellyn R

2011-01-01

Objective To identify factors associated with the cost of treating high-cost Medicare beneficiaries. Data Sources A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004–2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. Study Design Using 12 months of claims data from 2005 to 2006, the sample was divided into predicted high-cost (top quartile) and lower cost beneficiaries using a risk-adjustment model. For each group, total annual standardized costs of care were regressed on beneficiary, usual source of care physician, practice, and market characteristics. Principal Findings Among high-cost beneficiaries, health was the predominant predictor of costs, with most physician and practice and many market factors (including provider supply) insignificant or weakly related to cost. Beneficiaries whose usual physician was a medical specialist or reported inadequate office visit time, medical specialist supply, provider for-profit status, care fragmentation, and Medicare fees were associated with higher costs. Conclusions Health reform policies currently envisioned to improve care and lower costs may have small effects on high-cost patients who consume most resources. Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for “bending the cost curve.” PMID:21306368

Assessing Ecosystem Service Provision Under Climate Change to Support Conservation and Development Planning in Myanmar

NASA Technical Reports Server (NTRS)

Mandle, Lisa; Wolny, Stacie; Bhagabati, Nirmal; Helsingen, Hanna; Hamel, Perrine; Bartlett, Ryan; Dixon, Adam; Horton, Radley M.; Lesk, Corey; Manley, Danielle;

Economic evaluation of a Child Health Days strategy to deliver multiple maternal and child health interventions in Somalia.

PubMed

Vijayaraghavan, Maya; Wallace, Aaron; Mirza, Imran Raza; Kamadjeu, Raoul; Nandy, Robin; Durry, Elias; Everard, Marthe

2012-03-01

Child Health Days (CHDs) are increasingly used by countries to periodically deliver multiple maternal and child health interventions as time-limited events, particularly to populations not reached by routine health services. In countries with a weak health infrastructure, this strategy could be used to reach many underserved populations with an integrated package of services. In this study, we estimate the incremental costs, impact, cost-effectiveness, and return on investment of 2 rounds of CHDs that were conducted in Somalia in 2009 and 2010. We use program costs and population estimates reported by the World Health Organization and United Nations Children's Fund to estimate the average cost per beneficiary for each of 9 interventions delivered during 2 rounds of CHDs implemented during the periods of December 2008 to May 2009 and August 2009 to April 2010. Because unstable areas were unreachable, we calculated costs for targeted and accessible beneficiaries. We model the impact of the CHDs on child mortality using the Lives Saved Tool, convert these estimates of mortality reduction to life years saved, and derive the cost-effectiveness ratio and the return on investment. The estimated average incremental cost per intervention for each targeted beneficiary was $0.63, with the cost increasing to $0.77 per accessible beneficiary. The CHDs were estimated to save the lives of at least 10,000, or 500,000 life years for both rounds combined. The CHDs were cost-effective at $34.00/life year saved. For every $1 million invested in the strategy, an estimated 615 children's lives, or 29,500 life years, were saved. If the pentavalent vaccine had been delivered during the CHDs instead of diphtheria-pertussis-tetanus vaccine, an additional 5000 children's lives could have been saved. Despite high operational costs, CHDs are a very cost-effective service delivery strategy for addressing the leading causes of child mortality in a conflict setting like Somalia and compare favorably with other interventions rated as health sector "best buys" in sub-Saharan Africa.

A focus on the consumer: social marketing for change.

PubMed

Lucaire, L E

1985-01-01

Social marketing is the application of commercial marketing principles to advance a social cause, issue, behavior, product, or service. Social marketing has added a framework to social efforts that heretofore lacked organization and has inspired projects that otherwise might never have been initiated. In the US, social marketing techniques have been particularly successful in the health field. Although advertising and other communications are central to social marketing, the discipline also depends upon other elements of what is termed the marketing mix: product, price, place, and promotion. Social marketing is a cyclical process involving 6 steps: analysis; planning; development, testing, and refining elements of the plan; implementation; assessment of in-market effectiveness; and feedback. In developing countries, health has similarly been the greatest beneficiary to date of applied social marketing techniques. Family planning programs and oral rehydration therapy (ORT) projects have used social marketing techniques effectively in numerous developing countries. Social marketing has been even more widely applied in the sale of contraceptives in developing countries. Contraceptive social marketing (CSM) programs are well established in Bangladesh, Sri Lanka, India, Thailand, Nepal, Colombia, El Salvador, Jamaica, Mexico, and Egypt. More recently programs have been established in Honduras, Guatemala, Barbados, St. Vincent, and St. Lucia. SOMARC (Social Marketing for Change) is a project funded by the US Agency for International Development (AID) and is working with existing CSM programs and helping to launch new CSM programs. CSM programs are successfully functioning as legitimate marketing organizations in developing countries and are using local private sector resources in the process. Program results are encouraging. Social marketing requires both experience and sensitivity to local conditions. Many developing countries now have their own marketing resources. Local private sector advertising and marketing agencies are helping public and private sector programs. In countries where local resources are scarce, AID has created several programs to provide technical assistance in social marketing.

Short message service (SMS) applications for disease prevention in developing countries.

PubMed

Déglise, Carole; Suggs, L Suzanne; Odermatt, Peter

2012-01-12

The last decade has witnessed unprecedented growth in the number of mobile phones in the developing world, thus linking millions of previously unconnected people. The ubiquity of mobile phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention efforts. The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work. A systematic search of peer-reviewed and gray literature was performed for papers published in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries. A total of 34 SMS applications were described, among which 5 had findings of an evaluation reported. The majority of SMS applications were pilot projects in various levels of sophistication; nearly all came from gray literature sources. Many applications were initiated by the project with modes of intervention varying between one-way or two-way communication, with or without incentives, and with educative games. Evaluated interventions were well accepted by the beneficiaries. The primary barriers identified were language, timing of messages, mobile network fluctuations, lack of financial incentives, data privacy, and mobile phone turnover. This review illustrates that while many SMS applications for disease prevention exist, few have been evaluated. The dearth of peer-reviewed studies and the limited evidence found in this systematic review highlight the need for high-quality efficacy studies examining behavioral, social, and economic outcomes of SMS applications and mobile phone interventions aimed to promote health in developing country contexts.

Short Message Service (SMS) Applications for Disease Prevention in Developing Countries

PubMed Central

Suggs, L. Suzanne; Odermatt, Peter

2012-01-01

Background The last decade has witnessed unprecedented growth in the number of mobile phones in the developing world, thus linking millions of previously unconnected people. The ubiquity of mobile phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention efforts. Objective The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work. Methods A systematic search of peer-reviewed and gray literature was performed for papers published in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries. Results A total of 34 SMS applications were described, among which 5 had findings of an evaluation reported. The majority of SMS applications were pilot projects in various levels of sophistication; nearly all came from gray literature sources. Many applications were initiated by the project with modes of intervention varying between one-way or two-way communication, with or without incentives, and with educative games. Evaluated interventions were well accepted by the beneficiaries. The primary barriers identified were language, timing of messages, mobile network fluctuations, lack of financial incentives, data privacy, and mobile phone turnover. Conclusion This review illustrates that while many SMS applications for disease prevention exist, few have been evaluated. The dearth of peer-reviewed studies and the limited evidence found in this systematic review highlight the need for high-quality efficacy studies examining behavioral, social, and economic outcomes of SMS applications and mobile phone interventions aimed to promote health in developing country contexts. PMID:22262730

Shattering the silence of violence against women.

PubMed

1998-01-01

The UN Development Fund for Women has selected 23 projects in 18 developing countries to be beneficiaries of a $1.2 million trust fund dedicated to the elimination of violence against women. While the projects offer a variety of approaches to preventing and eliminating the domestic violence suffered by a third of the women in developing countries, all involve awareness-raising and advocacy, capacity-building, literacy, training, action research, and prevention/deterrence activities. A project in the Philippines will train women migrant workers who have been victimized by abuse to produce videos about their experience in order to raise consciousness about the rights of women and of workers. A South African project, which will address sexual assaults of high school students that occur in dating relationships, will involve a prevalence survey, a pilot project, an expansion of the project and curriculum development, a play on date rape, crisis intervention counseling, production of a video and manual, a national conference, and publication of essays produced by students who participated in the program. The Trust Fund was proposed by Japan in response to the urgent call for action issued by the 1995 UN Fourth World Conference on Women and is funded by donations from governments and private sources.

19 CFR 10.199 - Duty-free entry for certain beverages produced in Canada from Caribbean rum.

Code of Federal Regulations, 2010 CFR

2010-04-01

... sources (e.g., rum the growth, product or manufacture of a CBI beneficiary country or of the U.S. Virgin... produced in the territory of Canada from rum, provided that the rum: (1) Is the growth, product, or... order to claim the exemption, the importer must have the records described in paragraphs (d), (e), (f...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2014 CFR

2014-04-01

...) that are a product of the United States; and (3) Neither the fabricated components, materials or... footwear and parts of footwear, that are classifiable in an HTSUS subheading which carries a textile and....191(b)(1); and (3) A component, material, ingredient, or article shall be deemed to have not entered...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2012 CFR

2012-04-01

...) that are a product of the United States; and (3) Neither the fabricated components, materials or... footwear and parts of footwear, that are classifiable in an HTSUS subheading which carries a textile and....191(b)(1); and (3) A component, material, ingredient, or article shall be deemed to have not entered...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2011 CFR

2011-04-01

...) that are a product of the United States; and (3) Neither the fabricated components, materials or... footwear and parts of footwear, that are classifiable in an HTSUS subheading which carries a textile and....191(b)(1); and (3) A component, material, ingredient, or article shall be deemed to have not entered...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2013 CFR

2013-04-01

...) that are a product of the United States; and (3) Neither the fabricated components, materials or... footwear and parts of footwear, that are classifiable in an HTSUS subheading which carries a textile and....191(b)(1); and (3) A component, material, ingredient, or article shall be deemed to have not entered...

Development Co-operation and Linkages in Higher Education: Key Issues Concerning Policy and Organisation

NASA Astrophysics Data System (ADS)

van Audenhove, Leo

1998-09-01

The term linkage is used to indicate co-operation between an institution in the North and an institution in the South. Donor organisations have generally used linkages to support the development of higher education and research in developing countries. Over time, there has been a trend away from co-operation on individual academic projects towards broader development co- operation and concentration on selected institutions. This shift raises questions about organisation, procedures and support mechanisms, and about the mandate and capabilities of universities in the North, given the frequently asymmetrical relationship between Northern institutions with their own research agendas and Southern beneficiaries. The recent restructuring of Canadian, Dutch, Norwegian and Swedish support for higher education and research is the result of a search for new, more appropriate models of co-operation. This paper examines the evolution of key issues of policy and organisation within the international donor community.

New forms of development: branding innovative ideas and bidding for foreign aid in the maternal and child health service in Nepal.

PubMed

Adhikari, Radha; Smith, Pam; Sharma, Jeevan Raj; Chand, Obindra Bahadur

2018-03-27

Nepal has been receiving foreign aid since the early 1950s. Currently, the country's health care system is heavily dependent on aid, even for the provision of basic health services to its people. Globally, the mechanism for the dispersal of foreign aid is becoming increasingly complex. Numerous stakeholders are involved at various levels: donors, intermediary organisations, project-implementing partners and the beneficiaries, engaging not only in Nepal but also globally. To illustrate how branding and bidding occurs, and to discuss how this process has become increasingly vital in securing foreign aid to run MCH activities in Nepal. This paper is based on a qualitative study. The data collection method includes Key Informant Interviews, the review of relevant policy documents and secondary data, and finally field observation visits to four maternal and child health (MCH) projects, currently funded by foreign aid. Through these methods we planned to gain a comprehensive understanding of the aid dispersing mechanism, and the aid-securing strategies, used by organisations seeking funds to provide MCH services in Nepal. Study findings suggest that foreign aid for the provision of MCH services in Nepal is channeled increasingly to its beneficiaries, not through the Government system, but rather via various intermediary organisations, employing branding and bidding processes. These organisations adapt commercial models, seeking to justify their 'cost-effectiveness'. They argue that they are 'yielding good value for money', with short-term target oriented projects. This ethos is evident throughout the aid dispersing chain. Organisations use innovative ideas and intervention packages, branded internationally and nationally, and employ the appropriate language of commerce in their bid to secure funds. The paper raises an important question as to whether the current mechanisms of channeling foreign aid in the MCH sector, via intermediary organisations, can actually be cost-effective, given the complex bureaucratic processes involved. The study findings are very important, for Nepal's development in particular, and for international development in general. The paper concludes by recommending strongly that foreign aid should concentrate on supporting and strengthening the national government system. Complex bureaucratic process must be minimised and streamlined in order to provide quality care to the beneficiaries.

``We also wanted to learn'': Narratives of change from adults literate in African languages

NASA Astrophysics Data System (ADS)

Trudell, Joel; Cheffy, Ian

2017-10-01

This article discusses the impact of literacy programmes on those who learned to read and write in their own African languages. It draws on adult learners' reflections on the significance of literacy and numeracy in their everyday lives as evidenced in interviews conducted in 2014 and 2015 in rural sites in five African countries: Ethiopia, Kenya, Cameroon, Burkina Faso and Ghana. The research approach was influenced by the Most Significant Change (MSC) method of monitoring and evaluation, which collects and examines narratives that reveal beneficiaries' perceptions of change related to a given programme. This study emulates this approach in that it seeks to learn about perceived changes attributed to literacy acquisition from the perspectives of the beneficiaries, without imposing pre-established indicators. In the rural adult learners' view, literacy enabled lifelong learning outcomes that rivalled the results of primary schooling. Literacy programme graduates demonstrated extensive ongoing learning after they learned to read, write and calculate, consequently acquiring new literacy practices and new understandings of themselves. Even though many of those interviewed had been unable to attend school, they viewed the practices of reading and writing that they developed outside of school as equivalent to the practices of adults who had been educated in primary school.

Utilization of genetic tests: analysis of gene-specific billing in Medicare claims data.

PubMed

Lynch, Julie A; Berse, Brygida; Dotson, W David; Khoury, Muin J; Coomer, Nicole; Kautter, John

2017-08-01

We examined the utilization of precision medicine tests among Medicare beneficiaries through analysis of gene-specific tier 1 and 2 billing codes developed by the American Medical Association in 2012. We conducted a retrospective cross-sectional study. The primary source of data was 2013 Medicare 100% fee-for-service claims. We identified claims billed for each laboratory test, the number of patients tested, expenditures, and the diagnostic codes indicated for testing. We analyzed variations in testing by patient demographics and region of the country. Pharmacogenetic tests were billed most frequently, accounting for 48% of the expenditures for new codes. The most common indications for testing were breast cancer, long-term use of medications, and disorders of lipid metabolism. There was underutilization of guideline-recommended tumor mutation tests (e.g., epidermal growth factor receptor) and substantial overutilization of a test discouraged by guidelines (methylenetetrahydrofolate reductase). Methodology-based tier 2 codes represented 15% of all claims billed with the new codes. The highest rate of testing per beneficiary was in Mississippi and the lowest rate was in Alaska. Gene-specific billing codes significantly improved our ability to conduct population-level research of precision medicine. Analysis of these data in conjunction with clinical records should be conducted to validate findings.Genet Med advance online publication 26 January 2017.

Strategies for engaging the private sector in sexual and reproductive health: how effective are they?

PubMed

Peters, David H; Mirchandani, Gita G; Hansen, Peter M

2004-10-01

The private health sector provides a significant portion of sexual and reproductive health (SRH) services in developing countries. Yet little is known about which strategies for intervening with private providers can improve quality or coverage of services. We conducted a systematic review of the literature through PubMed from 1980 to 2003 to assess the effectiveness of private sector strategies for SRH services in developing countries. The strategies examined were regulating, contracting, financing, franchising, social marketing, training and collaborating. Over 700 studies were examined, though most were descriptive papers, with only 71 meeting our inclusion criteria of having a private sector strategy for one or more SRH services and the measurement of an outcome in the provider or the beneficiary. Nearly all studies (96%) had at least one positive association between SRH and the private sector strategy. About three-quarters of the studies involved training private providers, though combinations of strategies tended to give better results. Maternity services were most commonly addressed (55% of studies), followed by prevention and treatment of sexually transmitted diseases (32%). Using study design to rate the strength of evidence, we found that the evidence about effectiveness of private sector strategies on SRH services is weak. Most studies did not use comparison groups, or they relied on cross-sectional designs. Nearly all studies examined short-term effects, largely measuring changes in providers rather than changes in health status or other effects on beneficiaries. Five studies with more robust designs (randomized controlled trials) demonstrated that contraceptive use could be increased through supporting private providers, and showed cases where the knowledge and practices of private providers could be improved through training, regulation and incentives. Although tools to work with the private sector offer considerable promise, without stronger research designs, key questions regarding their feasibility and impact remain unanswered. Copyright 2004 Oxford University Press

24 CFR 5.109 - Equal Participation of Religious Organizations in HUD Programs and Activities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the definition, practice, and expression of its religious beliefs, provided that it does not engage in... program beneficiary or prospective program beneficiary on the basis of religion or religious belief. (g... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Equal Participation of Religious...

24 CFR 5.109 - Equal Participation of Religious Organizations in HUD Programs and Activities.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., practice, and expression of its religious beliefs, provided that it does not engage in any inherently... beneficiary or prospective program beneficiary on the basis of religion or religious belief. (g) Acquisition... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Equal Participation of Religious...

24 CFR 5.109 - Equal Participation of Religious Organizations in HUD Programs and Activities.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., practice, and expression of its religious beliefs, provided that it does not engage in any inherently... beneficiary or prospective program beneficiary on the basis of religion or religious belief. (g) Acquisition... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Equal Participation of Religious...

24 CFR 5.109 - Equal Participation of Religious Organizations in HUD Programs and Activities.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., practice, and expression of its religious beliefs, provided that it does not engage in any inherently... beneficiary or prospective program beneficiary on the basis of religion or religious belief. (g) Acquisition... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Equal Participation of Religious...

24 CFR 5.109 - Equal Participation of Religious Organizations in HUD Programs and Activities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the definition, practice, and expression of its religious beliefs, provided that it does not engage in... program beneficiary or prospective program beneficiary on the basis of religion or religious belief. (g... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Equal Participation of Religious...

Modeling the effects of urban expansion on natural capital stocks and ecosystem service flows: A case study in the Puget Sound, Washington, USA

USGS Publications Warehouse

Zank, Ben; Bagstad, Kenneth J.; Voigt, Brian; Villa, Ferdinando

2016-01-01

Urban expansion and its associated landscape modifications are important drivers of changes in ecosystem service (ES). This study examined the effects of two alternative land use-change development scenarios in the Puget Sound region of Washington State on natural capital stocks and ES flows. Land-use change model outputs served as inputs to five ES models developed using the Artificial Intelligence for Ecosystem Services (ARIES) platform. While natural capital stocks declined under managed (1.3–5.8%) and unmanaged (2.8–11.8%) development scenarios, ES flows increased by 18.5–56% and 23.2–55.7%, respectively. Human development of natural landscapes reduced their capacity for service provision, while simultaneously adding beneficiaries, particularly along the urban fringe. Using global and local Moran’s I, we identified three distinct patterns of change in ES due to projected landuse change. For services with location-dependent beneficiaries – open space proximity, viewsheds, and flood regulation – urbanization led to increased clustering and hot-spot intensities. ES flows were greatest in the managed land-use change scenario for open space proximity and flood regulation, and in the unmanaged land-use change scenario for viewsheds—a consequence of the differing ES flow mechanisms underpinning these services. We observed a third pattern – general declines in service provision – for carbon storage and sediment retention, where beneficiaries in our analysis were not location dependent. Contrary to past authors’ finding of ES declines under urbanization, a more nuanced analysis that maps and quantifies ES provision, beneficiaries, and flows better identifies gains and losses for specific ES beneficiaries as urban areas expand.

The Role of Education in Agricultural Projects for Food Security and Poverty Reduction in Kenya

NASA Astrophysics Data System (ADS)

Walingo, Mary Khakoni

2006-05-01

Agricultural development projects have been promoted in many places as a feature of poverty-reduction strategies. Such projects have often been implemented without a strong in-built education component, and hence have had little success. Agricultural projects seek to improve food security by diversifying a household's resource base and facilitating the social and economic empowerment of women. The present study presents a survey designed to assess the relationship between education level and ability to benefit from dairy-development projects in Kenya. Results reveal higher occupation and employment levels among beneficiary than non-beneficiary households. On the other hand, beneficiaries of poverty-reduction schemes require specialized training. Apart from project-specific training, the level of general education alone cannot predict the attainment of project objectives.

Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?

PubMed Central

Ulikpan, Anar; Mirzoev, Tolib; Jimenez, Eliana; Malik, Asmat; Hill, Peter S.

2014-01-01

Background The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development. Design Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation. Findings The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries’ governments nor the donors had the experience of development collaboration in this context. The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differing politics and governance context. Conclusions The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships. PMID:25231098

Exporting vices: smoking in Asia.

PubMed

Cutler, B

1988-08-01

Marketing statistics of U.S. cigarette exports indicate that despite notable declines in sales at home, sales to foreign countries, especially in Asia, Africa and Latin America, are growing dramatically. World cigarette consumption has doubled since 1960, mainly in less developed countries. In 1987, American tobacco firms increased cigarette exports 76%, or 1 billion in new sales. U.S. smoking dropped in 1985-86 from 30.4 to 26.5% of adults. In Taiwan, tariffs were removed from U.S. cigarettes, lowering prices from $2.86 to 1.30, and raising U.S. imports from $4.4 to 119 million. South Korean trade barriers were removed in May 1988, creating a large market. Japan imports 32% of exported U.S. cigarettes, has 120 million smokers, and is the beneficiary of a massive advertising campaign centered on young people and women. The Asian response to the smoking phenomenon is emerging in the form of restrictions on timing of TV advertising (Japan and Taiwan), health warnings (Japan and Taiwan), and restriction of smoking in public places (Hong Kong).

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

A Marketing Assessment of Beneficiaries at Kimbrough Army Community Hospital

DTIC Science & Technology

1993-05-01

environment, organizational goal formulation, strategy formulation, Marketing Assessment 10 organization and systems design ( Kotler , 1987). Second...environmental analysis itself is concerned with identifying marketing opportunities, threats, environmental trends and their implications ( Kotler , 1987...decision to develop beneficiary subgroups was based on the marketing principle of market segmentation which assumes that no one strategy will work for

Geographic Variations in Incremental Costs of Heart Disease Among Medicare Beneficiaries, by Type of Service, 2012.

PubMed

Wakim, Rita; Ritchey, Matthew; Hockenberry, Jason; Casper, Michele

2016-12-29

Using 2012 data on fee-for-service Medicare claims, we documented regional and county variation in incremental standardized costs of heart disease (ie, comparing costs between beneficiaries with heart disease and beneficiaries without heart disease) by type of service (eg, inpatient, outpatient, post-acute care). Absolute incremental total costs varied by region. Although the largest absolute incremental total costs of heart disease were concentrated in southern and Appalachian counties, geographic patterns of costs varied by type of service. These data can be used to inform development of policies and payment models that address the observed geographic disparities.

Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York.

PubMed

Unruh, Mark Aaron; Jung, Hye-Young; Kaushal, Rainu; Vest, Joshua R

2017-04-01

Follow-up with a primary care provider after hospital discharge has been associated with a reduced likelihood of readmission. However, primary care providers are frequently unaware of their patients' hospitalizations. Event notification may be an effective tool for reducing readmissions by notifying primary care providers when their patients have been admitted to and discharged from a hospital. We examined the effect of an event notification system on 30-day readmissions in the Bronx, New York. The Bronx has among the highest readmission rates in the country and is a particularly challenging setting to improve care due to the low socioeconomic status of the county and high rates of poor health behaviors among its residents. The study cohort included 2559 Medicare fee-for-service beneficiaries associated with 14 141 hospital admissions over the period January 2010 through June 2014. Linear regression models with beneficiary-level fixed-effects were used to estimate the impact of event notifications on readmissions by comparing the likelihood of rehospitalization for a beneficiary before and after event notifications were active. The unadjusted 30-day readmission rate when event notifications were not active was 29.5% compared to 26.5% when alerts were active. Regression estimates indicated that active hospitalization alert services were associated with a 2.9 percentage point reduction in the likelihood of readmission (95% confidence interval: -5.5, -0.4). Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

PubMed

Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P; Murthy, B N

2016-01-01

Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3)] with OOPE above median independently and also after adjusting for various covariates. RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

Characteristics and healthcare utilisation patterns of high-cost beneficiaries in the Netherlands: a cross-sectional claims database study

PubMed Central

Wammes, Joost Johan Godert; Tanke, Marit; Jonkers, Wilma; Westert, Gert P; Van der Wees, Philip; Jeurissen, Patrick PT

2017-01-01

Objective To determine medical needs, demographic characteristics and healthcare utilisation patterns of the top 1% and top 2%–5% high-cost beneficiaries in the Netherlands. Design Cross-sectional study using 1 year claims data. We broke down high-cost beneficiaries by demographics, the most cost-incurring condition per beneficiary and expensive treatment use. Setting Dutch curative health system, a health system with universal coverage. Participants 4.5 million beneficiaries of one health insurer. Measures Annual total costs through hospital, intensive care unit use, expensive drugs, other pharmaceuticals, mental care and others; demographics; most cost-incurring and secondary conditions; inpatient stay; number of morbidities; costs per ICD10-chapter (International Statistical Classification of Diseases, 10th revision); and expensive treatment use (including dialysis, transplant surgery, expensive drugs, intensive care unit and diagnosis-related groups >€30 000). Results The top 1% and top 2%–5% beneficiaries accounted for 23% and 26% of total expenditures, respectively. Among top 1% beneficiaries, hospital care represented 76% of spending, of which, respectively, 9.0% and 9.1% were spent on expensive drugs and ICU care. We found that 54% of top 1% beneficiaries were aged 65 years or younger and that average costs sharply decreased with higher age within the top 1% group. Expensive treatments contributed to high costs in one-third of top 1% beneficiaries and in less than 10% of top 2%–5% beneficiaries. The average number of conditions was 5.5 and 4.0 for top 1% and top 2%–5% beneficiaries, respectively. 53% of top 1% beneficiaries were treated for circulatory disorders but for only 22% of top 1% beneficiaries this was their most cost-incurring condition. Conclusions Expensive treatments, most cost-incurring condition and age proved to be informative variables for studying this heterogeneous population. Expensive treatments play a substantial role in high-costs beneficiaries. Interventions need to be aimed at beneficiaries of all ages; a sole focus on the elderly would leave many high-cost beneficiaries unaddressed. Tailored interventions are needed to meet the needs of high-cost beneficiaries and to avoid waste of scarce resources. PMID:29133323

Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST).

PubMed

Khurmi, Manpreet Singh; Sayinzoga, Felix; Berhe, Atakilt; Bucyana, Tatien; Mwali, Assumpta Kayinamura; Manzi, Emmanuel; Muthu, Maharajan

2017-01-01

The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.

Medical loss ratio as a potential regulatory tool in the Israeli healthcare system.

PubMed

Simon-Tuval, Tzahit; Horev, Tuvia; Kaplan, Giora

2015-01-01

The growth of the private health insurance sector in Western countries, which is characterized by information deficiencies and limited competition, necessitates the implementation of effective regulatory tools. One measure which is widely used is the medical loss ratio (MLR). Our objective was to analyze how MLR is applied as a regulatory measure in the Israeli voluntary health insurance (VHI) market in order to promote the protection of beneficiaries. The study will examine MLR values and the use of this tool by regulators of VHI in Israel. Descriptive analysis using 2005-2012 data from public reports of the Ministry of Health and the Ministry of Finance on VHI plans in three market segments: nonprofit health plans, group (collective) policies offered by commercial insurance companies and individual policies offered by commercial insurance companies. In 2012, 74% of the Israeli population owned VHI provided by nonprofit health plans and 43% owned VHI offered by for-profit commercial companies. At that time the MLRs of three nonprofit health plans were significantly lower than 80%, mostly in the upper layers of coverage. The MLR in the individual commercial segment was consistently low (38% in 2012). The use of MLR as a regulation tool was, and continues to be, relatively limited in all segments. The VHI in Israel covers several essential services that are not covered by the statutory benefits package as a result of budget constraints. Thus, due to the high penetration rate of VHI in Israel compared to European countries and the lower levels of MLR, in order to assure the protection of beneficiaries it may be warranted to increase the extent of regulation and adjust it to the nature of the services covered. This may include distinguishing between essential and nonessential coverages and implementation of the most suitable regulatory measures (such as an MLR threshold, limitation of services covered and adjusting the actuarial models to the beneficiaries' behavior), rather than focusing only on assuring solvency.

Ethics in practice: the state of the debate on promoting the social value of global health research in resource poor settings particularly Africa.

PubMed

Lairumbi, Geoffrey M; Michael, Parker; Fitzpatrick, Raymond; English, Michael C

2011-11-15

Promoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide. We reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services. Access to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries. Although in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. © 2011 Lairumbi et al; licensee BioMed Central Ltd.

Environment-Level Strategies to Support Independent Control of Finances: A Response to the SSA Review of Financial Capability Determination Review.

PubMed

Harper, Annie; Rowe, Michael

2017-01-01

The Social Security Administration (SSA) recently completed an evaluation of the process by which representative payees are assigned. The SSA report is welcome, particularly for its focus on developing more accurate, real-world assessments of a person's financial capability and its recognition of the need for more flexible options for people with disabilities. Crucially, the report discusses the impact of the broader environment-specifically, conditions related to living in poverty. However, it provides no guidance about environmental interventions that could enable more beneficiaries to manage their funds without a payee. Innovative financial products could be offered to beneficiaries, and the retail industry could develop processes to support responsible financial management by people with mental illness. Changes to SSA benefits systems, including raising benefits levels and asset limits, could enable more beneficiaries to manage their funds independently.

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013

PubMed Central

Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P.; Murthy, B. N.

2016-01-01

Introduction Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. Methods We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Results Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $ 11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $ 23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3–4.3)] with OOPE above median independently and also after adjusting for various covariates. Conclusion RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility. PMID:26895419

Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention.

PubMed

Pan, Jay; Lei, Xiaoyan; Liu, Gordon G

2016-11-01

Whether health insurance matters for health has long been a central issue for debate when assessing the full value of health insurance coverage in both developed and developing countries. In 2007, the government-led Urban Resident Basic Medical Insurance (URBMI) program was piloted in China, followed by a nationwide implementation in 2009. Different premium subsidies by government across cities and groups provide a unique opportunity to employ the instrumental variables estimation approach to identify the causal effects of health insurance on health. Using a national panel survey of the URBMI, we find that URBMI beneficiaries experience statistically better health than the uninsured. Furthermore, the insurance health benefit appears to be stronger for groups with disadvantaged education and income than for their counterparts. In addition, the insured receive more and better inpatient care, without paying more for services. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE uniform health maintenance organization (HMO) benefit--Prime enrollment fee exemption for survivors of active duty deceased sponsors and medically retired uniformed services members and their dependents. Final rule.

PubMed

2014-09-30

This final rule creates an exception to the usual rule that TRICARE Prime enrollment fees are uniform for all retirees and their dependents and responds to public comments received to the proposed rule published in the Federal Register on June 7, 2013. Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents are part of the retiree group under TRICARE rules. In acknowledgment and appreciation of the sacrifices of these two beneficiary categories, the Secretary of Defense has elected to exercise his authority under the United States Code to exempt Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents enrolled in TRICARE Prime from paying future increases to the TRICARE Prime annual enrollment fees. The Prime beneficiaries in these categories have made significant sacrifices for our country and are entitled to special recognition and benefits for their sacrifices. Therefore, the beneficiaries in these two TRICARE beneficiary categories who enrolled in TRICARE Prime prior to 10/1/2013, and those since that date, will have their annual enrollment fee frozen at the appropriate fiscal year rate: FY2011 rate $230 per single or $460 per family, FY2012 rate $260 or $520, FY2013 rate $269.38 or $538.56, or the FY2014 rate $273.84 or $547.68. The future beneficiaries added to these categories will have their fee frozen at the rate in effect at the time they are classified in either category and enroll in TRICARE Prime or, if not enrolling, at the rate in effect at the time of enrollment. The fee remains frozen as long as at least one family member remains enrolled in TRICARE Prime and there is not a break in enrollment. The fee charged for the dependent(s) of a Medically Retired Uniformed Services Member would not change if the dependent(s) was later re-classified a Survivor.

[School feeding programmes in Latin America. An analysis].

PubMed

Amigo, H

1997-12-01

Governments in Latin American countries invest large amounts of resources in school feeding programmes, part of educational and social strategies to reach highly vulnerable group within the respective societies. We analysed the criteria used in selecting the beneficiaries of these programmes, the food distributed, management structures and lessons that have been learned from these processes. Differences found among development strategies in each country were also considered. At present, these strategies are centred on the efficient use of resources, focusing interventions on the neediest groups, and leaving aside the idea of universal benefits. In general, countries provide most types of food, such as breakfast lunch, snacks or just a glass of milk, free of charge. Recipients receive up to 1.000 calories and 30 g of selected protein per day. About execution; Latin American States have generally abandoned the integral management of these programmes, a former characteristic that included the purchasing of or production, reparation and delivery of specific food stuffs. Instead, the respective States have only maintained the organisational functions of planning and control of priority actions whilst the private sector has progressively taken an active part in developing strategies. Community participation is restricted to a minimum. We expect that this paper will be taken into consideration by those who bear the responsibility of formulating, executing and evaluating nutritional interventions directed at schoolchildren in selected Latin American regions.

Medicare part D data: major changes on the horizon.

PubMed

Greenwald, Leslie M

2007-10-01

The 3 primary administrative data sets developed by the Centers for Medicare and Medicaid services (CMS) to support the Medicare Part D program implementation represent a valuable source of data for health services researchers. This paper describes the structure of the Medicare Part D program and the related databases, and discusses their utilization for research purposes. The Medicare Part D administrative data include information on plan benefits (integrated into the Health Plan Management System), beneficiary enrollment files, and prescription drug event (PDE) claims-type data. The enrollment data may be of use in investigating the benefits and plan types that appeal to beneficiaries, but their application is limited by the fact that, although individual beneficiaries' enrollment choices are recorded, only summary enrollment data are currently publicly available. PDE data are likely to be of most interest to researchers as they are detailed (including beneficiary identifiers, contract identifiers pharmacy provider information on drugs provided, drug cost, and insurance status), beneficiary-specific (allowing them to be linked to beneficiary characteristics), and an unusual output for a program reimbursed under a capitation-based system. Because PDE data are highly sensitive, only summary data on the number of Part D prescriptions filled are publicly available. Although the data collected in relation to the Medicare Part D program could be applied to many questions of interest to health services researchers, their utility is limited by the sensitive natures of many of these data, making it difficult currently to obtain access for research purposes.

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Death of individual beneficiary. 1.662(c)-2... Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1) or (2... not end with or within the last taxable year of a beneficiary (because of the beneficiary's death...

Health Insurance Knowledge Among Medicare Beneficiaries

PubMed Central

McCormack, Lauren A; Garfinkel, Steven A; Hibbard, Judith H; Keller, Susan D; Kilpatrick, Kerry E; Kosiak, Beth

2002-01-01

Objective To assess the effect of new consumer information materials about the Medicare program on beneficiary knowledge of their health care coverage under the Medicare system. Data Source A telephone survey of 2,107 Medicare beneficiaries in the 10-county Kansas City metropolitan statistical area. Study Design Beneficiaries were randomly assigned to a control group and three treatment groups each receiving a different set of Medicare informational materials. The “handbook-only” group received the Health Care Financing Administration's new Medicare & You 1999 handbook. The “bulletin” group received an abbreviated version of the handbook, and the “handbook + CAHPS” group received the Medicare & You handbook plus the Consumer Assessment of Health Plans (CAHPS)® survey report comparing the quality of health care provided by Medicare HMOs. Beneficiaries interested in receiving information were oversampled. Data Collection Methods Data were collected during two separate telephone surveys of Medicare beneficiaries: one survey of new beneficiaries and another survey of experienced beneficiaries. The intervention materials were mailed to sample members in advance of the interviews. Knowledge for the treatment groups was measured shortly after beneficiaries received the intervention materials. Principal Findings Respondents' knowledge was measured using a psychometrically valid and reliable 15-item measure. Beneficiaries who received the intervention materials answered significantly more questions correctly than control group members. The effect on beneficiary knowledge of providing the information was modest for all intervention groups but varied for experienced beneficiaries only, depending on the intervention they received. Conclusions The findings suggest that all of the new materials had a positive effect on beneficiary knowledge about Medicare and the Medicare + Choice program. While the absolute gain in knowledge was modest, it was greater than increases in knowledge associated with traditional Medicare information sources.

Are there differences in the Medicare experiences of beneficiaries in Puerto Rico compared with those in the U.S. mainland?

PubMed

Elliott, Marc N; Haviland, Amelia M; Dembosky, Jacob W; Hambarsoomian, Katrin; Weech-Maldonado, Robert

2012-03-01

Little is known about the healthcare experiences of Medicare beneficiaries in Puerto Rico. We compare the experiences of elderly Medicare beneficiaries in Puerto Rico with their English-preferring and Spanish-preferring Medicare counterparts in the U.S. mainland. Linear regression models compared mean Consumer Assessment of Healthcare Providers and Systems scores for these groups, using cross-sectional data from the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Medicare beneficiaries aged 65 years and older (6733 in Puerto Rico, 282,654 in the U.S. mainland) who completed the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Six composite measures of beneficiary reports and two measures of beneficiary-reported immunization. Beneficiaries in Puerto Rico reported less positive experiences than both English-preferring and Spanish-preferring U.S. mainland beneficiaries for getting needed care, getting care quickly, and immunization (P<0.05 in all cases). Beneficiaries in Puerto Rico reported better customer service than Spanish-preferring U.S. mainland beneficiaries and better doctor communication experiences than English-preferring U.S. mainland beneficiaries. Additional analyses find little variation in care experiences within Puerto Rico by region, plan type, or specific plan. Medicare beneficiaries in Puerto Rico report generally worse healthcare experiences than beneficiaries in the U.S. mainland for several Consumer Assessment of Healthcare Providers and Systems outcomes and lower immunization rates. Lower funding of healthcare services in Puerto Rico relative to the U.S. mainland may affect healthcare. Strategies such as patient and provider education, provider financial incentives, and increased use of information technologies may improve adherence to the recommended preventive care practices.

The Impact of Social Security on Return Migration among Latin American Elderly in the U.S.

PubMed Central

Vega, Alma

2014-01-01

International migration has long been considered the preserve of working-age adults. However, the rapid diversification of the elderly population calls for increased attention to the migration patterns of this group and its possible motivations. This study examines whether Latin American immigrants who are primary Social Security beneficiaries are more likely to return to their home countries during later life if they receive lower Social Security benefits. Using a regression discontinuity approach on restricted data from the U.S. Social Security Administration (N=1,515), this study presents the results of a natural experiment whereby the Social Security Administration unexpectedly lowered the Social Security benefits of the 1917-1921 birth cohorts due to a miscalculation in the benefit-calculation formula. Results suggest that approximately 10% of primary Social Security beneficiaries from Latin America born close to these dates return migrated, the probability of which was not affected by Social Security benefit levels. PMID:26279596

Insurance Companies Adapting to Trends by Adopting Medical Tourism.

PubMed

Paul, David P; Barker, Tyler; Watts, Angela L; Messinger, Ashley; Coustasse, Alberto

Health care costs in the United States are rising every year, and patients are seeking new ways to control their expenditures and save money. Going abroad to receive health care is a cheaper alternative than receiving the same or similar care at home. Insurance companies are beginning to realize the benefits of medical tourism for both themselves and their beneficiaries and have therefore started to introduce medical tourism plans for their clients as an option for their beneficiaries. This research study explores the benefits and risks of medical tourism and examines the US insurance market's reaction to the trend of increasing medical tourism. The US medical tourism industry mirrors that of the United Kingdom in recent years, with more patients seeking care abroad than in the United States. Insurance companies have introduced new plans providing the option of traveling abroad to countries such as India and Costa Rica. Medical tourism is gaining popularity with US residents, and insurance companies are recognizing this trend.

International NGOs and the role of network centrality in humanitarian aid operations: a case study of coordination during the 2000 Mozambique floods.

PubMed

Moore, Spencer; Eng, Eugenia; Daniel, Mark

2003-12-01

In February 2000, Mozambique suffered its worst flooding in almost 50 years: 699 people died and hundreds of thousands were displaced. Over 49 countries and 30 international non-governmental organisations provided humanitarian assistance. Coordination of disaster assistance is critical for effective humanitarian aid operations, but limited attention has been directed toward evaluating the system-wide structure of inter-organisational coordination during humanitarian operations. Network analysis methods were used to examine the structure of inter-organisational relations among 65 non-governmental organisations (NGOs) involved in the flood operations in Mozambique. Centrality scores were used to estimate NGO-specific potential for aid coordination and tested against NGO beneficiary numbers. The average number of relief- and recovery-period beneficiaries was significantly greater for NGOs with high relative to low centrality scores (p < 0.05). This report addresses the significance of these findings in the context of the Mozambican 2000 floods and the type of data required to evaluate system-wide coordination.

Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries

PubMed Central

Fung, Vicki; Reed, Mary; Price, Mary; Brand, Richard; Dow, William H; Newhouse, Joseph P; Hsu, John

2013-01-01

Objective There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS. Data Sources/Study Setting Medicare Advantage beneficiaries in 2008. Study Design We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities). Data Collection Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate). Principal Findings After adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p = .019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015). Conclusions Low-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors. PMID:23663197

Ex-Ante Economic Impact Assessment of Genetically Modified Banana Resistant to Xanthomonas Wilt in the Great Lakes Region of Africa.

PubMed

Ainembabazi, John Herbert; Tripathi, Leena; Rusike, Joseph; Abdoulaye, Tahirou; Manyong, Victor

2015-01-01

Credible empirical evidence is scanty on the social implications of genetically modified (GM) crops in Africa, especially on vegetatively propagated crops. Little is known about the future success of introducing GM technologies into staple crops such as bananas, which are widely produced and consumed in the Great Lakes Region of Africa (GLA). GM banana has a potential to control the destructive banana Xanthomonas wilt disease. To gain a better understanding of future adoption and consumption of GM banana in the GLA countries which are yet to permit the production of GM crops; specifically, to evaluate the potential economic impacts of GM cultivars resistant to banana Xanthomonas wilt disease. The paper uses data collected from farmers, traders, agricultural extension agents and key informants in the GLA. We analyze the perceptions of the respondents about the adoption and consumption of GM crop. Economic surplus model is used to determine future economic benefits and costs of producing GM banana. On the release of GM banana for commercialization, the expected initial adoption rate ranges from 21 to 70%, while the ceiling adoption rate is up to 100%. Investment in the development of GM banana is economically viable. However, aggregate benefits vary substantially across the target countries ranging from US$ 20 million to 953 million, highest in countries where disease incidence and production losses are high, ranging from 51 to 83% of production. The findings support investment in the development of GM banana resistant to Xanthomonas wilt disease. The main beneficiaries of this technology development are farmers and consumers, although the latter benefit more than the former from reduced prices. Designing a participatory breeding program involving farmers and consumers signifies the successful adoption and consumption of GM banana in the target countries.

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2011 CFR

2011-04-01

... assigned refer the beneficiary to a State VR agency for services? 411.400 Section 411.400 Employees... Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency for services...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2010 CFR

2010-04-01

... assigned refer the beneficiary to a State VR agency for services? 411.400 Section 411.400 Employees... Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency for services...

Income and assets of Social Security beneficiaries by type of benefit.

PubMed

Grad, S

1989-01-01

The SIPP data have provided a first look at the relative economic status of various types of Social Security beneficiaries. They have shown that the different types of Social Security beneficiaries face very different economic circumstances. Retired workers and wife beneficiaries have the highest family incomes adjusted for family size. Aged widows and minor children have the lowest family incomes, with high proportions of poor or near poor. And disabled workers are in between, but also have high proportions of poor or near poor. Retired-worker and wife beneficiary households also have considerably more asset holdings than disabled-worker or widow beneficiary households. Beneficiaries with high family incomes are very likely to live with relatives and to rely heavily on the relatives' income. The high-income families tend to have non-means-tested sources of family income other than Social Security amounting to substantial proportions of their total income and to have high asset holdings. Conversely, beneficiaries with low family incomes are very likely to live alone or with nonrelatives, to rely heavily on Social Security and means-tested benefits, and to have low asset holdings. A majority of ever-poor beneficiaries (with the exception of widow beneficiaries) are poor in only some months of a year. This situation is not consistent with the stereotype of beneficiaries living on fixed incomes. But the change in poverty status is often due to a change in the income of other family members rather than of the beneficiary. And in some cases, a change in poverty status occurs with little or no change in income as the cost of living rises.

The economic well-being of Social Security beneficiaries, with an emphasis on divorced beneficiaries.

PubMed

Weaver, D A

1997-01-01

There are numerous types of benefits paid under the Social Security programs of the United States, with each type of benefit having its own set of eligibility rules and benefit formula. It is likely that there is an association between the type of benefit a person receives and the economic circumstances of the beneficiary. This article explores that association using records from the Current Population Survey exactly matched to administrative records from the Social Security Administration. Divorced beneficiaries are a particular focus of this article. Type of benefit is found to be a strong predictor of economic well-being. Two large groups of beneficiaries, retired-worker and aged married spouse beneficiaries, are fairly well-off. Other types of beneficiaries tend to resemble the overall U.S. population or are decidedly worse off. Divorced spouse beneficiaries have an unusually high incidence of poverty and an unusually high incidence of serious health problems. A proposal to increase benefits for these beneficiaries is evaluated. Results of the analyses indicate that much of the additional Government expenditures would be received by those with low income.

The Influence of Co-Morbidity and Other Health Measures on Dental and Medical Care Use among Medicare beneficiaries 2002

PubMed Central

Chen, Haiyan; Moeller, John; Manski, Richard J.

2011-01-01

Objective To assess the impact of co-morbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. Methods A co-morbidity index is the main independent variable of our study. It includes oral cancer as a co-morbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and co-morbidity after controlling for other explanatory variables. Results High scores on the co-morbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for other types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20% of the sample with missing claims, but the resulting co-morbidity index performed no differently than the index constructed without imputation. Conclusions Co-morbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study’s findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries. PMID:21972460

The Mycotox Charter: Increasing Awareness of, and Concerted Action for, Minimizing Mycotoxin Exposure Worldwide

PubMed Central

Logrieco, Antonio F.; Eskola, Mari; Krska, Rudolf; Ayalew, Amare; Bhatnagar, Deepak; Chulze, Sofia; Li, Peiwu; Poapolathep, Amnart; Rahayu, Endang S.; Shephard, Gordon S.; Stepman, François; Zhang, Hao

2018-01-01

Mycotoxins are major food contaminants affecting global food security, especially in low and middle-income countries. The European Union (EU) funded project, MycoKey, focuses on “Integrated and innovative key actions for mycotoxin management in the food and feed chains” and the right to safe food through mycotoxin management strategies and regulation, which are fundamental to minimizing the unequal access to safe and sufficient food worldwide. As part of the MycoKey project, a Mycotoxin Charter (charter.mycokey.eu) was launched to share the need for global harmonization of mycotoxin legislation and policies and to minimize human and animal exposure worldwide, with particular attention to less developed countries that lack effective legislation. This document is in response to a demand that has built through previous European Framework Projects—MycoGlobe and MycoRed—in the previous decade to control and reduce mycotoxin contamination worldwide. All suppliers, participants and beneficiaries of the food supply chain, for example, farmers, consumers, stakeholders, researchers, members of civil society and government and so forth, are invited to sign this charter and to support this initiative. PMID:29617309

The Mycotox Charter: Increasing Awareness of, and Concerted Action for, Minimizing Mycotoxin Exposure Worldwide.

PubMed

Logrieco, Antonio F; Miller, J David; Eskola, Mari; Krska, Rudolf; Ayalew, Amare; Bandyopadhyay, Ranajit; Battilani, Paola; Bhatnagar, Deepak; Chulze, Sofia; De Saeger, Sarah; Li, Peiwu; Perrone, Giancarlo; Poapolathep, Amnart; Rahayu, Endang S; Shephard, Gordon S; Stepman, François; Zhang, Hao; Leslie, John F

2018-04-04

Mycotoxins are major food contaminants affecting global food security, especially in low and middle-income countries. The European Union (EU) funded project, MycoKey, focuses on “Integrated and innovative key actions for mycotoxin management in the food and feed chains” and the right to safe food through mycotoxin management strategies and regulation, which are fundamental to minimizing the unequal access to safe and sufficient food worldwide. As part of the MycoKey project, a Mycotoxin Charter (charter.mycokey.eu) was launched to share the need for global harmonization of mycotoxin legislation and policies and to minimize human and animal exposure worldwide, with particular attention to less developed countries that lack effective legislation. This document is in response to a demand that has built through previous European Framework Projects—MycoGlobe and MycoRed—in the previous decade to control and reduce mycotoxin contamination worldwide. All suppliers, participants and beneficiaries of the food supply chain, for example, farmers, consumers, stakeholders, researchers, members of civil society and government and so forth, are invited to sign this charter and to support this initiative.

Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme.

PubMed

Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

2015-04-27

Information about use of major surgery in India is scarce. This study aims to bridge this gap by auditing hospital claims from the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary care for major surgery through state-funded insurance to 68 million beneficiaries with limited household incomes-81% of population in states of Telangana and Andhra Pradesh (combined Human Development Index 0·485). Beneficiary households receive an annual coverage of INR 200 000 (US$3333) for admissions to any empanelled public or private hospital. Publicly available deidentified hospital claim data for all surgical procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. 677 332 surgical admissions (80% at private hospitals) were recorded at a mean annual rate of 259 per 100 000 beneficiaries (95% CI 235-283), excluding cataract and caesarean sections as these were not covered under the insurance programme. Men accounted for 56% of admissions. Injury was the most common cause for surgical admission (185 733; 27%) with surgical correction of long bone fractures being the most common procedure (144 997; 20%) identified in the audit. Diseases of digestive (110 922; 16%), genitourinary (82 505; 12%), and musculoskeletal system (70 053; 10%) were other leading causes for surgical admissions. Most hospital bed-days were used for injuries (584 days per 100 000 person years; 31%), digestive diseases (314 days; 17%), and musculoskeletal system (207 days; 11%), costing 19% (INR 4·4 billion), 13% (3·03 billion), and 11% (2·5 billion) of claims, respectively. Cardiovascular surgeries (53 023; 8%) alone accounted for 21% (INR 4·9 billion) of cost. Annual per capita cost of surgical claims was US$1·49 (95% CI 1·32-1·65). Our findings are limited to a population socioeconomically representative of India and other countries with low-income and middle-income. Despite near universal access for major surgery, use continues to remain low, at levels expected in countries with per capita health expenditure below US$100, and lower than a tenth of rates estimated at spending (US$400-1000) comparable with financial access provided. Hence, strategies beyond traditional financing for care are required to improve use of surgery in LMICs. The George Institute for Global Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Effects of Technological Advances on Outcomes for Elderly Persons with Exudative Age-Related Macular Degeneration

PubMed Central

Sloan, Frank A.; Hanrahan, Brian W.

2014-01-01

Importance Exudative age-related macular degeneration (AMD) is the major cause of blindness among U.S. elderly. Developing effective therapies for this disease has been difficult. Objective This study assessed the impacts of introducing new therapies for treating exudative AMD on vision of the affected population and other outcomes among newly diagnosed Medicare beneficiaries. Design The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression continuity design and propensity score matching (PSM) to assess the impacts on introduction/receipt of new technologies on study outcomes during a two-year follow-up period. Setting The analysis was based on longitudinal data for the U.S., 1994–2011, for Medicare beneficiaries with fee-for-service coverage. Participants The sample was limited to beneficiaries aged 68+ newly diagnosed with exudative AMD as indicated by beneficiaries having no claims with this diagnosis in a three-year look-back period. Exposures The comparisons with vision outcomes were after versus before introduction of photodynamic therapy (PDT) and anti-VEGF therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed with exudative AMD who received PDT or anti-VEGF therapy compared to beneficiaries with the diagnosis receiving no therapy for this disease. Main Outcome and Measure Onset of decrease in vision, vision loss or blindness, depression, and admission to long term care facilities. Results Introduction of anti-VEGF therapy reduced vision loss and onset of severe vision loss and blindness of beneficiaries newly diagnosed with exudative AMD by 43% [0.50 0.66] on average. Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% less likely on average to be admitted to a long-term care facility during follow-up. Conclusions and Relevance This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients with an exudative AMD diagnosis aged 68+ in community-based settings in the U.S. PMID:24458013

42 CFR 414.1235 - Cost measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Total per capita costs for all attributed beneficiaries with coronary artery disease. (4) Total per capita costs for all attributed beneficiaries with chronic obstructive pulmonary disease. (5) Total per capita costs for all attributed beneficiaries with heart failure. (6) Medicare Spending per Beneficiary...

The role of micro health insurance in providing financial risk protection in developing countries--a systematic review.

PubMed

Habib, Shifa Salman; Perveen, Shagufta; Khuwaja, Hussain Maqbool Ahmed

2016-03-22

Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. We conducted a systematic search for published literature using the search terms "Community based health insurance AND developing countries", "Micro health insurance AND developing countries", "Mutual health insurance AND developing countries", "mutual OR micro OR community based health insurance" "Health insurance AND impact AND poor" "Health insurance AND financial protection" and "mutual health organizations" on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on household savings, assets and consumption patterns. Our review suggests that MHI, targeted at the low-income households and tailored to suit the cultural and geographical structures in the various areas of Pakistan, may contribute towards providing protection to the households from catastrophe and impoverishment resulting from health expenditures. This paper emphasizes the need for further research to fill the knowledge gap that exists about the impact of MHI, using robust study designs and impact indicators.

20 CFR 416.621 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2011 CFR

2011-04-01

... beneficiary or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 416.621 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2010 CFR

2010-04-01

... beneficiary or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

Disenrollment from Medicare HMOs.

PubMed

Call, K T; Dowd, B E; Feldman, R; Lurie, N; McBean, M A; Maciejewski, M

2001-01-01

Since the program's inception, there has been great interest in determining whether beneficiaries who enter and subsequently leave Medicare health maintenance organizations (HMOs) are more or less costly than those remaining in fee-for-service (FFS) Medicare. To examine whether relatively high-cost beneficiaries disenroll from Medicare HMOs (disenrollment bias) and whether disenrollment bias varies by Medicare HMO market characteristics. In addition, we compare rates of surgical procedures and hospitalizations for ambulatory care-sensitive conditions for disenrollees and continuing FFS beneficiaries. Cross-sectional analysis of 1994 Medicare data. Medicare beneficiaries were first sampled from the 124 counties with at least 1000 Medicare HMO enrollees. From this pool, HMO disenrollees and a sample of continuing FFS beneficiaries were drawn. The FFS beneficiaries were assigned dates of "pseudodisenrollment." Expenditures and inpatient service use were compared for 6 months after disenrollment or pseudodisenrollment. The HMO disenrollees were no more likely than the continuing FFS beneficiaries to have positive total expenditures (Part A plus Part B) or Part B expenditures in the first 6 months after disenrollment. However, disenrollees were more likely to have Part A expenditures. Among beneficiaries with spending, disenrollees had higher total and Part B expenditures than continuing FFS beneficiaries. Moreover, the disparity in total and Part B spending between disenrollees and continuing FFS beneficiaries increased with HMO market penetration. Although Part A spending was higher for disenrollees with spending, it was not sensitive to changes in market share. The HMO disenrollees received more surgical procedures and were hospitalized for more of the ambulatory care-sensitive conditions than the FFS beneficiaries. On several measures, Medicare HMOs experienced favorable disenrollment relative to continuing FFS beneficiaries as recently as 1994, which increased as HMO market share increased.

78 FR 53507 - Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... (Beneficiary Travel Mileage Reimbursement Application Form) Activity Under OMB Review AGENCY: Veterans Health... Control No. 2900- NEW (Beneficiary Travel Mileage Reimbursement Application Form)'' in any correspondence....gov . Please refer to ``OMB Control No. 2900-NEW (Beneficiary Travel Mileage Reimbursement Application...

Understanding Trends in Medicare Spending, 2007-2014.

PubMed

Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B

2018-03-06

To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.

[Health care use by free complementary health insurance coverage beneficiaries in France in 2012].

PubMed

Tuppin, P; Samson, S; Colinot, N; Gastaldi-Menager, C; Fagot-Campagna, A; Gissot, C

2016-04-01

The objective was to investigate healthcare use among people covered by one of the two complementary healthcare insurance schemes available for people with low annual income: CMUC (universal complementary healthcare insurance) and, for people whose income exceeds the CMUC ceiling, ACS (aid for complementary healthcare insurance). Comparisons were made between CMUC and ACS beneficiaries versus CMUC and ACS non-beneficiaries and between CMUC beneficiaries and ACS beneficiaries. Using the national health insurance information system (SNIIRAM), people less than 60 years old covered by the general national health insurance (86% of the 66 million inhabitants) and with ACS or CMUC coverage in 2012 were selected. Diseases were identified using hospital diagnosis, drugs refunds and long-term chronic disease status. Hospital related diagnoses were categorized in major hospital activity groups. Sex- and age-standardized relative risk (RR) were calculated. There were 4.4 million (9.6%) CMUC beneficiaries and 732,000 (1.6%) ACS beneficiaries (56% and 54% women; mean age: 24 years and 29 years respectively versus 52% and 30 years for CMUC or ACS non-beneficiaries). CMUC or ACS beneficiaries had more often cardiovascular diseases (RR=1.4;2.1) and diabetes (RR=2.2;2.4). Their sex- and age-standardized hospitalisation rates for all diagnosis were higher (18%; 17%, RR=1.3;1.4) than CMUC or ACS non-beneficiaries (13%). This was especially the case for the following major groups: toxicology, intoxications, alcohol major group (RR=3.8;4.0); psychiatry (RR=2.8;4.1); respiratory disease (RR=1.9;2.3); infectious disease (RR=1.9;2.7). Compared with CMUC beneficiaries, ACS beneficiaries had more often cancer (RR=1.5), cardiovascular disease (RR=1.5), neurological disease (RR=2.7), psychiatric illness (RR=2.6), end-stage renal disease (RR=2.8), hemophilia (RR=1.4) or cystic fibrosis (RR=1.6) and they received also more often disability allowance (20%, 4%). The disease and hospitalisation rates of ACS beneficiaries are similar or higher than those of CMUC beneficiaries, especially for disabling diseases. Both CMUC and ACS beneficiaries received healthcare for chronic diseases that can be targeted by prevention and screening programs for more optimal healthcare. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

42 CFR 411.23 - Beneficiary's cooperation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Beneficiary's cooperation. 411.23 Section 411.23... Medicare Payment: General Provisions § 411.23 Beneficiary's cooperation. (a) If CMS takes action to recover conditional payments, the beneficiary must cooperate in the action. (b) If CMS's recovery action is...

42 CFR § 512.450 - Beneficiary choice and beneficiary notification.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... providers or suppliers, nor may the EPM participant accept such payments. (b) Required beneficiary... beneficiary will be responsible for payment for the services furnished by the SNF during that stay, except...

Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?

PubMed

Jacobs, Paul D; Buntin, Melinda B

2015-07-01

To evaluate the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. We matched respondents in the 2008 Medicare Current Beneficiary Survey to the Medicare Advantage (MA) plans available to them using the Bid Pricing Tool and previously unavailable data on beneficiaries' plan choices. We estimated a 2-stage nested logit model of Medicare plan choice decision making, including the decision to choose traditional fee-for-service (FFS) Medicare or an MA plan, and for those choosing MA, which specific plan they chose. Beneficiaries living in areas with higher average monthly rebates available from MA plans were more likely to choose MA rather than FFS. When choosing MA plans, beneficiaries are roughly 2 to 3 times more responsive to dollars spent to reduce cost sharing than reductions in their premium. We calculated an elasticity of plan choice with respect to the monthly MA premium of -0.20. Beneficiaries with lower incomes are more sensitive to plan premiums and cost sharing than higher-income beneficiaries. MA plans appear to have a limited incentive to aggressively price their products, and seem to compete primarily over reduced beneficiary cost sharing. Given the limitations of the current plan choice environment, policies designed to encourage the selection of lower-cost plans may require increasing premium differences between plans and providing the tools to enable beneficiaries to easily assess those differences.

Patient financial responsibility for observation care.

PubMed

Kangovi, Shreya; Cafardi, Susannah G; Smith, Robyn A; Kulkarni, Raina; Grande, David

2015-11-01

As observation care grows, Medicare beneficiaries are increasingly likely to revisit observation care instead of being readmitted. This trend has potential financial implications for Medicare beneficiaries because observation care-although typically hospital based-is classified as an outpatient service. Beneficiaries who are readmitted pay the inpatient deductible only once per benefit period. In contrast, beneficiaries who have multiple care episodes under observations status are subject to coinsurance at every stay and could accrue higher cumulative costs. We were interested in answering the question: Do Medicare beneficiaries who revisit observation care pay more than they would have had they been readmitted? We used a 20% sample of the Medicare Outpatient Standard Analytic File (2010-2012) to determine the total cumulative financial liability for Medicare beneficiaries who revisit observation care multiple times within a 60-day period. Participants were fee-for-service Medicare beneficiaries who had Part A and Part B coverage for a full calendar year (or until death) during the study period. Our primary measure was beneficiary financial responsibility for facilities fees. On average, beneficiaries with multiple observation stays in a 60-day period had a cumulative financial liability of $947.40 (803.62), which is significantly lower than the $1100 inpatient deductible (P < 0.01). However, 26.6% of these beneficiaries had a cumulative financial liability that exceeded the inpatient deductible. More than a quarter of Medicare beneficiaries with multiple observation stays in a 60-day time period have a higher financial liability than they would have had under Part A benefits. © 2015 Society of Hospital Medicine.

International assistance and health care reform in Poland: barriers to project development and implementation.

PubMed

Sabbat, J

1997-09-01

The restoration of democracy in Poland initiated a major system transformation including reform of the health sector. The international community were quick to respond to the need for assistance. Polish proposals were supported by international experts and projects were developed together with international development agencies and donors. Donors had no experience of central and eastern Europe, these countries had never been beneficiaries of aid and neither side had experience working together. Progress and absorption of funds was slow. Comparative experience from developing countries was used to analyze the barriers encountered in project development and implementation in Poland. The conditions necessary for implementation were not satisfied. Insufficient attention was paid to the project process. Barriers originate on the side of both donors and recipients and additionally from programme characteristics. The most serious problems experience in Poland were lack of government commitment to health care reform leading to failure to provide counterpart funds and low capacity for absorption of aid. Rent seeking attitudes were important. Donor paternalistic attitudes, complex procedures and lack of innovative approach were also present. Poor coordination was a problem on both sides. Multi-lateral projects were too complex and it was not always possible to integrate project activities with routine ones. External consultants played an excessive role in project development and implementation, absorbing a large portion of funds. The barriers have been operationalised to create a checklist which requires validation elsewhere and may be useful for those working in this field.

38 CFR 9.4 - Beneficiaries and options.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Beneficiaries and options... SERVICEMEMBERS' GROUP LIFE INSURANCE AND VETERANS' GROUP LIFE INSURANCE § 9.4 Beneficiaries and options. Any designation of beneficiary or election of settlement options is subject to the provisions of 38 U.S.C. 1970...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

38 CFR 6.6 - Change of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Change of beneficiary. 6.6 Section 6.6 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED STATES GOVERNMENT LIFE INSURANCE Beneficiary of United States Government Life Insurance § 6.6 Change of beneficiary...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Government employees as beneficiaries. 17.13 Section 17.13....13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government employee who is not...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

Importance of Economic Evaluation in Health Care: An Indian Perspective.

PubMed

Dang, Amit; Likhar, Nishkarsh; Alok, Utkarsh

2016-05-01

Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. Economic evaluation is one part of health economics, and it is a tool for comparing costs and consequences of different interventions. Health technology assessment is a technique for economic evaluation that is well adapted by developed countries. The traditional classification of economic evaluation includes cost-minimization, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. There has been uncertainty in the conduct of such economic evaluations in India, due to some hesitancy with respect to the adoption of their guidelines. The biggest challenge in this evolutionary method is lack of understanding of methods in current use by all those involved in the provision and purchasing of health care. In some countries, different methods of economic evaluation have been adopted for decision making, most commonly to address the question of public subsidies for the purchase of medicines. There is limited evidence on the impact of health insurance on the health and economic well-being of beneficiaries in developing countries. India is currently pursuing several strategies to improve health services for its population, including investing in government-provided services as well as purchasing services from public and private providers through various schemes. Prospects for future growth and development in this field are required in India because rapid health care inflation, increasing rates of chronic conditions, aging population, and increasing technology diffusion will require greater economic efficiency into health care systems. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

An Analysis of a Dual-Eligible Population at Reynolds Army Community Hospital, Fort Sill, Oklahoma

DTIC Science & Technology

1998-05-08

commanders were required to determine their MTF’s efficiency by developing business plans and analyzing beneficiary population based on catchment...boomers" become eligible for benefits. HCFA reports that the fastest growing groups are the oldest-old (85 and older), the under 65-disabled and the... reported in 1995 that a small percentage of beneficiaries, who suffer from chronic and incapacitating illnesses, account for the largest portion of

Analyses of Military Healthcare Benefit Design and Delivery: Study in Support of the Military Compensation and Retirement Modernization Commission

DTIC Science & Technology

2015-01-01

Health Sciences , and other specialized skill training and professional development education programs; • Base Operations/Communications – DoD medical and... Actuary lowered its estimate of future per capita medical spending for dual-eligible beneficiaries (i.e., beneficiaries eligible for both TRICARE and...of the covered population into account. While advanced actuarial modeling would be required to determine each plan’s actual premiums, here we

Challenging the neoliberal trend: the Venezuelan health care reform alternative.

PubMed

Muntaner, Carles; Salazar, René M Guerra; Rueda, Sergio; Armada, Francisco

2006-01-01

Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Misión Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Misión Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada.

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for beneficiaries enrolled in MA MSA... Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for beneficiaries enrolled in MA MSA... Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2014-10-01 2014-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2012-10-01 2012-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2013-10-01 2013-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

How does beneficiary knowledge of the Medicare program vary by type of insurance?

PubMed

McCormack, Lauren A; Uhrig, Jennifer D

2003-08-01

Prior research found that Medicare beneficiaries' knowledge of the Medicare program varied by the type of supplemental insurance they had. However, none of these studies used both multivariate methods and nationally representative data to examine the issue. OBJECTIVES To measure beneficiary knowledge of the Medicare program and to evaluate how knowledge varies by type of supplemental insurance. A mail survey with telephone follow-up to a nationally representative random sample of Medicare beneficiaries, which had a 76% response rate. The purpose of the study was to evaluate the effects of providing the Medicare & You handbook on beneficiary knowledge, information needs, and health plan decision making. A total of 3738 Medicare beneficiaries who completed the survey. A psychometrically validated 22-item index that reflects Medicare-related knowledge in seven different content areas. RESULTS Overall, beneficiaries with a Medicare HMO or non-employer-sponsored supplemental insurance were more knowledgeable about Medicare than those who had Medicare only. In general, beneficiaries tended to be more knowledgeable about issues related to the type of insurance they had (fee-for-service or managed care) than other types of insurance. Higher levels of knowledge about one's own type of insurance may suggest that beneficiaries learn by experience or they learn more about that type of insurance before enrollment. Further research is needed to better understand how and when beneficiaries learn about insurance and what educational strategies are more effective at increasing knowledge.

Use and Spending for Biologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among US Medicare Beneficiaries.

PubMed

Yazdany, Jinoos; Tonner, Chris; Schmajuk, Gabriela

2015-09-01

Biologic therapies have assumed an important role in treating rheumatoid arthritis (RA). We sought to investigate use, spending, and patient cost-sharing for Medicare beneficiaries using biologic drugs for RA, comparing patients exposed to minimal cost-sharing because of a Part D low-income subsidy (LIS) to those facing substantial out-of-pocket costs (OOP). We performed a retrospective, nationwide study using 2009 Medicare claims for a 5% random sample of beneficiaries with RA who had at least 1 RA drug dispensed. We analyzed biologic drug utilization and costs across the Part B (medical benefit) and Part D (pharmacy benefit) programs by LIS status using multinomial regression. We also projected OOP costs as the Affordable Care Act (ACA) mandates closure of the Part D coverage gap by 2020. Among 6,932 beneficiaries, 1,812 (26.1%) received a biologic drug. LIS beneficiaries were significantly more likely to obtain Part D home-administered biologics (relative risk ratio [RRR] 2.98, 95% confidence interval [95% CI] 2.50-3.56), while non-LIS beneficiaries were less likely to receive Part D biologic agents (RRR 0.58, 95% CI 0.48-0.69). OOP costs in Part D were lower, as expected, for LIS beneficiaries ($72 versus $3,751 per year for non-LIS). Non-LIS beneficiaries had lower costs for Part B facility-administered biologic agents (range $0-$2,584) than for Part D home-administered biologic agents. ACA reforms will narrow OOP differences between Part D and B for non-LIS beneficiaries. In contrast to LIS beneficiaries who receive mostly Part D home-administered biologic DMARDs, nonsubsidized beneficiaries have significant cost-based incentives to obtain facility-administered biologic DMARDs through Part B. The ACA will result in only slightly lower costs for Part D biologic drugs for these beneficiaries. © 2015, American College of Rheumatology.

Description and implementation of a surveillance network for bluetongue in the Balkans and in adjoining areas of south-eastern Europe.

PubMed

Dall'Acqua, F; Paladini, C; Meiswinkel, R; Savini, L; Calistri, P

2006-01-01

During the recent severe outbreaks of bluetongue (BT) in the Mediterranean Basin, the BT virus (BTV) spread beyond its historical limits into the Balkan region. One of the primary impacts of BT is the cessation in livestock trade which can have severe economic and social consequences. The authors briefly describe the development of the collaborative East-BTnet programme which aims to assist all affected and at-risk Balkan states and adjoining countries in the management of BT, and in the development of individual national surveillance systems. The beneficiary countries involved, and led by the World organisation for animal health (Office International des Epizooties) Collaborating Centre for veterinary training, epidemiology, food safety and animal welfare of the Istituto Zooprofilattico dell'Abruzzo e del Molise 'G. Caporale' in collaboration with the Institute for the Protection and the Security of the Citizen, the European Commission Joint Research Centre (IPSC-JRC), were Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, the Former Yugoslavia Republic of Macedonia, Kosovo, Malta, Romania, Serbia and Montenegro, Slovenia and Turkey. A regional web-based surveillance network is a valuable tool for controlling and managing transboundary animal diseases such as BT. Its implementation in the Balkan region and in adjoining areas of south-eastern Europe is described and discussed.

Influence of sustained deworming pressure on the anthelmintic resistance status in strongyles of sheep under field conditions.

PubMed

Vijayasarathi, M K; Sreekumar, C; Venkataramanan, R; Raman, M

2016-10-01

Anthelmintic resistance (AR) status in Madras Red sheep from selected field flocks of a government funded scheme, covered by regular, sustained anthelmintic treatment for more than 10 years was determined. Parameters such as fecal egg count reduction test (FECRT), larval paralysis assay (LPA), and allele-specific-PCR (AS-PCR) were used to test the efficacy of fenbendazole, tetramisole, and ivermectin at recommended doses, in two seasons. Sheep belonging to non-beneficiary farmers were used as controls. Mean FECRT values of beneficiary group during winter and summer seasons were 77.77 and 76.04, 93.65 and 92.12, and 95.37 and 98.06 %, respectively, for fenbendazole, tetramisole, and ivermectin. In the non-beneficiary groups, the corresponding values were 74.82 and 81.09 %, 96.05 and 97.40 %, and 97.26 and 98.23 %, respectively. The results revealed resistance to fenbendazole, suspect resistance to tetramisole and susceptibility to ivermectin in beneficiary flock. In non-beneficiary flock, while resistance was noticed against fenbendazole, both tetramisole and ivermectin were effective. FECR values were found to be significantly different between beneficiary and non-beneficiary groups against tetramisole. The results of LPA confirmed this finding, as 50 % of the Haemonchus contortus larvae were paralyzed at the concentration of 0.0156 μg/ml in the beneficiary group, while those of non-beneficiary groups required lower concentrations of 0.0078 μg/ml. AS-PCR revealed the predominance of heterozygous susceptible population of H. contortus in the beneficiary group. In this study, resistance to fenbendazole was confirmed in both the beneficiary and non-beneficiary groups and this could be attributed to frequent use of benzimidazoles as seen from the deworming records. Emergence of tetramisole resistance was detected in the beneficiary group, where the drug was used continuously for 4 years. Ivermectin was found to be effective in all the flocks. It is recommended that the practice of routine deworming of three to four times a year should be avoided, as it can lead to emergence of anthelmintic resistance.

The Value of Satellite Early Warning Systems in Kenya and Guatemala: Results and Lessons Learned from Contingent Valuation and Loss Avoidance Approaches

NASA Astrophysics Data System (ADS)

Morrison, I.; Berenter, J. S.

2017-12-01

SERVIR, the joint USAID and NASA initiative, conducted two studies to assess the value of two distinctly different Early Warning Systems (EWS) in Guatemala and Kenya. Each study applied a unique method to asses EWS value. The evaluation team conducted a Contingent Valuation (CV) choice experiment to measure the value of a near-real time VIIRS and MODIS-based hot-spot mapping tool for forest management professionals targeting seasonal forest fires in Northern Guatemala. The team also conducted a survey-based Damage and Loss Avoidance (DaLA) exercise to calculate the monetary benefits of a MODIS-derived frost forecasting system for farmers in the tea-growing highlands of Kenya. This presentation compares and contrasts the use and utility of these two valuation approaches to assess EWS value. Although interest in these methods is growing, few empirical studies have applied them to benefit and value assessment for EWS. Furthermore, the application of CV and DaLA methods is much less common outside of the developed world. Empirical findings from these two studies indicated significant value for two substantially different beneficiary groups: natural resource management specialists and smallholder tea farmers. Additionally, the valuation processes generated secondary information that can help improve the format and delivery of both types of EWS outputs for user and beneficiary communities in Kenya and Guatemala. Based on lessons learned from the two studies, this presentation will also compare and contrast the methodological and logistical advantages, challenges, and limitations in applying the CV and DaLA methods in developing countries. By reviewing these two valuation methods alongside each other, the authors will outline conditions where they can be applied - individually or jointly - to other early warning systems and delivery contexts.

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

20 CFR 404.2040 - Use of benefit payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., if a beneficiary is a member of an Aid to Families With Dependent Children (AFDC) assistance unit, we... beneficiary's brother, who is the payee, learns the beneficiary needs new shoes and does not have any funds to... a pair of shoes for $29. He also takes the beneficiary to see a movie which costs $3. When they...

26 CFR 1.501(c)(8)-1 - Fraternal beneficiary societies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Fraternal beneficiary societies. 1.501(c)(8)-1... beneficiary societies. (a) A fraternal beneficiary society is exempt from tax only if operated under the lodge... exempt it is also necessary that the society have an established system for the payment to its members or...

26 CFR 1.501(c)(8)-1 - Fraternal beneficiary societies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Fraternal beneficiary societies. 1.501(c)(8)-1... beneficiary societies. (a) A fraternal beneficiary society is exempt from tax only if operated under the lodge... exempt it is also necessary that the society have an established system for the payment to its members or...

5 CFR 1651.4 - How to change or cancel a designation of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of beneficiary, the participant must submit to the TSP record keeper a new TSP designation of beneficiary form meeting the requirements of § 1651.3 to the TSP record keeper. If the TSP receives more than... the participant. A participant may change a TSP beneficiary at any time, without the knowledge or...

The effect of the illness episode approach on Medicare beneficiaries' health insurance decisions.

PubMed Central

Sofaer, S; Kenney, E; Davidson, B

1992-01-01

This article reports on a quasi-experimental test of the Illness Episode Approach (IEA), a new approach to providing Medicare beneficiaries with information about the financial consequences of alternative health care coverage decisions. Beneficiaries were randomly assigned to free, three-hour workshops, half using materials developed through application of the IEA, half using traditional comparative information on insurance options. Analysis of data collected before and after the workshops indicates that participants in the Illness Episode sessions were more likely to drop duplicative coverage, to spend less on premiums, and to report that their decisions to change coverage had met their expectations. The entire sample of workshop participants showed significant increases in knowledge of Medicare and their own insurance, as well as improved satisfaction with the cost of their health care coverage. PMID:1464539

Medicare Part D Roulette: Potential Implications of Random Assignment and Plan Restrictions

PubMed Central

Patel, Rajul A.; Walberg, Mark P.; Woelfel, Joseph A.; Amaral, Michelle M.; Varu, Paresh

2013-01-01

Background Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. Objective We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. Methods Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan. Results Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. Conclusions Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance. PMID:24753963

Assessing Medicare beneficiaries' willingness-to-pay for medication therapy management services.

PubMed

Woelfel, Joseph A; Carr-Lopez, Sian M; Delos Santos, Melanie; Bui, Ann; Patel, Rajul A; Walberg, Mark P; Galal, Suzanne M

2014-02-01

To assess Medicare beneficiaries' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount. A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries' WTP for MTM. Nine outreach events in cities across Central/Northern California during Medicare's 2011 open-enrollment period. A total of 277 Medicare beneficiaries participated in the study. Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session. The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs. The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

Market variations in intensity of Medicare service use and beneficiary experiences with care.

PubMed

Mittler, Jessica N; Landon, Bruce E; Fisher, Elliot S; Cleary, Paul D; Zaslavsky, Alan M

2010-06-01

Examine associations between patient experiences with care and service use across markets. Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index. We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets. We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid. Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care. Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries.

PubMed

Zhang, Ning Jackie; Wan, Thomas T H; Rossiter, Louis F; Murawski, Matthew M; Patel, Urvashi B

2008-05-01

To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. Findings indicate that the disease state management (DSM) program statistically significantly improved patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions. A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.

Medicare Beneficiary Satisfaction with Durable Medical Equipment Suppliers

PubMed Central

Hoerger, Thomas J.; Finkelstein, Eric A.; Bernard, Shulamit L.

2001-01-01

CMS has recently launched a series of initiatives to control Medicare spending on durable medical equipment (DME) and prosthetics, orthotics, and supplies (DMEPOS). An important question is how these initiatives will affect beneficiary satisfaction. Using survey data, we analyze Medicare beneficiary satisfaction with DMEPOS suppliers in two Florida counties. Our results show that beneficiaries are currently highly satisfied with their DMEPOS suppliers. Beneficiary satisfaction is positively related to rapid delivery, training, dependability, and frequency of service. Results of our analysis can be used as baseline estimates in evaluating CMS initiatives to reduce Medicare payments for DMEPOS. PMID:12500367

Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review.

PubMed

Banke-Thomas, Aduragbemi Oluwabusayo; Madaj, Barbara; Charles, Ameh; van den Broek, Nynke

2015-06-24

Increased scarcity of public resources has led to a concomitant drive to account for value-for-money of interventions. Traditionally, cost-effectiveness, cost-utility and cost-benefit analyses have been used to assess value-for-money of public health interventions. The social return on investment (SROI) methodology has capacity to measure broader socio-economic outcomes, analysing and computing views of multiple stakeholders in a singular monetary ratio. This review provides an overview of SROI application in public health, explores lessons learnt from previous studies and makes recommendations for future SROI application in public health. A systematic review of peer-reviewed and grey literature to identify SROI studies published between January 1996 and December 2014 was conducted. All articles describing conduct of public health SROI studies and which reported a SROI ratio were included. An existing 12-point framework was used to assess study quality. Data were extracted using pre-developed codes: SROI type, type of commissioning organisation, study country, public health area in which SROI was conducted, stakeholders included in study, discount rate used, SROI ratio obtained, time horizon of analysis and reported lessons learnt. 40 SROI studies, of varying quality, including 33 from high-income countries and 7 from low middle-income countries, met the inclusion criteria. SROI application increased since its first use in 2005 until 2011, declining afterwards. SROI has been applied across different public health areas including health promotion (12 studies), mental health (11), sexual and reproductive health (6), child health (4), nutrition (3), healthcare management (2), health education and environmental health (1 each). Qualitative and quantitative methods have been used to gather information for public health SROI studies. However, there remains a lack of consensus on who to include as beneficiaries, how to account for counterfactual and appropriate study-time horizon. Reported SROI ratios vary widely (1.1:1 to 65:1). SROI can be applied across healthcare settings. Best practices such as analysis involving only beneficiaries (not all stakeholders), providing justification for discount rates used in models, using purchasing power parity equivalents for monetary valuations and incorporating objective designs such as case-control or before-and-after designs for accounting for outcomes will improve robustness of public health SROI studies.

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

Access to Oral Osteoporosis Drugs among Female Medicare Part D Beneficiaries

PubMed Central

Lin, Chia-Wei; Karaca-Mandic, Pinar; McCullough, Jeffrey S.; Weaver, Lesley

2014-01-01

Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies. PMID:24837398

Medicare Advantage: options for standardizing benefits and information to improve consumer choice.

PubMed

O'Brien, Ellen; Hoadley, Jack

2008-04-01

The Medicare Advantage (MA) program offers beneficiaries a choice of private health plans as alternatives to the traditional fee-for-service Medicare program. MA plans potentially provide additional value, but as plan choices have proliferated, consumers contemplating their options have had difficulty understanding how they differ. Through "standardization" more consistent types of information and a limited number of dimensions along which plans vary--MA plans could reduce complexity and improve beneficiaries' ability to make informed choices. Such standardization steps would offer more meaningful variation in the health coverage options available to beneficiaries, Medicare officials and their community partners would find it far easier to educate beneficiaries about their health plan choices, and beneficiaries would better understand what they were buying. Standardization might also strengthen the ability of the market-based Medicare Advantage program to incorporate beneficiary preferences.

Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.

PubMed

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2017-10-01

To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Net returns, fiscal risks, and the optimal patient mix for a profit-maximizing hospital.

PubMed

Ozatalay, S; Broyles, R

1987-10-01

As is well recognized, the provisions of PL98-21 not only transfer financial risks from the Medicare program to the hospital but also induce institutions to adjust the diagnostic mix of Medicare beneficiaries so as to maximize net income or minimize the net loss. This paper employs variation in the set of net returns as the sole measure of financial risk and develops a model that identifies the mix of beneficiaries that maximizes net income, subject to a given level of risk. The results indicate that the provisions of PL98-21 induce the institution to deny admission to elderly patients presenting conditions for which the net return is relatively low and the variance in the cost per case is large. Further, the paper suggests that the treatment of beneficiaries at a level commensurate with previous periods or the preferences of physicians may jeopardize the viability and solvency of Medicare-dependent hospitals.

[Consumer satisfaction study in philanthropic hospital health plans].

PubMed

Gerschman, Silvia; Veiga, Luciana; Guimarães, César; Ugá, Maria Alicia Dominguez; Portela, Margareth Crisóstomo; Vasconcellos, Miguel Murat; Barbosa, Pedro Ribeiro; Lima, Sheyla Maria Lemos

2007-01-01

This paper presents the findings of research aimed at identifying and analyzing the argumentation and rationale that justify the satisfaction of consumers with their health plans. The qualitative method applied used the focus group technique, for which the following aspects were defined: the criteria for choosing the health plans which were considered, the composition of the group and its distribution, recruitment strategy, and infrastructure and dynamics of the meetings. The health plan beneficiaries were classified into groups according to their social class, the place where they lived, mainly, the relationship that they established with the health plan operators which enabled us to develop a typology for the plan beneficiaries. Initially, we indicated how the health plan beneficiaries assess and use the Brazilian Unified Health System (SUS), and, then, considering the types of plans defined, we evaluated their degree of satisfaction with the different aspects of health care, and identified which aspects mostly contributed explain their satisfaction.

Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare.

PubMed

Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D

2011-10-14

Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.

Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries.

PubMed

McClintock, Heather F; Kurichi, Jibby E; Kwong, Pui L; Xie, Dawei; Streim, Joel E; Pezzin, Liliana E; Hennessey, Sean; Na, Ling; Bogner, Hillary R

2017-06-01

The aim of this study was to examine whether activity limitation stages were associated with patient-reported trouble getting needed health care among Medicare beneficiaries. This was a population-based study (n = 35,912) of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey for years 2001-2010. Beneficiaries were classified into an activity limitation stage from 0 (no limitation) to IV (complete) derived from self-reported or proxy-reported difficulty performing activities of daily living and instrumental activities of daily living. Beneficiaries reported whether they had trouble getting health care in the subsequent year. A multivariable logistic regression model examined the association between activity limitation stages and trouble getting needed care. Compared with beneficiaries with no limitations (activities of daily living stage 0), the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for stage I (mild) to stage IV (complete) for trouble getting needed health care ranged from OR = 1.53 (95% CI, 1.32-1.76) to OR = 2.86 (95% CI, 1.97-4.14). High costs (31.7%), not having enough money (31.2%), and supplies/services not covered (24.2%) were the most common reasons for reporting trouble getting needed health care. Medicare beneficiaries at higher stages of activity limitations reported trouble getting needed health care, which was commonly attributed to financial barriers.

Market Characteristics and Awareness of Managed Care Options Among Elderly Beneficiaries Enrolled in Traditional Medicare

PubMed Central

Mittler, Jessica N.; Landon, Bruce E.; Zaslavsky, Alan M.; Cleary, Paul D.

2011-01-01

Background Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. Objectives To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Research Design Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Subjects Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Measures Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Results Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Conclusions Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. PMID:22340776

Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service.

PubMed

Martino, Steven C; Elliott, Marc N; Haviland, Amelia M; Saliba, Debra; Burkhart, Q; Kanouse, David E

2016-06-01

To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment. © Health Research and Educational Trust.

A game theory-reinforcement learning (GT-RL) method to develop optimal operation policies for multi-operator reservoir systems

NASA Astrophysics Data System (ADS)

Madani, Kaveh; Hooshyar, Milad

2014-11-01

Reservoir systems with multiple operators can benefit from coordination of operation policies. To maximize the total benefit of these systems the literature has normally used the social planner's approach. Based on this approach operation decisions are optimized using a multi-objective optimization model with a compound system's objective. While the utility of the system can be increased this way, fair allocation of benefits among the operators remains challenging for the social planner who has to assign controversial weights to the system's beneficiaries and their objectives. Cooperative game theory provides an alternative framework for fair and efficient allocation of the incremental benefits of cooperation. To determine the fair and efficient utility shares of the beneficiaries, cooperative game theory solution methods consider the gains of each party in the status quo (non-cooperation) as well as what can be gained through the grand coalition (social planner's solution or full cooperation) and partial coalitions. Nevertheless, estimation of the benefits of different coalitions can be challenging in complex multi-beneficiary systems. Reinforcement learning can be used to address this challenge and determine the gains of the beneficiaries for different levels of cooperation, i.e., non-cooperation, partial cooperation, and full cooperation, providing the essential input for allocation based on cooperative game theory. This paper develops a game theory-reinforcement learning (GT-RL) method for determining the optimal operation policies in multi-operator multi-reservoir systems with respect to fairness and efficiency criteria. As the first step to underline the utility of the GT-RL method in solving complex multi-agent multi-reservoir problems without a need for developing compound objectives and weight assignment, the proposed method is applied to a hypothetical three-agent three-reservoir system.

Benefit distribution of social health insurance: evidence from china's urban resident basic medical insurance.

PubMed

Pan, Jay; Tian, Sen; Zhou, Qin; Han, Wei

2016-09-01

Equity is one of the essential objectives of the social health insurance. This article evaluates the benefit distribution of the China's Urban Residents' Basic Medical Insurance (URBMI), covering 300 million urban populations. Using the URBMI Household Survey data fielded between 2007 and 2011, we estimate the benefit distribution by the two-part model, and find that the URBMI beneficiaries from lower income groups benefited less than that of higher income groups. In other words, government subsidy that was supposed to promote the universal coverage of health care flew more to the rich. Our study provides new evidence on China's health insurance system reform, and it bears meaningful policy implication for other developing countries facing similar challenges on the way to universal coverage of health insurance. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Disparities in home health service providers among Medicare beneficiaries with stroke.

PubMed

Iyer, Medha; Bhavsar, Grishma P; Bennett, Kevin J; Probst, Janice C

2016-01-01

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Nurse Migration: A Canadian Case Study

PubMed Central

Little, Lisa

2007-01-01

Objective To synthesize information about nurse migration in and out of Canada and analyze its role as a policy lever to address the Canadian nursing shortage. Principal Findings Canada is both a source and a destination country for international nurse migration with an estimated net loss of nurses. The United States is the major beneficiary of Canadian nurse emigration resulting from the reduction of full-time jobs for nurses in Canada due to health system reforms. Canada faces a significant projected shortage of nurses that is too large to be ameliorated by ethical international nurse recruitment and immigration. Conclusions The current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority, and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency. PMID:17489918

Business model innovation in the water sector in developing countries.

PubMed

Gebauer, Heiko; Saul, Caroline Jennings

2014-08-01

Various technologies have been deployed in household devices or micro-water treatment plants for mitigating fluoride and arsenic, and thereby provide safe and affordable drinking water in low-income countries. While the technologies have improved considerably, organizations still face challenges in making them financially sustainable. Financial sustainability questions the business models behind these water technologies. This article makes three contributions to business models in the context of fluoride and arsenic mitigation. Firstly, we describe four business models: A) low-value devices given away to people living in extreme poverty, B) high-value devices sold to low-income customers, C) communities as beneficiaries of micro-water treatment plants and D) entrepreneurs as franchisees for selling water services and highlight the emergence of hybrid business models. Secondly, we show current business model innovations such as cost transparency & cost reductions, secured & extended water payments, business diversification and distribution channels. Thirdly, we describe skills and competencies as part of capacity building for creating even more business model innovations. Together, these three contributions will create more awareness of the role of business models in scaling-up water treatment technologies. Copyright © 2014 Elsevier B.V. All rights reserved.

38 CFR 17.106 - VA collection rules; third-party payers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... beneficiary were to incur the costs on the beneficiary's own behalf. (2) Definitions. For the purposes of this... beneficiary for healthcare services or products. (H) A third-party administrator. (b) Calculating reasonable...

MEDICARE CURRENT BENEFICIARY SURVEY (MCBS) DATA

EPA Science Inventory

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is a comprehe...

7 CFR 1710.104 - Service to non-RE Act beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GUARANTEES Loan Purposes and Basic Policies § 1710.104 Service to non-RE Act beneficiaries. (a) To the... made to finance electric facilities to serve consumers that are not RE Act beneficiaries. (b) Loan...

Employment among Social Security disability program beneficiaries, 1996-2007.

PubMed

Mamun, Arif; O'Leary, Paul; Wittenburg, David C; Gregory, Jesse

2011-01-01

We use linked administrative data from program and earnings records to summarize the 2007 employment rates of Social Security disability program beneficiaries at the national and state levels, as well as changes in employment since 1996. The findings provide new information on the employment activities of beneficiaries that should be useful in assessing current agency policies and providing benchmarks for ongoing demonstration projects and future return-to-work initiatives. The overall employment rate--which we define as annual earnings over $1,000--was 12 percent in 2007. Substantial variation exists within the population. Disability Insurance beneficiaries and those younger than age 40 were much more likely to work relative to other Social Security beneficiaries. Additionally, substantial regional variation exists across states; employment rates ranged from 7 percent (West Virginia) to 23 percent (North Dakota). Moreover, we find that the employment rates among beneficiaries were sensitive to the business cycle and persistent over time.

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

26 CFR 509.121 - Beneficiaries of an estate or trust.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) REGULATIONS UNDER TAX CONVENTIONS SWITZERLAND General Income Tax § 509.121 Beneficiaries of an estate or trust... concerned, a nonresident alien who is a resident of Switzerland and who is a beneficiary of an estate or...

Ex-Ante Economic Impact Assessment of Genetically Modified Banana Resistant to Xanthomonas Wilt in the Great Lakes Region of Africa

PubMed Central

Ainembabazi, John Herbert; Tripathi, Leena; Rusike, Joseph; Abdoulaye, Tahirou; Manyong, Victor

2015-01-01

Background Credible empirical evidence is scanty on the social implications of genetically modified (GM) crops in Africa, especially on vegetatively propagated crops. Little is known about the future success of introducing GM technologies into staple crops such as bananas, which are widely produced and consumed in the Great Lakes Region of Africa (GLA). GM banana has a potential to control the destructive banana Xanthomonas wilt disease. Objective To gain a better understanding of future adoption and consumption of GM banana in the GLA countries which are yet to permit the production of GM crops; specifically, to evaluate the potential economic impacts of GM cultivars resistant to banana Xanthomonas wilt disease. Data Sources The paper uses data collected from farmers, traders, agricultural extension agents and key informants in the GLA. Analysis We analyze the perceptions of the respondents about the adoption and consumption of GM crop. Economic surplus model is used to determine future economic benefits and costs of producing GM banana. Results On the release of GM banana for commercialization, the expected initial adoption rate ranges from 21 to 70%, while the ceiling adoption rate is up to 100%. Investment in the development of GM banana is economically viable. However, aggregate benefits vary substantially across the target countries ranging from US$ 20 million to 953 million, highest in countries where disease incidence and production losses are high, ranging from 51 to 83% of production. Conclusion The findings support investment in the development of GM banana resistant to Xanthomonas wilt disease. The main beneficiaries of this technology development are farmers and consumers, although the latter benefit more than the former from reduced prices. Designing a participatory breeding program involving farmers and consumers signifies the successful adoption and consumption of GM banana in the target countries. PMID:26414379

Medicare Part D: successes and continuing challenges. Impact of Medicare Part D on Massachusetts health programs and beneficiaries.

PubMed

Thomas, Cindy Parks; Sussman, Jeffrey

2007-05-30

On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

Are consumer-directed home care beneficiaries satisfied? Evidence from Washington state.

PubMed

Wiener, Joshua M; Anderson, Wayne L; Khatutsky, Galina

2007-12-01

This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study, we developed an 8-item Satisfaction With Paid Personal Assistance Scale as the measure of satisfaction. In predicting satisfaction with personal assistance services, we estimated an ordinary least squares regression model that was right-censored to account for the large percentage of respondents who were highly satisfied with their care. Among the older population, but not younger people with disabilities, beneficiaries receiving consumer-directed services were more satisfied than individuals receiving agency-directed care. There was no evidence that quality of care was less with consumer-directed services. In addition, overall satisfaction levels with paid home care were very high. This study supports the premise that consumer satisfaction, an important measure of quality, in consumer-directed home care is not inferior to that in agency-directed care. The positive effect of consumer direction for older people underlines the fact that this service option is relevant for this population. In addition, this research provides evidence that home- and community-based services are of high quality, at least on one dimension.

[Cost of a health care system for dependent older adults in Chile, 2012-2020].

PubMed

Matus-López, Mauricio; Pedraza, Camilo Cid

2014-07-01

To estimate the relative and absolute costs of a home-based health care system for dependent older adults in Chile and to consider the methodological factors to take into account in estimates for other models in other countries. Sex- and age-specific prevalence rates were used, based on microdata from the National Dependency Survey (ENDPM 2009), and three scenarios were projected for 2012 - 2020. The beneficiary population and the demand were estimated for 12 home-based health care programs. The characteristics of the programs (number of hours and type of care) were based on expert opinions, adjusted through a literature review. Public and private system wages/hours were used. Overall, 20.3% of people over 65 years of age would be beneficiaries of the system; 21.7% of all women and 18.4% of all men, for a total of 336 874 people in 2012. The annual cost of the system is 1.214 billion dollars for 2012, equivalent to 0.45% of GDP (gross domestic product). This figure could increase by between 32.1% and 33.1% by 2020. The cost of an initial system for dependent older adults in Chile is relatively low in comparison to the models seen in industrialized countries. In terms of methodology, it is particularly important for there to be prior discussion of the desired model to be implemented and the financial capacity to achieve this. Furthermore, the option of using expert opinions as the basis for the evaluation is validated, although it is recommended that this be expanded.

20 CFR 404.2021 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2010 CFR

2010-04-01

... or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who has... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 404.2021 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2011 CFR

2011-04-01

... or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who has... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2012 CFR

2012-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2011 CFR

2011-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2014 CFR

2014-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2013 CFR

2013-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

Round table discussion " Development of qualification framework in meteorology (TEMPUS QUALIMET)"

NASA Astrophysics Data System (ADS)

Bashmakova, I.; Belotserkovsky, A.; Karlin, L.; Petrosyan, A.; Serditova, N.; Zilitinkevich, S.

2010-09-01

The international consortium has started implementing a project aimed at the development of unified framework of qualifications in meteorology (QualiMet), setting a system of recognition and award of qualifications up to Doctoral level based on standards of knowledge, skill and competence acquired by learners is underway. The QualiMet has the following specific objectives: 1. To develop standards of knowledge, skills and competence for all qualifications up to Doctoral level needed in all possible occupations meteorology learner can undertake, by July 2011 2. To develop reciprocally recognized rubrics, criteria, methods and tools for assessing the compliance with the developed standards (quality assurance), by July 2012 3. To set the network of Centers of Excellence as the primary designer of sample education programs and learning experiences, both in brick-and-mortar and distant setting of delivery, leading to achievement of the developed standards, by December 2012 4. To set a system of mutual international recognition and award of qualifications in meteorology based on the developed procedures and establishment of self-regulatory public organization, by December 2012 The main beneficiaries of the project are: 1. Meteorology learners from the consortium countries. They will be able to make informed decisions about available qualification choices and progression options and provided an opportunity for students and graduates to participate in the system of international continuous education. 2. Meteorology employers from the consortium countries, They will be able to specify the level of knowledge, skill and competence required for occupational roles, evaluate qualifications presented, connect training and development with business needs. 3. Students and academic staff of all the consortium members, who will gain the increased mobility and exchange the fluxes of culturally and institutionally diversified lecturers and qualified specialists

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

PubMed

Nielsen, Maj Britt D; Vinsløv Hansen, Jørgen; Aust, Birgit; Tverborgvik, Torill; Thomsen, Birthe L; Bue Bjorner, Jakob; Steen Mortensen, Ole; Rugulies, Reiner; Winzor, Glen; Ørbæk, Palle; Helverskov, Trine; Kristensen, Nicolai; Melchior Poulsen, Otto

2015-02-01

In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. ISRCTN43004323. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Chronic health conditions in Medicare beneficiaries 65 years old, and older with HIV infection.

PubMed

Friedman, Eleanor E; Duffus, Wayne A

2016-10-23

To examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/HIV+) at least 65 years old and compare their chronic disease prevalence with beneficiaries without HIV. National fee-for-service Medicare claims data (parts A and B) from 2006 to 2009 were used to create a retrospective cohort of beneficiaries at least 65 years old. Beneficiaries with an inpatient or skilled nursing facility claim, or outpatient claims with HIV diagnosis codes were considered HIV+. HIV+ beneficiaries were compared with uninfected beneficiaries on demographic factors and on the prevalence of hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, and diabetes. Odds ratios (OR), 95% confidence intervals (CIs), and P values were calculated. Adjustment variables included age, sex, race/ethnicity, end stage renal disease (ESRD), and dual Medicare-Medicaid enrollment. Chronic conditions were examined individually and as an index from zero to all five conditions. Of 29 060 418 eligible beneficiaries, 24 735 (0.09%) were HIV+. HIV+ beneficiaries were more likely to be Hispanic, African-American, male, and younger (P > 0.0001) and were 1.5-2.1 times as likely to have a chronic disease [diabetes (adjusted OR) 1.51, 95% CI (1.47, 1.55): rheumatoid arthritis/osteoarthritis 2.14, 95% CI (2.08, 2.19)], and 2.4-7 times as likely to have 1-5 comorbid chronic conditions [1 condition (adjusted OR) 2.38, 95% CI (2.21, 2.57): 5 conditions 7.07, 95% CI (6.61, 7.56)]. Our results show that PLWHIV at least 65 years old are at higher risk of comorbidities than other fee-for-service Medicare beneficiaries. This finding has implications for the cost and health management of PLWHIV 65 years and older.

Potential savings associated with drug substitution in Medicare Part D: the Translating Research into Action for Diabetes (TRIAD) study.

PubMed

Duru, O Kenrik; Ettner, Susan L; Turk, Norman; Mangione, Carol M; Brown, Arleen F; Fu, Jeffery; Simien, Leslie; Tseng, Chien-Wen

2014-01-01

Drug substitution is a promising approach to reducing medication costs. To calculate the potential savings in a Medicare Part D plan from generic or therapeutic substitution for commonly prescribed drugs. Cross-sectional, simulation analysis. Low-income subsidy (LIS) beneficiaries (n = 145,056) and non low-income subsidy (non-LIS) beneficiaries (n = 1,040,030) enrolled in a large, national Part D health insurer in 2007 and eligible for a possible substitution. Using administrative data from 2007, we identified claims filled for brand-name drugs for which a direct generic substitute was available. We also identified the 50 highest cost drugs separately for LIS and non-LIS beneficiaries, and reached consensus on which drugs had possible therapeutic substitutes (27 for LIS, 30 for non-LIS). For each possible substitution, we used average daily costs of the original and substitute drugs to calculate the potential out-of-pocket savings, health plan savings, and when applicable, savings for the government/LIS subsidy. Overall, 39 % of LIS beneficiaries and 51 % of non-LIS beneficiaries were eligible for a generic and/or therapeutic substitution. Generic substitutions resulted in an average annual savings of $160 in the case of LIS beneficiaries and $127 in the case of non-LIS beneficiaries. Therapeutic substitutions resulted in an average annual savings of $452 in the case of LIS beneficiaries and $389 in the case of non-LIS beneficiaries. Our findings indicate that drug substitution, particularly therapeutic substitution, could result in significant cost savings. There is a need for additional studies evaluating the acceptability of therapeutic substitution interventions within Medicare Part D.

Impact of the 2013 National Rollout of CMS Competitive Bidding Program: The Disruption Continues.

PubMed

Puckrein, Gary A; Hirsch, Irl B; Parkin, Christopher G; Taylor, Bruce T; Xu, Liou; Marrero, David G

2018-05-01

Use of glucose monitoring is essential to the safety of individuals with insulin-treated diabetes. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact of this rollout to determine if the adverse outcomes seen in 2011 persisted. This longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected by the 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS. The percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increases of 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013. Disruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented. © 2017 by the American Diabetes Association.

Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.

PubMed

Goldstein, Jennifer N; Zhang, Zugui; Schwartz, J Sanford; Hicks, LeRoi S

2018-01-01

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries. We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated. After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24). Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability. Copyright © 2018 Elsevier Inc. All rights reserved.

78 FR 36035 - Proposed Information Collection Activity: [Beneficiary Travel Mileage Reimbursement Application...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... Activity: [Beneficiary Travel Mileage Reimbursement Application Form]; Comment Request AGENCY: Veterans... qualified Veterans or other claimants who incur expense in traveling to healthcare. DATES: Written comments...: [email protected] . Please refer to ``OMB Control No. 2900--NEW (Beneficiary Travel Mileage...

20 CFR 10.718 - Are payments to a beneficiary as a result of an insurance policy which the beneficiary has...

Code of Federal Regulations, 2010 CFR

2010-04-01

... OWCP or SOL? 10.718 Section 10.718 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... reported to OWCP or SOL? Since payments received by a FECA beneficiary pursuant to an insurance policy...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2014 CFR

2014-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2012 CFR

2012-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2013 CFR

2013-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

Cost-sharing, physician utilization, and adverse selection among Medicare beneficiaries with chronic health conditions.

PubMed

Hoffman, Geoffrey

2015-02-01

Pooled data from the 2007, 2009, and 2011/2012 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared with HMO enrollees but fewer visits compared with those with supplemental (1.04, p = .001) and Medicaid (1.55, p = .003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared with those of similar health status with supplemental (1.30, p = .001) or Medicaid coverage (2.15, p = .002). For subpopulations with several chronic conditions, FFS only beneficiaries also had fewer visits compared with beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs. © The Author(s) 2014.

Additional reductions in Medicare spending growth will likely require shifting costs to beneficiaries.

PubMed

Chernew, Michael E

2013-05-01

Policy makers have considerable interest in reducing Medicare spending growth. Clarity in the debate on reducing Medicare spending growth requires recognition of three important distinctions: the difference between public and total spending on health, the difference between the level of health spending and rate of health spending growth, and the difference between growth per beneficiary and growth in the number of beneficiaries in Medicare. The primary policy issue facing the US health care system is the rate of spending growth in public programs, and solving that problem will probably require reforms to the entire health care sector. The Affordable Care Act created a projected trajectory for Medicare spending per beneficiary that is lower than historical growth rates. Although opportunities for one-time savings exist, any long-term savings from Medicare, beyond those already forecast, will probably require a shift in spending from taxpayers to beneficiaries via higher beneficiary premium contributions (overall or via means testing), changes in eligibility, or greater cost sharing at the point of service.

Shifting to Medicaid-Managed Long-Term Care: Are Vulnerable Florida Beneficiaries Properly Informed?

PubMed

Peterson, Lindsay J; Hyer, Kathryn

2016-10-01

To examine and assess the adequacy of informational material provided to Florida long-term care beneficiaries being required to choose a managed care provider as part of a statewide, mandatory shift to Medicaid-managed long-term care (MMLTC). Informational materials provided by the state of Florida to 90,000 Medicaid long-term care beneficiaries via print mailings and a state website were examined using established content, usability, and readability criteria. Overall, the presentation minimized cognitive complexity, but the information was lacking in critical areas, such as providing clear explanations of the change taking place and the significance of beneficiaries' choices, and enabling beneficiaries to assess their own needs and preferences. A key feature of managed care is the users' choice of plans, but amid a significant policy shift toward MMLTC in Florida, vulnerable beneficiaries may not be receiving the information necessary to make choices that best meet their needs. Our analysis offers lessons to other states shifting to MMLTC. © The Author(s) 2015.

Social Security disability beneficiaries with work-related goals and expectations.

PubMed

Livermore, Gina A

2011-01-01

This study examines working-age Social Security Disability Insurance and Supplemental Security Income beneficiaries who report having work goals or expectations, referring to these individuals as "work-oriented." The study uses data from the 2004 National Beneficiary Survey matched to administrative data spanning 2004-2007 to identify work-oriented beneficiaries and to analyze their sociodemographic, health, and employment characteristics, as well as their earnings-related benefit suspensions and terminations. Relative to other disability beneficiaries, the 40 percent classified as work-oriented were younger and more educated, had been on the disability rolls a shorter time, had lower income from public assistance, and were healthier. Just over half had recently engaged in work or in work preparation activities at interview, about half had earnings at some point during 2004-2007, and 10 percent left the disability rolls because of earnings for at least 1 month during that period. The findings show that a large share of beneficiaries have work goals, most are attempting to work, and many experience some success.

Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

PubMed

Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

2016-04-01

To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries.

PubMed

Colla, Carrie H; Lewis, Valerie A; Kao, Lee-Sien; O'Malley, A James; Chang, Chiang-Hua; Fisher, Elliott S

2016-08-01

Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. Total spending decreased by $34 (95% CI, -$52 to -$15) per beneficiary-quarter after ACO contract implementation across the overall Medicare population (n = 15 592 600) and decreased $114 in clinically vulnerable patients (n = 8 673 823) (95% CI, -$178 to -$50). In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively (95% CIs: -2.1 to -0.4 and -4.8 to -1.3), and hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively (95% CIs: -5.2 to -0.7 and -7.1 to -1.2). Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries. Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments. Savings were realized through reductions in use of institutional settings in clinically vulnerable patients.

Market and beneficiary characteristics associated with enrollment in Medicare managed care plans and fee-for-service.

PubMed

Shimada, Stephanie L; Zaslavsky, Alan M; Zaborski, Lawrence B; O'Malley, A James; Heller, Amy; Cleary, Paul D

2009-05-01

Risk selection in the Medicare managed care program ("Medicare Advantage") is an important policy concern. Past research has shown that Medicare managed care plans tend to attract healthier beneficiaries and that market characteristics such as managed care penetration may also affect risk selection. To assess whether patient enrollment in Medicare managed care (MMC) or traditional fee-for-service (FFS) Medicare is related to beneficiary and market characteristics and provide a baseline for understanding how changes in Medicare policy affect MMC enrollment over time. Data sources were the 2004 Medicare MMC and FFS CAHPS surveys, the Social Security Administration's Master Beneficiary Record, MMC Market Penetration Files, and 2000 Census data. We estimated logistic regression models to assess what beneficiary characteristics predict enrollment in MMC and the moderating effects of market characteristics. Enrollees in MMC plans tend to have better health than those in FFS. This effect is weaker in areas with more competition. Latinos and beneficiaries with less education and lower income, as indicated by earnings history or local-area median income, are more likely to enroll in MMC. Enrollment in MMC is related to beneficiary characteristics, including health status and socioeconomic status, and is modified by MMC presence in the local market. Because vulnerable subgroups are more likely to enroll in MMC plans, the Centers for Medicare & Medicaid Services should monitor how changes to Medicare Advantage policies and payment methods may affect beneficiaries in those groups.

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

20 CFR 410.585 - Conservation and investment of payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

....585 Section 410.585 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND... beneficiary) (Social Security No.), a minor, for whom (Name of payee) is representative payee for black lung... adult beneficiary should be registered as follows: , (Name of beneficiary) (Social Security No.), for...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

12 CFR 330.10 - Revocable trust accounts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... because the account owner has named only three different beneficiaries in the revocable trust accounts—his... records identify (through a code or otherwise) the account as a revocable trust account.) The settlor of a... insured depository institution. (c) Definition of beneficiary. For purposes of this section, a beneficiary...

75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

32 CFR 728.56 - Treasury Department beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other... may be beneficiaries of the Treasury Department and may be rendered care as set forth below. (1.... Customs Service. (5) Prisoners (detainees) of the U.S. Customs Service. (b) Care authorized. (1) Secret...

26 CFR 1.401-2 - Impossibility of diversion under the trust instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... thereafter before the satisfaction of all liabilities to employees or their beneficiaries covered by the... not solely designed for the proper satisfaction of all liabilities to employees or their beneficiaries... phrase “prior to the satisfaction of all liabilities with respect to employees and their beneficiaries...

26 CFR 1.501(c)(9)-4 - Voluntary employees' beneficiary associations; inurement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Voluntary employees' beneficiary associations... Voluntary employees' beneficiary associations; inurement. (a) General rule. No part of the net earnings of an employees' association may inure to the benefit of any private shareholder or individual other...

42 CFR 482.92 - Condition of participation: Organ recovery and receipt.

Code of Federal Regulations, 2014 CFR

2014-10-01

... donor-beneficiary blood type and other vital data for the deceased organ recovery, organ receipt, and... donor's blood type and other vital data are compatible with transplantation of the intended beneficiary... donor's blood type and other vital data are compatible with transplantation of the intended beneficiary...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

42 CFR 435.1007 - Categorically needy, medically needy, and qualified Medicare beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Categorically needy, medically needy, and qualified Medicare beneficiaries. 435.1007 Section 435.1007 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Limitations on Ffp § 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries. (a...

20 CFR 10.712 - What amounts are included in the gross recovery?

Code of Federal Regulations, 2010 CFR

2010-04-01

... contested verdict attributable to each of several plaintiffs, OWCP or SOL will accept that division. (b) In..., OWCP or SOL will determine the appropriate amount of the FECA beneficiary's gross recovery and advise the beneficiary of its determination. FECA beneficiaries may accept OWCP's or SOL's determination or...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 1.501(c)(10)-1 - Certain fraternal beneficiary societies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Certain fraternal beneficiary societies. 1.501(c... fraternal beneficiary societies. (a) For taxable years beginning after December 31, 1969, an organization... society order, or association, described in section 501(c)(8) and the regulations thereunder except that...

26 CFR 1.501(c)(10)-1 - Certain fraternal beneficiary societies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Certain fraternal beneficiary societies. 1.501(c... fraternal beneficiary societies. (a) For taxable years beginning after December 31, 1969, an organization... society order, or association, described in section 501(c)(8) and the regulations thereunder except that...

42 CFR 415.120 - Conditions for payment: Radiology services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Radiology services. 415.120... Services to Beneficiaries in Providers § 415.120 Conditions for payment: Radiology services. (a) Services to beneficiaries. The carrier pays for radiology services furnished by a physician to a beneficiary...

Beneficiary price sensitivity in the Medicare prescription drug plan market.

PubMed

Frakt, Austin B; Pizer, Steven D

2010-01-01

The Medicare stand-alone prescription drug plan (PDP) came into existence in 2006 as part of the Medicare prescription drug benefit. It is the most popular plan type among Medicare drug plans and large numbers of plans are available to all beneficiaries. In this article we present the first analysis of beneficiary price sensitivity in the PDP market. Our estimate of elasticity of enrollment with respect to premium, -1.45, is larger in magnitude than has been found in the Medicare HMO market. This high degree of beneficiary price sensitivity for PDPs is consistent with relatively low product differentiation, low fixed costs of entry in the PDP market, and the fact that, in contrast to changing HMOs, beneficiaries can select a PDP without disrupting doctor-patient relationships.

Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

PubMed

Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

2016-03-01

There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. Project HOPE—The People-to-People Health Foundation, Inc.

Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies.

PubMed

Zheng, Nan Tracy; Haber, Susan; Hoover, Sonja; Feng, Zhanlian

2017-12-01

Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service. © Health Research and Educational Trust.

Medicaid beneficiaries in california reported less positive experiences when assigned to a managed care plan.

PubMed

McDonnell, Diana D; Graham, Carrie L

2015-03-01

In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms. Project HOPE—The People-to-People Health Foundation, Inc.

Primary care physician workforce and Medicare beneficiaries' health outcomes.

PubMed

Chang, Chiang-Hua; Stukel, Therese A; Flood, Ann Barry; Goodman, David C

2011-05-25

Despite a widespread interest in increasing the numbers of primary care physicians to improve care and to moderate costs, the relationship of the primary care physician workforce to patient-level outcomes remains poorly understood. To measure the association between the adult primary care physician workforce and individual patient outcomes. A cross-sectional analysis of the outcomes of a 2007 20% sample of fee-for-service Medicare beneficiaries aged 65 years or older (N = 5,132,936), which used 2 measures of adult primary care physicians (general internists and family physicians) across Primary Care Service Areas (N = 6542): (1) American Medical Association (AMA) Masterfile nonfederal, office-based physicians per total population and (2) office-based primary care clinical full-time equivalents (FTEs) per Medicare beneficiary derived from Medicare claims. Annual individual-level outcomes (mortality, ambulatory care sensitive condition [ACSC] hospitalizations, and Medicare program spending), adjusted for individual patient characteristics and geographic area variables. Marked variation was observed in the primary care physician workforce across areas, but low correlation was observed between the 2 primary care workforce measures (Spearman r = 0.056; P < .001). Compared with areas with the lowest quintile of primary care physician measure using AMA Masterfile counts, beneficiaries in the highest quintile had fewer ACSC hospitalizations (74.90 vs 79.61 per 1000 beneficiaries; relative rate [RR], 0.94; 95% confidence interval [CI], 0.93-0.95), lower mortality (5.38 vs 5.47 per 100 beneficiaries; RR, 0.98; 95% CI, 0.97-0.997), and no significant difference in total Medicare spending ($8722 vs $8765 per beneficiary; RR, 1.00; 95% CI, 0.99-1.00). Beneficiaries residing in areas with the highest quintile of primary care clinician FTEs compared with those in the lowest quintile had lower mortality (5.19 vs 5.49 per 100 beneficiaries; RR, 0.95; 95% CI, 0.93-0.96), fewer ACSC hospitalizations (72.53 vs 79.48 per 1000 beneficiaries; RR, 0.91; 95% CI, 0.90-0.92), and higher overall Medicare spending ($8857 vs $8769 per beneficiary; RR, 1.01; 95% CI, 1.004-1.02). A higher level of primary care physician workforce, particularly with an FTE measure that may more accurately reflect ambulatory primary care, was generally associated with favorable patient outcomes.

Linking Employee Development Activity, Social Exchange and Organizational Citizenship Behavior

ERIC Educational Resources Information Center

Pierce, Heather R.; Maurer, Todd J.

2009-01-01

The authors examined "perceived beneficiary" of employee development (self, organization) for relationships with employee development activity. Perceived organizational support served as a moderator. The authors conclude that employees may engage in development activities to partly benefit their organization to the extent that a positive exchange…

75 FR 24967 - Andean Trade Preference Act: Impact on the U.S. Economy and on Andean Drug Crop Eradication

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-06

...Section 206 of the ATPA (19 U.S.C. 3204) requires the Commission to report biennially to the Congress by September 30 of each reporting year on the economic impact of the Act on U.S. industries and U.S. consumers, as well as on the effectiveness of the Act in promoting drug related crop eradication and crop substitution efforts by beneficiary countries. The Commission prepares these reports under investigation No. 332-352, Andean Trade Preference Act: Impact on the U.S. Economy and on Andean Drug Crop Eradication.

77 FR 28620 - Andean Trade Preference Act: Impact on the U.S. Economy and on Andean Drug Crop Eradication

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-15

...Section 206 of the ATPA (19 U.S.C. 3204) requires the Commission to report biennially to the Congress by September 30 of each reporting year on the economic impact of the Act on U.S. industries and U.S. consumers, as well as on the effectiveness of the Act in promoting drug related crop eradication and crop substitution efforts by beneficiary countries. The Commission prepares these reports under investigation No. 332-352, Andean Trade Preference Act: Impact on the U.S. Economy and on Andean Drug Crop Eradication.

Impact of cost sharing on prescription drugs used by Medicare beneficiaries.

PubMed

Goedken, Amber M; Urmie, Julie M; Farris, Karen B; Doucette, William R

2010-06-01

Incentive-based prescription drug cost sharing can encourage seniors to use generic medications. Little information exists about prescription drug cost sharing and generic use in employer-sponsored plans after the implementation of Medicare Part D. To compare prescription drug cost sharing across prescription insurance type for Medicare beneficiaries after Medicare Part D, to assess the impact of that cost sharing on the number of medications used, and to examine how generic utilization rates differ before and after Medicare Part D and across the type of insurance. This longitudinal study of Medicare beneficiaries aged 65 years and older used Web-based surveys administered in 2005 and 2007 by Harris Interactive((R)) to collect information on prescription drug coverage and medication use. Co-payment plans were categorized as low, medium, or high co-payment plans. Multiple regression was used to assess the impact of co-payment rank on the number of prescription drugs. t-Tests and analysis of variance were used to compare generic use over time and between coverage types. One thousand two hundred twenty and 1024 respondents completed the baseline and follow-up surveys, respectively. Among 3-tier co-payment plans, brand drug co-payments were higher for Part D plans ($26 for preferred brand and $55 for nonpreferred brand) than employer-based plans ($20 for preferred brand and $39 for nonpreferred brand). Co-payment was not a significant predictor for the number of prescription drugs. Generic use was lowest among beneficiaries in employer plans both before and after Part D. In 2007, generic use among beneficiaries with Part D was not significantly different from the generic use for beneficiaries with no drug coverage. Medicare beneficiaries in Part D had higher cost sharing amounts than those with employer coverage, but higher cost sharing was not significantly linked to lower prescription use. Generic use for Part D beneficiaries was higher than that for beneficiaries with employer coverage but the same as that for beneficiaries without drug coverage. Copyright 2010 Elsevier Inc. All rights reserved.

An update on the prevalence and incidence of epilepsy among older adults.

PubMed

Ip, Queeny; Malone, Daniel C; Chong, Jenny; Harris, Robin B; Labiner, David M

2018-01-01

To estimate the prevalence and incidence of epilepsy among beneficiaries of Arizona Medicare aged 65 and over. An analysis of Medicare administrative claims data for 2009-2011 for the State of Arizona was conducted. Epilepsy was defined as a beneficiary who had either≥one claim with diagnostic code of 345.xx (epilepsy) or at least two claims with diagnosis code of 780.3x (seizure) ≥30days apart. Stroke-related and psychiatric comorbidities were determined by diagnostic codes. Average annual prevalence and incidence were calculated and stratified by demographic characteristics and comorbidities. Odds ratios (OR) and 95% confidence intervals (CI) were calculated as measures of effect for prevalence and incidence and the chi-square statistic was calculated to compare the proportions of epilepsy cases with and without comorbidities (alpha=0.05). The overall average annual prevalence and incidence over the study period was 15.2/1000 and 6.1/1000, respectively. Relative to the 65-69 age group and White beneficiaries, the highest prevalence was observed for beneficiaries 85 years or older (19.8/1000, OR 1.66, 95% CI 1.53-1.81) and Native Americans (21.2/1000, OR 1.42, 95% CI 1.25-1.62). In contrast, the highest incidence rates were observed for beneficiaries 85 years and older (8.5/1000, OR 1.82, 95% CI 1.60-2.07) and for Black beneficiaries (8.7/1000, OR 1.44, 95% CI 1.12-1.86). The incidence rate for Native Americans was not significantly different from that for White beneficiaries (6.2/1000, OR 1.02, 95% CI 0.81-1.29). More than one quarter of all cases (25.7%) and 31% of incident cases had either stroke-related and/or psychiatric comorbidities (all p-values < 0.001). Epilepsy is a significant neurological disease among Medicare beneficiaries 65 years and older. Beneficiaries aged 85 and older and Black and Native Americans experienced higher rates of epilepsy than other demographic subgroups compared to White beneficiaries. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

PubMed

Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

2016-04-01

To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p < .001). Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p < .001). Using data from Medicare claims, beneficiaries with similar functional status, medical diagnosis history, and demographics had similar acute care costs regardless of whether they were admitted to a nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

PubMed Central

Colla, Carrie H.; Lewis, Valerie A.; Kao, Lee-Sien; O’Malley, A. James; Chang, Chiang-Hua; Fisher, Elliott S.

2016-01-01

IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. OBJECTIVE To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. EXPOSURES Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. RESULTS Total spending decreased by $34 (95% CI, −$52 to −$15) per beneficiary-quarter after ACO contract implementation across the overall Medicare population (n = 15 592 600) and decreased $114 in clinically vulnerable patients (n = 8 673 823) (95% CI, −$178 to −$50). In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively (95% CIs: −2.1 to −0.4 and −4.8 to −1.3), and hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively (95% CIs: −5.2 to −0.7 and −7.1 to −1.2). Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries. CONCLUSIONS AND RELEVANCE Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments. Savings were realized through reductions in use of institutional settings in clinically vulnerable patients. PMID:27322485

26 CFR 54.4980B-3 - Qualified beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

26 CFR 54.4980B-3 - Qualified beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

5 CFR 870.802 - Designation of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the specified period, insurance benefits will be paid as if the beneficiary had died before the..., benefits will be paid according to the order of precedence shown in § 870.801(a). (3) If a court order... before the death of the insured, the insured individual can designate a beneficiary. Benefits will be...

77 FR 1862 - Mailing of Tickets Under the Ticket to Work Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-12

... Tickets Under the Ticket to Work Program AGENCY: Social Security Administration. ACTION: Interim final... Ticket to Work (Ticket) to disabled beneficiaries for participation in the Ticket to Work program (Ticket... beneficiaries who are most likely to return to work. We will send a Ticket to any eligible disabled beneficiary...

42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... BENEFIT General Provisions § 423.6 Cost-sharing in beneficiary education and enrollment-related costs. The...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

77 FR 23265 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... utilization of Medicare services by American Indian and Alaska Native (AI/AN) beneficiaries, to identify and... evaluated previously by any agency or individual, so data on the extent of transportation barriers for rural AI/AN beneficiaries to Medicare services by AI/AN Medicare beneficiaries are not available except...

20 CFR 416.615 - Information considered in determining whether to make representative payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... management of benefit payments. For example, a statement by a physician or other medical professional based upon his or her recent examination of the beneficiary and his or her knowledge of the beneficiary's... other medical professional as to whether the beneficiary is able to manage or direct the management of...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

20 CFR 416.601 - Introduction.

Code of Federal Regulations, 2012 CFR

2012-04-01

... representative payee if we have determined that the beneficiary is not able to manage or direct the management of... payment. (1) Our policy is that every beneficiary has the right to manage his or her own benefits. However... beneficiary and a question arises concerning his or her ability to manage or direct the management of benefit...

20 CFR 416.601 - Introduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... representative payee if we have determined that the beneficiary is not able to manage or direct the management of... payment. (1) Our policy is that every beneficiary has the right to manage his or her own benefits. However... beneficiary and a question arises concerning his or her ability to manage or direct the management of benefit...

20 CFR 410.584 - Use of benefits for current maintenance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.584 Use of benefits... for the beneficiary's current maintenance. Where a beneficiary is receiving care in an institution... individuals it provides with care and services like those it provides the beneficiary and charges made for...

20 CFR 410.584 - Use of benefits for current maintenance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.584 Use of benefits... for the beneficiary's current maintenance. Where a beneficiary is receiving care in an institution... individuals it provides with care and services like those it provides the beneficiary and charges made for...

Self-Reported Cancer Screening among Elderly Medicare Beneficiaries: A Rural-Urban Comparison

ERIC Educational Resources Information Center

Fan, Lin; Mohile, Supriya; Zhang, Ning; Fiscella, Kevin; Noyes, Katia

2012-01-01

Purpose: We examined the rural-urban disparity of screening for breast cancer and colorectal cancer (CRC) among the elder Medicare beneficiaries and assessed rurality's independent impact on receipt of screening. Methods: Using 2005 Medicare Current Beneficiary Survey, we applied weighted logistic regression to estimate the overall rural-urban…

Are Consumer-Directed Home Care Beneficiaries Satisfied? Evidence from Washington State

ERIC Educational Resources Information Center

Wiener, Joshua M.; Anderson, Wayne L.; Khatutsky, Galina

2007-01-01

Purpose: This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. Design and Methods: The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study,…

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

5 CFR 843.205 - Designation of beneficiary-form and execution.

Code of Federal Regulations, 2010 CFR

2010-01-01

... execution. 843.205 Section 843.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... One-time Payments § 843.205 Designation of beneficiary—form and execution. (a) A designation of..., corporation, or legal entity may be named as beneficiary. (e) A change of beneficiary may be made at any time...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

38 CFR 3.217 - Submission of statements or information affecting entitlement to benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the identity of the provider as either the beneficiary or his or her fiduciary by obtaining specific information about the beneficiary that can be verified from the beneficiary's VA records, such as Social... statement provided, the date such information or statement was provided, the identity of the provider, the...

76 FR 36173 - U.S. Registration of Aircraft in the Name of Owner Trustees for Non-U.S. Citizen Beneficiary

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-21

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration U.S. Registration of Aircraft in the Name of Owner Trustees for Non-U.S. Citizen Beneficiary AGENCY: Federal Aviation Administration, (FAA..., Oklahoma, concerning aircraft registration by owner trustees for non- U.S. citizen beneficiaries...

Cancer Outcomes in Low-Income Elders: Is There An Advantage to Being on Medicaid?

PubMed Central

Koroukian, Siran M.; Bakaki, Paul M.; Owusu, Cynthia; Earle, Craig C.; Cooper, Gregory S.

2012-01-01

Background Because of reduced financial barriers, dual Medicare-Medicaid enrollment of low-income Medicare beneficiaries may be associated with receipt of definitive cancer treatment and favorable survival outcomes. Methods We used a database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Medicaid files, death certificates, and U.S. Census data. The study population included community-dwelling Medicare fee-for-service beneficiaries, age 66 years or older, with low incomes, residing in Ohio, and diagnosed with incident loco-regional breast (n=838), colorectal (n=784), or prostate cancer (n=946) in years 1997–2001. We identified as “duals” Medicare beneficiaries who were enrolled in Medicaid at least three months prior to cancer diagnosis. Multivariable logistic regression and survival models were developed to analyze the association between dual status and (1) receipt of definitive treatment; and (2) overall and disease-specific survival, after adjusting for tumor stage and patient covariates. Results Dual status was associated with a significantly lower likelihood to receive definitive treatment among colorectal cancer patients (Adjusted Odds Ratio: 0.60, 95% Confidence Interval, or CI, [0.38, 0.95]), but not among breast or prostate cancer patients. Furthermore, dual status was associated with decreased overall survival among prostate cancer patients (Adjusted Hazard Ratio, or AHR, 1.45, 95% CI [1.05, 2.02]), and decreased disease-specific survival among colorectal cancer patients (AHR: 1.52 [1.05, 2.19]). Conclusion Enrollment of low-income Medicare beneficiaries in Medicaid is not associated with favorable treatment patterns or survival outcomes. Differences in health and functional status between community-dwelling duals and non-duals might help explain the observed disparities. PMID:24800139

Obtaining advance beneficiary notices for Medicare physician providers.

PubMed

Carter, Darren

2003-01-01

Medicare has established medical necessity rules that define the medical conditions that make beneficiaries eligible for particular services. These rules are codified in local medical review policies (LMRPs) that are established by Medicare claims payment contractors. If a beneficiary's provider does not inform the patient that a service may not be covered, the provider cannot subsequently bill the beneficiary for the service if it is denied. This article discusses the application of these policies. It illustrates the circumstances in which advance beneficiary notices (ABN) are required to ensure that patients have been notified that services rendered will not be covered by Medicare and will become their financial responsibility. The author also presents special applications of the ABN regulations as they apply to the EMTALA rules, anti-kickback, and other statutes. Samples of the official ABN forms are illustrated.

Balance billing under Medicare: protecting beneficiaries and preserving physician participation.

PubMed

Colby, D C; Rice, T; Bernstein, J; Nelson, L

1995-01-01

Medicare's experience with balance billing provides valuable lessons for policy making for national or state health care reform. Medicare developed several policies to encourage physicians to become participating providers who accept Medicare-allowed charges as payment in full. Only nonparticipating physicians are permitted to bill for additional amounts beyond that paid by Medicare, and there are limits on the amount of balance billing per claim. As shown by the analysis of claims presented in this article, Medicare has successfully provided financial protection to beneficiaries. In 1986, more than 60 percent of expenditures for physician services were on assigned claims for which there could be no balance billing; by 1990, 80 percent of expenditures were on assigned claims. Balance billing decreased by about 30 percent during the same period. Although these policies have been successful in reducing total expenditures for balance billing, they may not provide financial protection to the most economically vulnerable beneficiaries. Using survey and claims data, we found that the poor have lower balance billing expenditures for services provided by primary care physicians, but that there is no relationship between poverty status and balance billing expenditures for services of nonprimary care physicians. In addition, most low-income beneficiaries are liable for balance bills. Under health care reform, adoption of Medicare's incentive-based approach with mandatory assignment for the poor would allow for some choice based on price and would provide financial protection for all consumers.

Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.

PubMed

Kuye, Ifedayo O; Frank, Richard G; McWilliams, J Michael

2013-06-24

Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration. To examine the role of beneficiaries' cognitive abilities in explaining this puzzle. Analysis of survey data from the nationally representative Health and Retirement Study. Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying. Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions. Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5% vs 52.0%; P = .002), LIS awareness (58.3% vs 33.3%; P = .001), and LIS application (25.5% vs 12.7%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02). Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.

Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions.

PubMed

Mroz, Tracy M; Meadow, Ann; Colantuoni, Elizabeth; Leff, Bruce; Wolff, Jennifer L

2018-06-01

To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. Retrospective analysis. Home health agencies. Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. Not applicable. Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

The Differences in Health Care Utilization between Medical Aid and Health Insurance: A Longitudinal Study Using Propensity Score Matching

PubMed Central

Kim, Jae-Hyun; Lee, Kwang-Soo; Yoo, Ki-Bong; Park, Eun-Cheol

2015-01-01

Study Objectives Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled) or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI) achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries. Methods & Design Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used. Results The number of outpatient visits was 1.431 times higher (p<0.0001) in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001) in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268) for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156). Conclusions Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided. PMID:25816234

Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

PubMed

Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

2017-07-01

The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

'The stars seem aligned': a qualitative study to understand the effects of context on scale-up of maternal and newborn health innovations in Ethiopia, India and Nigeria.

PubMed

Spicer, Neil; Berhanu, Della; Bhattacharya, Dipankar; Tilley-Gyado, Ritgak Dimka; Gautham, Meenakshi; Schellenberg, Joanna; Tamire-Woldemariam, Addis; Umar, Nasir; Wickremasinghe, Deepthi

2016-11-25

Donors commonly fund innovative interventions to improve health in the hope that governments of low and middle-income countries will scale-up those that are shown to be effective. Yet innovations can be slow to be adopted by country governments and implemented at scale. Our study explores this problem by identifying key contextual factors influencing scale-up of maternal and newborn health innovations in three low-income settings: Ethiopia, the six states of northeast Nigeria and Uttar Pradesh state in India. We conducted 150 semi-structured interviews in 2012/13 with stakeholders from government, development partner agencies, externally funded implementers including civil society organisations, academic institutions and professional associations to understand scale-up of innovations to improve the health of mothers and newborns these study settings. We analysed interview data with the aid of a common analytic framework to enable cross-country comparison, with Nvivo to code themes. We found that multiple contextual factors enabled and undermined attempts to catalyse scale-up of donor-funded maternal and newborn health innovations. Factors influencing government decisions to accept innovations at scale included: how health policy decisions are made; prioritising and funding maternal and newborn health; and development partner harmonisation. Factors influencing the implementation of innovations at scale included: health systems capacity in the three settings; and security in northeast Nigeria. Contextual factors influencing beneficiary communities' uptake of innovations at scale included: sociocultural contexts; and access to healthcare. We conclude that context is critical: externally funded implementers need to assess and adapt for contexts if they are to successfully position an innovation for scale-up.

Use of a Knowledge Management System in Waste Management Projects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gruendler, D.; Boetsch, W.U.; Holzhauer, U.

2006-07-01

In Germany the knowledge management system 'WasteInfo' about waste management and disposal issues has been developed and implemented. Beneficiaries of 'WasteInfo' are official decision makers having access to a large information pool. The information pool is fed by experts, so called authors This means compiling of information, evaluation and assigning of appropriate properties (metadata) to this information. The knowledge management system 'WasteInfo' has been introduced at the WM04, the operation of 'WasteInfo' at the WM05. The recent contribution describes the additional advantage of the KMS being used as a tool for the dealing with waste management projects. This specific aspectmore » will be demonstrated using a project concerning a comparative analysis of the implementation of repositories in six countries using nuclear power as examples: The information of 'WasteInfo' is assigned to categories and structured according to its origin and type of publication. To use 'WasteInfo' as a tool for the processing the projects, a suitable set of categories has to be developed for each project. Apart from technical and scientific aspects, the selected project deals with repository strategies and policies in various countries, with the roles of applicants and authorities in licensing procedures, with safety philosophy and with socio-economic concerns. This new point of view has to be modelled in the categories. Similar to this, new sources of information such as local and regional dailies or particular web-sites have to be taken into consideration. In this way 'WasteInfo' represents an open document which reflects the current status of the respective repository policy in several countries. Information with particular meaning for the German repository planning is marked and by this may influence the German strategy. (authors)« less

20 CFR 410.586 - Use of benefits for beneficiary in institution.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.586 Use of... certified on behalf of the beneficiary shall give highest priority to expenditure of the payments for the... § 410.584) in providing care and maintenance. It is considered in the best interest of the beneficiary...

20 CFR 410.586 - Use of benefits for beneficiary in institution.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.586 Use of... certified on behalf of the beneficiary shall give highest priority to expenditure of the payments for the... § 410.584) in providing care and maintenance. It is considered in the best interest of the beneficiary...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2014 CFR

2014-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2013 CFR

2013-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2012 CFR

2012-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2011 CFR

2011-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Death of individual beneficiaries. 1.652(c)-2...) INCOME TAX (CONTINUED) INCOME TAXES Trusts Which Distribute Current Income Only § 1.652(c)-2 Death of... the beneficiary's death), the extent to which the income is included in the gross income of the...

12 CFR 745.4 - Revocable trust accounts.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-death account naming the same niece and a friend as beneficiaries. The maximum coverage available to the... beneficiaries in the revocable trust accounts—his niece and cousin in the first, and the same niece and a friend... names two friends, “B” and “C” as beneficiaries. At the same NCUA-insured credit union, A establishes a...

Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit: Rural-Urban Differences

ERIC Educational Resources Information Center

Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Van Nostrand, Joan F.; Eggert, Gerald M.

2010-01-01

Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19…

Climate impacts on hydropower and consequences for global electricity supply investment needs

DOE PAGES

Turner, Sean W. D.; Hejazi, Mohamad; Kim, Son H.; ...

2017-11-15

Climate change is projected to increase hydropower generation in some parts of the world and decrease it in others. Here we explore the possible consequences of these impacts for the electricity supply sector at the global scale. Regional hydropower projections are developed by forcing a coupled global hydrological and dam model with downscaled, bias-corrected climate realizations. Consequent impacts on power sector composition and associated emissions and investment costs are explored using the Global Change Assessment Model (GCAM). We find that climate-driven changes in hydropower generation may shift power demands onto and away from carbon intensive technologies. This then causes significantlymore » altered power sector CO 2 emissions in several hydro-dependent regions, although the net global impact is modest. For drying regions, we estimate a global, cumulative investment need of approximately one trillion dollars (±$500 billion) this century to make up for deteriorated hydropower generation caused by climate change. Total investments avoided are of a similar magnitude across regions projected to experience increased precipitation. Investment risks and opportunities are concentrated in hydro-dependent countries for which significant climate change is expected. Various countries throughout the Balkans, Latin America and Southern Africa are most vulnerable, whilst Norway, Canada, and Bhutan emerge as clear beneficiaries.« less

Climate impacts on hydropower and consequences for global electricity supply investment needs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turner, Sean W. D.; Hejazi, Mohamad; Kim, Son H.

Climate change is projected to increase hydropower generation in some parts of the world and decrease it in others. Here we explore the possible consequences of these impacts for the electricity supply sector at the global scale. Regional hydropower projections are developed by forcing a coupled global hydrological and dam model with downscaled, bias-corrected climate realizations. Consequent impacts on power sector composition and associated emissions and investment costs are explored using the Global Change Assessment Model (GCAM). We find that climate-driven changes in hydropower generation may shift power demands onto and away from carbon intensive technologies. This then causes significantlymore » altered power sector CO 2 emissions in several hydro-dependent regions, although the net global impact is modest. For drying regions, we estimate a global, cumulative investment need of approximately one trillion dollars (±$500 billion) this century to make up for deteriorated hydropower generation caused by climate change. Total investments avoided are of a similar magnitude across regions projected to experience increased precipitation. Investment risks and opportunities are concentrated in hydro-dependent countries for which significant climate change is expected. Various countries throughout the Balkans, Latin America and Southern Africa are most vulnerable, whilst Norway, Canada, and Bhutan emerge as clear beneficiaries.« less

Learning effect of a conditional cash transfer programme on poor rural women's selection of delivery care in Mexico.

PubMed

Sosa-Rubí, Sandra G; Walker, Dilys; Serván, Edson; Bautista-Arredondo, Sergio

2011-11-01

BACKGROUND The Mexican programme Oportunidades/Progresa conditionally transfers money to beneficiary families. Over the past 10 years, poor rural women have been obliged to attend antenatal care (ANC) visits and reproductive health talks. We propose that the length of time in the programme influences women's preferences, thus increasing their use not only of services directly linked to the cash transfers, but also of other services, such as clinic-based delivery, whose utilization is not obligatory. OBJECTIVE To analyse the long-term effect of Oportunidades on women's use of antenatal and delivery care. METHODOLOGY 5051 women aged between 15 and 49 years old with at least one child aged less than 24 months living in rural localities were analysed. Multilevel probit and logit models were used to analyse ANC visits and physician/nurse attended delivery, respectively. Models were adjusted with individual and socio-economic variables and the locality's exposure time to Oportunidades. Findings On average women living in localities with longer exposure to Oportunidades report 2.1% more ANC visits than women living in localities with less exposure. Young women aged 15-19 and 20-24 years and living in localities with longer exposure to Oportunidades (since 1998) have 88% and 41% greater likelihood of choosing a physician/nurse vs. traditional midwife for childbirth, respectively. Women of indigenous origin are 68.9% less likely to choose a physician/nurse for delivery care than non-indigenous women. CONCLUSIONS An increase in the average number of ANC visits has been achieved among Oportunidades beneficiaries. An indirect effect is the increased selection of a physician/nurse for delivery care among young women living in localities with greater exposure time to Oportunidades. Disadvantaged women in Mexico (indigenous women) continue to have less access to skilled delivery care. Developing countries must develop strategies to increase access and use of skilled obstetric care for marginalized women.

Potential adult Medicaid beneficiaries under the Patient Protection and Affordable Care Act compared with current adult Medicaid beneficiaries.

PubMed

Chang, Tammy; Davis, Matthew

2013-01-01

Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007-2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% "excellent" or "very good," 40.4% "good") than current beneficiaries (33.5% "excellent" or "very good," 31.6% "good"; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs 38.0%; P = .002), and moderate and heavier alcohol use (21.6% vs 16.0% and 16.5% vs 9.8%; P <.001, respectively) are more common among the potentially eligible population than among current beneficiaries. Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries. Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease.

Are Press Depictions of Affordable Care Act Beneficiaries Favorable to Policy Durability?

PubMed

Chattopadhyay, Jacqueline

2015-01-01

If successfully implemented and enduring, the Affordable Care Act (ACA) stands to expand health insurance access in absolute terms, reduce inter-group disparities in that access, and reduce exposure to the financial vulnerabilities illness entails. Its durability--meaning both avoidance of outright retrenchment and fidelity to its policy aims--is thus of scholarly interest. Past literature suggests that social constructions of a policy's beneficiaries may impact durability. This paper first describes media portrayals of ACA beneficiaries with an eye toward answering three descriptive questions: (1) Do portrayals depict beneficiaries as economically heterogeneous? (2) Do portrayals focus attention on groups that have acquired new political relevance due to the ACA, such as young adults? (3) What themes that have served as messages about beneficiary "deservingness" in past social policy are most frequent in ACA beneficiary portrayals? The paper then assesses how the portrayal patterns that these questions uncover may work both for and against the ACA's durability, finding reasons for confidence as well as caution. Using manual and automated methods, this paper analyzes newspaper text from August 2013 through January 2014 to trace portrayals of two ACA "target populations" before and during the new law's first open-enrollment period: those newly eligible for Medicaid, and those eligible for subsidies to assist in the purchase of private health insurance under the ACA. This paper also studies newspaper text portrayals of two groups informally crafted by the ACA in this timeframe: those gaining health insurance and those losing it. The text data uncover the following answers to the three descriptive questions for the timeframe studied: (1) Portrayals may underplay beneficiaries' economic heterogeneity. (2) Portrayals pay little attention to young adults. (3) Portrayals emphasize themes of workforce participation, economic self-sufficiency, and insider status. Health status, age, gender, and race/ethnicity appear to receive little attention. Existing literature suggests that these portrayal patterns may both support and limit ACA durability. In favor of durability is that ACA beneficiaries are depicted in terms that have been associated with deservingness in past American social policy--particularly being cast as workers and insiders. Yet, the results also give three reasons for caution. First, ACA insurance-losers are also portrayed as deserving. Second, it is unclear how the portrayal patterns found may impact the durability of the ACA's efforts to cut insurance disparities by age, health status, and especially race/ethnicity. Third, portrayals' strong casting of beneficiaries as workers, and limited attention to beneficiaries' economic heterogeneity and to young adults, may do little to help cultivate beneficiary political engagement around the ACA.

The Impact of Medicare Part D on the Proportion of Out-of-Pocket Prescription Drug Costs Among Older Adults With Diabetes.

PubMed

Choi, Yoon Jeong; Jia, Haomiao; Gross, Tal; Weinger, Katie; Stone, Patricia W; Smaldone, Arlene M

2017-04-01

The purpose of this study was to evaluate the impact of Medicare Part D on reducing the financial burden of prescription drugs in older adults with diabetes. Using Medical Expenditure Panel Survey data (2000-2011), interrupted time series and difference-in-difference analyses were used to examine out-of-pocket costs for prescription drugs in 4,664 Medicare beneficiaries (≥65 years of age) compared with 2,938 younger, non-Medicare adults (50-60 years) with diabetes and to estimate the causal effects of Medicare Part D. Part D enrollment of Medicare beneficiaries with diabetes gradually increased from 45.7% (2006) to 52.4% (2011). Compared with years 2000-2005, out-of-pocket pharmacy costs decreased by 13.5% (SE 2.1) for all Medicare beneficiaries with diabetes following Part D implementation; on average, Part D beneficiaries had 5.3% (0.8) lower costs compared with those without Part D. Compared with a younger group with diabetes, out-of-pocket pharmacy costs decreased by 19.4% (1.7) for Medicare beneficiaries after Part D. Part D beneficiaries with diabetes who experienced the coverage gap decreased from 60.1% (2006) to 40.9% (2011) over this period. These findings demonstrate that although Medicare Part D has been effective in reducing the out-of-pocket cost burden of prescription drugs, approximately two out of five Part D beneficiaries with diabetes experienced the coverage gap in 2011. Future research is needed to examine the impact of Affordable Care Act provisions to close the coverage gap on the cost burden of prescription drugs for Medicare beneficiaries with diabetes. © 2017 by the American Diabetes Association.

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

PubMed

Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

2016-06-01

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica.

PubMed

Gordon-Strachan, Georgiana; Cunningham-Myrie, Colette; Fox, Kristin; Kirton, Claremont; Fraser, Raphael; McLeod, Georgia; Forrester, Terrence

2015-01-01

To determine whether there was a difference in wealth and cardiovascular disease (CVD) risk between microcredit loan beneficiaries and community-matched non-beneficiaries (controls). Seven hundred and twenty-six households of microcredit loan beneficiaries were matched with 726 controls by age, sex and community. A standardised interviewer administered questionnaire was used to collect data on health and household expenditure. Weights, heights, waist circumference and blood pressure measurements were taken for an adult and one child (6-16 years) from each household. Amongst adults, there was no difference in the prevalence of pre-hypertension and hypertension. More male (68.1% vs. 47.8%) and female beneficiaries (84.5% vs. 77.9%) were overweight/obese. More male (17.2% vs. 7.1%; P < 0.05) and female beneficiaries (68.5% vs. 63.3%; P < 0.05) exhibited substantially increased risk for CVD. Children of beneficiaries displayed higher mean BMI-for-age z-scores than their control peers: males 0.56 [95% CI 0.40-0.72] vs. 0.18 [95% CI 0.02-0.35] (P < 0.001) and females 0.66 [95% CI 0.52-0.80] vs. 0.42 [95% CI 0.29-0.56] (P < 0.001). Based on BMI-for-age z-scores, children of beneficiaries had greater odds of being overweight/obese (OR = 1.46; 95% CI 1.18-1.82) Beneficiaries were economically better off; their mean total annual expenditure and house ownership were significantly higher than controls (P < 0.001). Microcredit financing is positively associated with wealth acquisition but worsened cardiovascular risk status. © 2014 John Wiley & Sons Ltd.

Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference?

PubMed

Culler, Steven D; Cohen, David J; Brown, Phillip P; Kugelmass, Aaron D; Reynolds, Matthew R; Ambrose, Karen; Schlosser, Michael L; Simon, April W; Katz, Marc R

2018-04-01

This study reports trends in volume and adverse events associated with isolated aortic valve procedures performed in Medicare beneficiaries between 2009 and 2015. This retrospective study used the annual fiscal year Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure. Outcome measures included three mortality rates and nine in-hospital adverse events. The final study population consisted of 233,660 hospitalizations. During the study period, Medicare beneficiaries undergoing an aortic valve procedure increased from 22,076 to 49,362, for an average annual growth rate of 14.45%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 10.7 in 2012 to 41.1 in 2015. Overall, in-hospital mortality rates, cumulative 30-day mortality rates, and 90-day postdischarge mortality rates declined annually during the study period. However, the 90-day mortality rate for TAVR was nearly double the rate for the tissue surgical aortic valve replacement group. Nearly 68% of Medicare beneficiaries experienced at least one in-hospital adverse event during their index hospitalization. Medicare beneficiaries undergoing TAVR had the lowest observed adverse events rates among the aortic valve procedures in 2015. The total number of Medicare beneficiaries undergoing isolated aortic valve procedures increased from 47.5 to 88.9 per 100,000 Medicare beneficiaries during the study period. Aortic valve procedures increased significantly during this study period primarily due to the increase in TAVR, with clinical outcomes improving as well. Although long-term outcomes of TAVR are still under investigation, these results are promising. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease.

PubMed

Rosenson, Robert S; Kent, Shia T; Brown, Todd M; Farkouh, Michael E; Levitan, Emily B; Yun, Huifeng; Sharma, Pradeep; Safford, Monika M; Kilgore, Meredith; Muntner, Paul; Bittner, Vera

2015-01-27

National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events. This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge. We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg. Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge. The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

PubMed Central

2014-01-01

Background Nigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS). Uptake to date has been disappointing, however. The aim of this study is to review the present status of CBHI in SSA in general to highlight the issues that affect its successful integration within the NHIS of Nigeria and more widely in developing countries. Methods A literature survey using PubMed and EconLit was carried out to identify and review studies that report factors affecting implementation of CBHI in SSA with a focus on Nigeria. Results CBHI schemes with a variety of designs have been introduced across SSA but with generally disappointing results so far. Two exceptions are Ghana and Rwanda, both of which have introduced schemes with effective government control and support coupled with intensive implementation programmes. Poor support for CBHI is repeatedly linked elsewhere with failure to engage and account for the ‘real world’ needs of beneficiaries, lack of clear legislative and regulatory frameworks, inadequate financial support, and unrealistic enrolment requirements. Nigeria’s CBHI-type schemes for the informal sectors of its NHIS have been set up under an appropriate legislative framework, but work is needed to eliminate regressive financing, to involve scheme members in the setting up and management of programmes, to inform and educate more effectively, to eliminate lack of confidence in the schemes, and to address inequity in provision. Targeted subsidies should also be considered. Conclusions Disappointing uptake of CBHI-type NHIS elements in Nigeria can be addressed through closer integration of informal and formal programmes under the NHIS umbrella, with increasing involvement of beneficiaries in scheme design and management, improved communication and education, and targeted financial assistance. PMID:24559409

Using rapid assessment and response to operationalise physical activity strategic health communication campaigns in Tonga.

PubMed

Turk, Tahir; Latu, Netina; Cocker-Palu, Elizabeth; Liavaa, Villiami; Vivili, Paul; Gloede, Sara; Simons, Allison

2013-04-01

The aim of the present study was to identify stakeholder and program beneficiary needs and wants in relation to a netball communication strategy in Tonga. In addition, the study aimed to more clearly identify audience segments for targeting of communication campaigns and to identify any barriers or benefits to engaging in the physical activity program. A rapid assessment and response (RAR) methodology was used. The elicitation research encompassed qualitative fieldwork approaches, including semistructured interviews with key informants and focus group discussions with program beneficiaries. Desk research of secondary data sources supported in-field findings. A number of potential barriers to behavioural compliance existed, including cultural factors, gender discrimination, socioeconomic factors, stigmatising attitudes, the threat of domestic violence, infrastructure and training issues. Factors contributing to participation in physical activity included the fun and social aspects of the sport, incentives (including career opportunities, highlighting the health benefits of the activity and the provision of religious and cultural sanctions by local leaders towards the increased physical activity of women. The consultative approach of RAR provided a more in-depth understanding of the need for greater levels of physical activity and opportunities for engagement by all stakeholders. The approach facilitated opportunities for the proposed health behaviours to be realised through the communication strategy. Essential insights for the strategy design were identified from key informants, as well as ensuring future engagement of these stakeholders into the strategy. So what? The expanded use of RAR to inform the design of social marketing interventions is a practical approach to data collection for non-communicable diseases and other health issues in developing countries. The approach allows for the rapid mobilisation of scarce resources for the implementation of more strategic, targeted communication campaigns to support behavioural changes.

Roles of community helpers in using the Medicare Part D benefit

PubMed Central

Hensley, Melissa A.

2013-01-01

Objectives To examine the experiences of low-income Part D beneficiaries with mental illness and their use of community helpers to access prescription medicines. Methods Individual semi-structured interviews were conducted with 26 Medicare beneficiaries with mental illness in community settings. The transcripts were analyzed for content related to community help-seeking and attitudes toward family and professional helpers. Results Medicare Part D beneficiaries with mental illness used the assistance of community helpers extensively. Pharmacists, nurses, community mental health case managers, and family members assisted beneficiaries with understanding their benefit plans and interpreting paperwork from plans and government agencies. Community helpers also assisted with tasks related to medication adherence. Mental health consumers appreciated the help that they received from family members and professionals. Conclusion This group of Medicare beneficiaries would have experienced difficulty in using their benefits and obtaining their medication without considerable help from professionals and family members in the community. PMID:21317520

FASB Statement No. 136 clarifies transfers of assets.

PubMed

Luecke, R W; Meeting, D T

2000-03-01

FASB Statement of Financial Accounting Standards No. 136, Transfers of Assets to a Not-for-Profit Organization or Charitable Trust That Raises or Holds Contributions for Others, provides guidance and establishes accounting standards for the transfer of assets from donors to not-for-profit organizations that may then transfer those same assets to a beneficiary organization. Recipient organizations that accept financial assets from a donor and agree to use those assets on behalf of a specified unaffiliated beneficiary or transfer those assets, the return on investment of those assets, or both to that beneficiary must recognize the assets received from the donor and recognize the assets' fair value as a liability to the beneficiary. The statement describes circumstances in which a transfer of assets to a recipient organization is accounted for as an asset and corresponding liability of the recipient organization, and as an asset and donation revenue by the beneficiary organization because the transfer is irrevocable.

Medicare Part D Beneficiaries' Plan Switching Decisions and Information Processing.

PubMed

Han, Jayoung; Urmie, Julie

2017-03-01

Medicare Part D beneficiaries tend not to switch plans despite the government's efforts to engage beneficiaries in the plan switching process. Understanding current and alternative plan features is a necessary step to make informed plan switching decisions. This study explored beneficiaries' plan switching using a mixed-methods approach, with a focus on the concept of information processing. We found large variation in beneficiary comprehension of plan information among both switchers and nonswitchers. Knowledge about alternative plans was especially poor, with only about half of switchers and 2 in 10 nonswitchers being well informed about plans other than their current plan. We also found that helpers had a prominent role in plan decision making-nearly twice as many switchers as nonswitchers worked with helpers for their plan selection. Our study suggests that easier access to helpers as well as helpers' extensive involvement in the decision-making process promote informed plan switching decisions.

Discourse on malaria elimination: where do forcibly displaced persons fit in these discussions?

PubMed Central

2013-01-01

Background Individuals forcibly displaced are some of the poorest people in the world, living in areas where infrastructure and services are at a bare minimum. Out of a total of 10,549,686 refugees protected and assisted by the United Nations High Commissioner for Refugees globally, 6,917,496 (65.6%) live in areas where malaria is transmitted. Historically, national malaria control programmes have excluded displaced populations. Results The current discourse on malaria elimination rarely includes discussion of forcibly displaced persons who reside within malaria-eliminating countries. Of the 100 malaria-endemic countries, 64 are controlling malaria and 36 are in some stage of elimination. Of these, 30 malaria-controlling countries and 13 countries in some phase of elimination host displaced populations of ≥50,000, even though 13 of the 36 (36.1%) malaria-elimination countries host displaced populations of ≥50,000 people. Discussion Now is the time for the malaria community to incorporate forcibly displaced populations residing within malarious areas into malaria control activities. Beneficiaries, whether they are internally displaced persons or refugees, should be viewed as partners in the delivery of malaria interventions and not simply as recipients. Conclusion Until equitable and sustainable malaria control includes everyone residing in an endemic area, the goal of malaria elimination will not be met. PMID:23575209

Medicare spending by state: the border-crossing adjustment.

PubMed

Basu, J; Lazenby, H C; Levit, K R

1995-01-01

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the netflow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States.

Building a Stronger System for Tracking Nutrition-Sensitive Spending: A Methodology and Estimate of Global Spending for Nutrition-Sensitive Foreign Aid.

PubMed

Ickes, Scott B; Trichler, Rachel B; Parks, Bradley C

2015-12-01

There is growing awareness that the necessary solutions for improving nutrition outcomes are multisectorial. As such, investments are increasingly directed toward "nutrition-sensitive" approaches that not only address an underlying or basic determinant of nutrition but also seek to achieve an explicit nutrition goal or outcome. Understanding how and where official development assistance (ODA) for nutrition is invested remains an important but complex challenge, as development projects components vary in their application to nutrition outcomes. Currently, no systematic method exists for tracking nutrition-sensitive ODA. To develop a methodology for classifying and tracking nutrition-sensitive ODA and to produce estimates of the amount of nutrition-sensitive aid received by countries with a high burden of undernutrition. We analyzed all financial flows reported to the Organization for Economic Co-Operation and Development's Development Assistance Committee Creditor Reporting Service in 2010 to estimate these investments. We assessed the relationships between national stunting prevalence, stunting burden, under-5 mortality, and the amount of nutrition-specific and nutrition-sensitive ODA. We estimate that, in 2010, a total of $379·4 million (M) US dollars (USD) was committed to nutrition-specific projects and programs of which 25 designated beneficiaries (countries and regions) accounted for nearly 85% ($320 M). A total of $1.79 billion (B) was committed to nutrition-sensitive spending, of which the top 25 countries/regions accounted for $1.4 B (82%). Nine categories of development activities accounted for 75% of nutrition-sensitive spending, led by Reproductive Health Care (30·4%), Food Aid/Food Security Programs (14·1%), Emergency Food Aid (13·2%), and Basic Health Care (5·0%). Multivariate linear regression models indicate that the amount of nutrition-sensitive (P = .001) and total nutrition ODA was significantly predicted by stunting prevalence (P = .001). The size of the total population of stunted children significantly predicted the amount of nutrition-specific ODA (P < .001). The recipient profile of nutrition-specific and nutrition-sensitive ODA is related but distinct. Nutrition indicators are associated with the level of nutrition-related ODA commitments to recipient countries. A reliable estimate of nutrition spending is critical for effective planning by both donors and recipients and key for success, as the global development community recommits to a new round of goals to address the interrelated causes of undernutrition in low-income countries. © The Author(s) 2015.

Prevention of carcinoma of cervix with human papillomavirus vaccine.

PubMed

Gavarasana, S; Kalasapudi, R S; Rao, T D; Thirumala, S

2000-01-01

Carcinoma of cervix is the most common cancer found among the women of India. Though cervical cytology screening was effective in preventing carcinoma of cervix in developed nations, it is considered unsuitable in developing countries. Recent research has established an etiological link between human papillomavirus infection and carcinoma of cervix. In this review, an attempt is made to answer the question, 'whether carcinoma of cervix can be prevented with human papillomavirus vaccine?' Literature search using Pubmed and Medline was carried out and relevant articles were reviewed. There is ample experimental evidence to show that DNA of human papillomavirus integrates with cervical cell genome. Viral genes E6 and E7 of HPV type 16 and 18 inactivate p53 function and Rb gene, thus immortalize the cervical epithelial cells. Recombinant vaccines blocked the function of E6 and E7 genes preventing development of papillomas in animals. Vaccination with HPV-VLPs encoding for genes of E6 and E7 neutralizes HPV integrated genome of malignant cells of uterine cervix. Based on experimental evidence, it is possible to prevent carcinoma of cervix with human papillomavirus vaccine, Further research is necessary to identify a effective and safe HPV vaccine, routes of administration and characteristics of potential beneficiaries.

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2012 CFR

2012-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2013 CFR

2013-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2014 CFR

2014-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2011 CFR

2011-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

20 CFR 10.706 - How will a beneficiary know if OWCP or SOL has determined that action against a third party is...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How will a beneficiary know if OWCP or SOL... Third Party Liability § 10.706 How will a beneficiary know if OWCP or SOL has determined that action... is transferred to SOL, a second notification may be issued. ...

The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural America

ERIC Educational Resources Information Center

Weingarten, Joseph P.; Brittman, Susan; Hu, Wenrong; Przybyszewski, Chris; Hammond, Judith M.; FitzGerald, Dawn

2006-01-01

Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were…

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2012 CFR

2012-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2014 CFR

2014-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2013 CFR

2013-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

26 CFR 1.167(h)-1 - Life tenants and beneficiaries of trusts and estates.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Life tenants and beneficiaries of trusts and estates. 1.167(h)-1 Section 1.167(h)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... and Corporations § 1.167(h)-1 Life tenants and beneficiaries of trusts and estates. (a) Life tenants...

The Impact of Changing Financial Work Incentives on the Earnings of Social Security Disability Insurance (SSDI) Beneficiaries

ERIC Educational Resources Information Center

Weathers, Robert R., II; Hemmeter, Jeffrey

2011-01-01

SSDI beneficiaries lose their entire cash benefit if they perform work that is substantial gainful activity (SGA) after using Social Security work incentive programs. The complete loss of benefits might be a work disincentive for beneficiaries. We report results from a pilot project that replaces the complete loss of benefits with a gradual…

Obesity utilization and health-related quality of life in Medicare enrollees.

PubMed

Malinoff, Rochelle L; Elliott, Marc N; Giordano, Laura A; Grace, Susan C; Burroughs, James N

2013-01-01

The obese, with disproportionate chronic disease incidence, consume a large share of health care resources and drive up per capita Medicare spending. This study examined the prevalence of obesity and its association with health status, health-related quality of life (HRQOL), function, and outpatient utilization among Medicare Advantage seniors. Results indicate that obese beneficiaries, much more than overweight beneficiaries, have poorer health, functions, and HRQOL than normal weight beneficiaries and have substantially higher outpatient utilization. While weight loss is beneficial to both the overweight and obese, the markedly worse health status and high utilization of obese beneficiaries may merit particular attention.

The effect of consumer incentives on Medicaid beneficiaries' compliance with well-child visit guidelines.

PubMed

Nyman, John A; Abraham, Jean M; Riley, William

2013-01-01

The Affordable Care Act of 2010 recommends that consumer incentives be employed to increase the use of preventive care by Medicaid beneficiaries, but few evaluative studies exist. This study evaluates a Target gift card incentive employed by a Minnesota health plan serving Medicaid beneficiaries over the period 2002-2003. Lacking a contemporaneous control group, the proximity between the child's residence and the nearest Target store was used as the intervention variable. Using alternative specifications for the intervention variable, results of the difference-in-differences equations suggest that the incentive program significantly increased the likelihood that a Medicaid beneficiary would have a well-child visit.

Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.

PubMed

Gross, D J; Alecxih, L; Gibson, M J; Corea, J; Caplan, C; Brangan, N

1999-04-01

To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and services, but spent less than the other groups on prescription drugs and dental care-services not covered by Medicare. While Medicaid provides substantial protection for some lower-income Medicare beneficiaries, out-of-pocket health care spending continues to be a substantial burden for most of this population. Medicare reform discussions that focus on shifting more costs to beneficiaries should take into account the dramatic costs of health care already faced by this vulnerable population.

Assessing ecosystem service provision under climate change to support conservation and development planning in Myanmar

PubMed Central

Wolny, Stacie; Bhagabati, Nirmal; Helsingen, Hanna; Hamel, Perrine; Bartlett, Ryan; Dixon, Adam; Horton, Radley; Lesk, Corey; Manley, Danielle; De Mel, Manishka; Bader, Daniel; Nay Won Myint, Sai; Myint, Win; Su Mon, Myat

2017-01-01

Inclusion of ecosystem services (ES) information into national-scale development and climate adaptation planning has yet to become common practice, despite demand from decision makers. Identifying where ES originate and to whom the benefits flow–under current and future climate conditions–is especially critical in rapidly developing countries, where the risk of ES loss is high. Here, using Myanmar as a case study, we assess where and how ecosystems provide key benefits to the country’s people and infrastructure. We model the supply of and demand for sediment retention, dry-season baseflows, flood risk reduction and coastal storm protection from multiple beneficiaries. We find that locations currently providing the greatest amount of services are likely to remain important under the range of climate conditions considered, demonstrating their importance in planning for climate resilience. Overlap between priority areas for ES provision and biodiversity conservation is higher than expected by chance overall, but the areas important for multiple ES are underrepresented in currently designated protected areas and Key Biodiversity Areas. Our results are contributing to development planning in Myanmar, and our approach could be extended to other contexts where there is demand for national-scale natural capital information to shape development plans and policies. PMID:28934282

Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract?

PubMed Central

Price, Rebecca Anhang; Haviland, Amelia M; Hambarsoomian, Katrin; Dembosky, Jacob W; Gaillot, Sarah; Weech-Maldonado, Robert; Williams, Malcolm V; Elliott, Marc N

2015-01-01

Objective To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. Data Sources/Study Setting Exactly 492,495 Medicare beneficiaries responding to the 2008–2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Data Collection/Extraction Methods Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. Principal Findings As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. Conclusions The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores. PMID:25752334

Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia.

PubMed

Abner, Erin L; Jicha, Gregory A; Christian, W Jay; Schreurs, Bernard G

2016-06-01

Older adults living in rural areas may face barriers to obtaining a diagnosis of Alzheimer's disease and related disorders (ADRD). We sought to examine rural-urban differences in prevalence of ADRD among Medicare beneficiaries in Kentucky and West Virginia, 2 contiguous, geographically similar states with large rural areas and aged populations. We used Centers for Medicare and Medicaid Services Public Use Files data from 2007 to 2013 to assess prevalence of ADRD at the county level among all Medicare beneficiaries in each state. Rural-Urban Continuum Codes were used to classify counties as rural or urban. We used Poisson regression to estimate unadjusted and adjusted prevalence ratios. Primary analyses focused on 2013 data and were repeated for 2007 to 2012. This study was completely ecologic. After adjusting for state, average beneficiary age, percent of female beneficiaries, percent of beneficiaries eligible for Medicaid in each county, Central Appalachian county, percent of age-eligible residents enrolled in Medicare, and percent of residents under age 65 enrolled in Medicare in our adjusted models, we found that 2013 ADRD diagnostic prevalence was 11% lower in rural counties (95% CI: 9%-13%). Medicare beneficiaries in rural counties in Kentucky and West Virginia may be underdiagnosed with respect to ADRD. However, due to the ecologic design, and evidence of a younger, more heavily male beneficiary population in some rural areas, further studies using individual-level data are needed to confirm the results. © 2015 National Rural Health Association.

How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

PubMed

Willink, Amber; Shoen, Cathy; Davis, Karen

2018-01-01

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

Incidence of Norovirus-Associated Medical Encounters among Active Duty United States Military Personnel and Their Dependents.

PubMed

Rha, Brian; Lopman, Benjamin A; Alcala, Ashley N; Riddle, Mark S; Porter, Chad K

2016-01-01

Norovirus is a leading cause of gastroenteritis episodes and outbreaks in US military deployments, but estimates of endemic disease burden among military personnel in garrison are lacking. Diagnostic codes from gastroenteritis-associated medical encounters of active duty military personnel and their beneficiaries from July 1998-June 2011 were obtained from the Armed Forces Health Surveillance Center. Using time-series regression models, cause-unspecified encounters were modeled as a function of encounters for specific enteropathogens. Model residuals (representing unexplained encounters) were used to estimate norovirus-attributable medical encounters. Incidence rates were calculated using population data for both active duty and beneficiary populations. The estimated annual mean rate of norovirus-associated medically-attended visits among active duty personnel and their beneficiaries was 292 (95% CI: 258 to 326) and 93 (95% CI: 80 to 105) encounters per 10,000 persons, respectively. Rates were highest among beneficiaries <5 years of age with a median annual rate of 435 (range: 318 to 646) encounters per 10,000 children. Norovirus was estimated to cause 31% and 27% of all-cause gastroenteritis encounters in the active duty and beneficiary populations, respectively, with over 60% occurring between November and April. There was no evidence of any lag effect where norovirus disease occurred in one population before the other, or in one beneficiary age group before the others. Norovirus is a major cause of medically-attended gastroenteritis among non-deployed US military active duty members as well as in their beneficiaries.

20 CFR 411.600 - Is there a process for resolving disputes between beneficiaries and ENs that are not State VR...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Is there a process for resolving disputes between beneficiaries and ENs that are not State VR agencies? 411.600 Section 411.600 Employees' Benefits... resolving disputes between beneficiaries and ENs that are not State VR agencies? Yes. After an IWP is signed...

20 CFR 411.600 - Is there a process for resolving disputes between beneficiaries and ENs that are not State VR...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Is there a process for resolving disputes between beneficiaries and ENs that are not State VR agencies? 411.600 Section 411.600 Employees' Benefits... resolving disputes between beneficiaries and ENs that are not State VR agencies? Yes. After an IWP is signed...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE....652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules in §§ 1...

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study.

PubMed

Reid, Rachel O; Deb, Partha; Howell, Benjamin L; Conway, Patrick H; Shrank, William H

2016-02-01

To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

How Social Care Beneficiaries in Poland Rate Relative Harmfulness of Various Tobacco and Nicotine-Containing Products.

PubMed

Milcarz, Marek; Polańska, Kinga; Bak-Romaniszyn, Leokadia; Kaleta, Dorota

2017-09-07

The aim of the study was to examine how social care beneficiaries rate the relative harmfulness of tobacco/nicotine-containing products compared to traditional cigarettes. This information is crucial for the development of effective tobacco control strategies targeting disadvantaged populations. The cross-sectional study covered 1817 respondents who were taking advantage of social aid services offered by the local social care institutions in the Piotrkowski district, via face-to-face interviews. The linear regression analysis indicated that relative to women, men consider slim cigarettes, smokeless tobacco and e-cigarettes to be more harmful than traditional cigarettes ( p < 0.05). The smokers of traditional cigarettes reported menthol cigarettes to be less harmful than traditional cigarettes, relative to the non-smokers ( p = 0.05). The current results demonstrate that social care beneficiaries are not aware of the fact that some products are less harmful than others. Education concerning tobacco/nicotine products should include advice on how to reduce the adverse health effects of smoking (e.g., avoiding inhalation of combusted products), while driving the awareness that no nicotine-containing products are safe.

How Social Care Beneficiaries in Poland Rate Relative Harmfulness of Various Tobacco and Nicotine-Containing Products

PubMed Central

Milcarz, Marek; Polańska, Kinga; Bak-Romaniszyn, Leokadia; Kaleta, Dorota

2017-01-01

The aim of the study was to examine how social care beneficiaries rate the relative harmfulness of tobacco/nicotine-containing products compared to traditional cigarettes. This information is crucial for the development of effective tobacco control strategies targeting disadvantaged populations. The cross-sectional study covered 1817 respondents who were taking advantage of social aid services offered by the local social care institutions in the Piotrkowski district, via face-to-face interviews. The linear regression analysis indicated that relative to women, men consider slim cigarettes, smokeless tobacco and e-cigarettes to be more harmful than traditional cigarettes (p < 0.05). The smokers of traditional cigarettes reported menthol cigarettes to be less harmful than traditional cigarettes, relative to the non-smokers (p = 0.05). The current results demonstrate that social care beneficiaries are not aware of the fact that some products are less harmful than others. Education concerning tobacco/nicotine products should include advice on how to reduce the adverse health effects of smoking (e.g., avoiding inhalation of combusted products), while driving the awareness that no nicotine-containing products are safe. PMID:28880223

24 CFR 8.6 - Communications.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Communications. 8.6 Section 8.6... URBAN DEVELOPMENT General Provisions § 8.6 Communications. (a) The recipient shall take appropriate steps to ensure effective communication with applicants, beneficiaries, and members of the public. (1...

24 CFR 8.6 - Communications.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Communications. 8.6 Section 8.6... URBAN DEVELOPMENT General Provisions § 8.6 Communications. (a) The recipient shall take appropriate steps to ensure effective communication with applicants, beneficiaries, and members of the public. (1...

24 CFR 8.6 - Communications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Communications. 8.6 Section 8.6... URBAN DEVELOPMENT General Provisions § 8.6 Communications. (a) The recipient shall take appropriate steps to ensure effective communication with applicants, beneficiaries, and members of the public. (1...

76 FR 16712 - Participation by Religious Organizations in USAID Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... are defined without reference to religion, (iii) has the effect of furthering a development objective... available to a wide range of organizations and beneficiaries which are defined without reference to religion...

75 FR 15434 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

... beneficiaries. The Deficit Reduction Act (DRA) of 2005 modified section 1927 to require additional reporting... Regulations Development, Attention: Document Identifier/OMB Control Number, Room C4-26-05, 7500 Security...

Increasing urban community empowerment through changing of poverty rate index on the productive zakat impact

NASA Astrophysics Data System (ADS)

Zaenal, M. H.; Astuti, A. D.; Sadariyah, A. S.

2018-01-01

We show how changes in poverty measures can be applied into growth of islamic philanthropy distribution via zakat, and we use the methodology to zakat community development (ZCD) program in Bantul during the 2016. The purpose of the present paper is to prove zakat is able to be a solution part for the community empowerment. The result is the number of productive zakat program beneficiaries whose income is below the poverty line (poor category) before the program are 244 people (H = 0.171) and after the program change to 168 (H = 0.118), which means the program has succeeded in reducing the number of poor people by 76 people (5.34 percent). The poverty gap (P1) of beneficiaries of productive zakat program in Bantul also decrease. The gap between poverty line and average income of beneficiaries is Rp 63,763 before the program, while the gap after the program is Rp 56,992. The income gap (I) is also decline from 0.197 to 0.169. Poverty severity of beneficiaries of productive zakat program in Bantul seen by Sen Index (P2) decrease from 0.093 to 0.062, while using Foster-Greer-Thorbecke Index (P3), the poverty severity decrease from 0.010 to 0.004. The analysis revealed the zakat community empowerment was significant economically in suppressing the poverty rate, and possible for reducing inequality and ending poverty in Indonesia.

Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries

PubMed Central

Chang, Tammy; Davis, Matthew

2013-01-01

PURPOSE Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. METHODS We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007–2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). RESULTS Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% “excellent” or “very good,” 40.4% “good”) than current beneficiaries (33.5% “excellent” or “very good,” 31.6% “good”; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs 38.0%; P = .002), and moderate and heavier alcohol use (21.6% vs 16.0% and 16.5% vs 9.8%; P <.001, respectively) are more common among the potentially eligible population than among current beneficiaries. CONCLUSIONS Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries. Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease. PMID:24019271

Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program.

PubMed

Ettner, Susan L; Johnson, Steven

2003-01-01

The adequacy of risk adjustment to eliminate incentives for managed care organizations (MCOs) to avoid enrolling costly patients had been questioned. This study explored systematic differences in expenditures between beneficiaries with and without substance disorders assigned to the same capitation rate group under the Maryland Medicaid HealthChoice program. The investigators used fiscal year (FY) 1995 to 1997 Medicaid data to assign beneficiaries to rate cells based on FY 1995 diagnoses and compared the distribution of expenditures for beneficiaries with and without substance disorders, defined using FY 1997 and FY 1995 diagnoses. Results showed that differences in FY 1997 expenditures between beneficiaries with and without FY 1995 substance disorders were negligible. However, MCOs could expect greater average losses and lower average profits on beneficiaries with FY 1997 substance disorders. Thus, the adjusted clinical groups methodology used to adjust capitation payments in the HealthChoice program attenuated, but did not eliminate, financial incentives for MCOs to avoid substance abusers.

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

PubMed Central

Kane, Robert L; Wysocki, Andrea; Parashuram, Shriram; Shippee, Tetyana; Lum, Terry

2013-01-01

Background: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs. Objectives: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use. Research Design: Secondary analysis of linked MAX and Medicare data in seven states. Subjects: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles. Measures: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures. Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. PMID:24753971

Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts.

PubMed

Elliott, Marc N; Landon, Bruce E; Zaslavsky, Alan M; Edwards, Carol; Orr, Nathan; Beckett, Megan K; Mallett, Joshua; Cleary, Paul D

2016-03-01

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.

PubMed

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2018-04-01

To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation. © Health Research and Educational Trust.

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul

PubMed Central

Kim, Jungah; Shon, Changwoo

2018-01-01

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care. PMID:29673147

Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States.

PubMed

Mehrotra, Ateev; Huskamp, Haiden A; Souza, Jeffrey; Uscher-Pines, Lori; Rose, Sherri; Landon, Bruce E; Jena, Anupam B; Busch, Alisa B

2017-05-01

Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004-14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was notable variation across states: In 2014 nine had more than twenty-five visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. States with a telemedicine parity law and a pro-telemental health regulatory environment had significantly higher rates of telemental health use than those that did not. Project HOPE—The People-to-People Health Foundation, Inc.

Effects of state-level medicaid policies and patient characteristics on time to breast cancer surgery among medicaid beneficiaries.

PubMed

Halpern, Michael T; Schrag, Deborah

2016-08-01

Medicaid beneficiaries with cancer are less likely to receive timely and high-quality care. This study examined whether differences in state-level Medicaid policies affect delays in time to surgery (TTS) among women diagnosed with breast cancer. Using 2006-2008 Medicaid data, we identified women aged 18-64 enrolled in Medicaid diagnosed with breast cancer. Analyses examined associations of state-specific Medicaid surgery reimbursements, Medicaid eligibility recertification period (annually vs. shorter) and required patient copayment on time from breast cancer diagnosis to receipt of breast surgery. Patients receiving neoadjuvant therapy were excluded. Separate multivariable regression analyses controlling for patient demographic characteristics and clustering by state were performed for breast conserving surgery (BCS), inpatient mastectomy, and outpatient mastectomy. The study included 7542 Medicaid beneficiaries with breast cancer: 3272 received BCS, 2156 outpatient mastectomy, and 2115 inpatient mastectomy. Higher Medicaid reimbursements for BCS were associated with decreased time from diagnosis to surgery. A 12-month (vs. <12 month) Medicaid eligibility recertification period was associated with decreased TTS for BCS and outpatient mastectomy. Black Medicaid beneficiaries (compared with non-Hispanic White beneficiaries) were more likely to experience delays for all three types of surgery, while Hispanic beneficiaries were more likely to experience delays only for outpatient mastectomy. State-level Medicaid policies and patient characteristics can affect receipt of timely surgery among Medicaid beneficiaries with breast cancer. As delays in surgery can increase morbidity and mortality, changes to state Medicaid policies and health system programs are needed to improve access to care for this vulnerable population.

Incidence of Norovirus-Associated Medical Encounters among Active Duty United States Military Personnel and Their Dependents

PubMed Central

Rha, Brian; Lopman, Benjamin A.; Alcala, Ashley N.; Riddle, Mark S.; Porter, Chad K.

2016-01-01

Background Norovirus is a leading cause of gastroenteritis episodes and outbreaks in US military deployments, but estimates of endemic disease burden among military personnel in garrison are lacking. Methods Diagnostic codes from gastroenteritis-associated medical encounters of active duty military personnel and their beneficiaries from July 1998–June 2011 were obtained from the Armed Forces Health Surveillance Center. Using time-series regression models, cause-unspecified encounters were modeled as a function of encounters for specific enteropathogens. Model residuals (representing unexplained encounters) were used to estimate norovirus-attributable medical encounters. Incidence rates were calculated using population data for both active duty and beneficiary populations. Results The estimated annual mean rate of norovirus-associated medically-attended visits among active duty personnel and their beneficiaries was 292 (95% CI: 258 to 326) and 93 (95% CI: 80 to 105) encounters per 10,000 persons, respectively. Rates were highest among beneficiaries <5 years of age with a median annual rate of 435 (range: 318 to 646) encounters per 10,000 children. Norovirus was estimated to cause 31% and 27% of all-cause gastroenteritis encounters in the active duty and beneficiary populations, respectively, with over 60% occurring between November and April. There was no evidence of any lag effect where norovirus disease occurred in one population before the other, or in one beneficiary age group before the others. Conclusions Norovirus is a major cause of medically-attended gastroenteritis among non-deployed US military active duty members as well as in their beneficiaries. PMID:27115602

How well does a single question about health predict the financial health of Medicare managed care plans?

PubMed

Bierman, A S; Bubolz, T A; Fisher, E S; Wasson, J H

1999-01-01

Responses to simple questions that predict subsequent health care utilization are of interest to both capitated health plans and the payer. To determine how responses to a single question about general health status predict subsequent health care expenditures. Participants in the 1992 Medicare Current Beneficiary Survey were asked the following question: "In general, compared to other people your age, would you say your health is: excellent, very good, good, fair or poor?" To obtain each participant's total Medicare expenditures and number of hospitalizations in the ensuing year, we linked the responses to this question with data from the 1993 Medicare Continuous History Survey. Nationally representative sample of 8775 noninstitutionalized Medicare beneficiaries 65 years of age and older. Annual age- and sex-adjusted Medicare expenditures and hospitalization rates. Eighteen percent of the beneficiaries rated their health as excellent, 56% rated it as very good or good, 17% rated it as fair, and 7% rated it as poor. Medicare expenditures had a marked inverse relation to self-assessed health ratings. In the year after assessment, age- and sex-adjusted annual expenditures varied fivefold, from $8743 for beneficiaries rating their health as poor to $1656 for beneficiaries rating their health as excellent. Hospitalization rates followed the same pattern: Respondents who rated their health as poor had 675 hospitalizations per 1000 beneficiaries per year compared with 136 per 1000 for those rating their health as excellent. The response to a single question about general health status strongly predicts subsequent health care utilization. Self-reports of fair or poor health identify a group of high-risk patients who may benefit from targeted interventions. Because the current Medicare capitation formula does not account for health status, health plans can maximize profits by disproportionately enrolling beneficiaries who judge their health to be good. However, they are at a competitive disadvantage if they enroll beneficiaries who view themselves as sick.

Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

PubMed Central

Goldman, Dana; Weaver, Lesley; Karaca-Mandic, Pinar

2014-01-01

Objectives To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. Design Retrospective cohort study. Setting Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. Participants 1 808 355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. Results Among 1 208 100 beneficiaries with an opioid prescription, 418 530 (34.6%) filled prescriptions from two providers, 171 420 (14.2%) from three providers, and 143 344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110 671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment. Conclusions Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use. PMID:24553363

Health plan decision making with new medicare information materials.

PubMed Central

McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

2001-01-01

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume. PMID:11482588

Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy.

PubMed

Dusetzina, Stacie B; Keating, Nancy L

2016-02-01

Orally administered anticancer medications are among the fastest growing components of cancer care. These medications are expensive, and cost-sharing requirements for patients can be a barrier to their use. For Medicare beneficiaries, the Affordable Care Act will close the Part D coverage gap (doughnut hole), which will reduce cost sharing from 100% in 2010 to 25% in 2020 for drug spending above $2,960 until the beneficiary reaches $4,700 in out-of-pocket spending. How much these changes will reduce out-of-pocket costs is unclear. We used the Medicare July 2014 Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services for 1,114 stand-alone and 2,230 Medicare Advantage prescription drug formularies, which represent all formularies in 2014. We identified orally administered anticancer medications and summarized drug costs, cost-sharing designs used by available plans, and the estimated out-of-pocket costs for beneficiaries without low-income subsidies who take a single drug before and after the doughnut hole closes. Little variation existed in formulary design across plans and products. The average price per month for included products was $10,060 (range, $5,123 to $16,093). In 2010, median beneficiary annual out-of-pocket costs for a typical treatment duration ranged from $6,456 (interquartile range, $6,433 to $6,482) for dabrafenib to $12,160 (interquartile range, $12,102 to $12,262) for sunitinib. With the assumption that prices remain stable, after the doughnut hole closes, beneficiaries will spend approximately $2,550 less. Out-of-pocket costs for Medicare beneficiaries taking orally administered anticancer medications are high and will remain so after the doughnut hole closes. Efforts are needed to improve affordability of high-cost cancer drugs for beneficiaries who need them. © 2015 by American Society of Clinical Oncology.

Health plan decision making with new medicare information materials.

PubMed

McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

2001-07-01

To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

DataView: Medicare Spending by State: The Border-Crossing Adjustment

PubMed Central

Basu, Joy; Lazenby, Helen C.; Levit, Katharine R.

1995-01-01

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the net flow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States. PMID:10157375

Flu shots and the characteristics of unvaccinated elderly Medicare beneficiaries.

PubMed

Lochner, Kimberly A; Wynne, Marc

2011-12-21

Data from the Medicare Current Beneficiary Survey, 2009. • Overall, 73% of Medicare beneficiaries aged 65 years and older reported receiving a flu shot for the 2008 flu season, but vaccination rates varied by socio-demographic characteristics. Flu vaccination was lowest for beneficiaries aged 65-74 years old, who were non-Hispanic Blacks and Hispanics, were not married, had less than a high school education, or who were eligible for Medicaid (i.e., dual eligibles). • Healthcare utilization and personal health behavior were also related to vaccination rates, with current smokers and those with no hospitalizations or physician visits being less likely to be vaccinated. • Among those beneficiaries who reported receiving a flu shot, 59% received it in a physician's office or clinic, with the next most common setting being in the community (21%); e.g., grocery store, shopping mall, library, or church. • Among those beneficiaries who did not receive a flu shot, the most common reasons were beliefs that the shot could cause side effects or disease (20%), that they didn't think the shot could prevent the flu (17%), or that the shot wasn't needed (16%). Less than 1% reported that they didn't get the flu shot because of cost. Elderly persons (aged 65 years and older) are at increased risk of complications from influenza, with the majority of influenza-related hospitalizations and deaths occurring among the elderly (Fiore et al., 2010). Most physicians recommend their elderly patients get a flu shot each year, and many hospitals inquire about elderly patient's immunization status upon admission, providing a vaccination if requested. The importance of getting a flu shot is underscored by the Department of Health and Human Services' Healthy People initiative, which has set a vaccination goal of 90% for the Nation's elderly by the year 2020 (Department of Health and Human Services [DHHS], 2011). Although all costs related to flu shots are covered by Medicare, requiring no co-pay on the part of the beneficiary (Centers for Medicare and Medicaid Services, 2011), for the 2008 flu season, only 73% of non-institutionalized Medicare beneficiaries, aged 65 years and older, reported receiving one. This report presents the most recent data on flu vaccination rates among non-institutionalized elderly Medicare beneficiaries and their association with socio-demographic and personal health characteristics. The report also describes the places beneficiaries received their flu shot and, for those not getting vaccinated, the reasons reported for not doing so. Public Domain.

42 CFR 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan...

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... defined at § 447.78, track beneficiaries' incurred premiums and cost sharing through a mechanism developed...

42 CFR 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan...

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... defined at § 447.78, track beneficiaries' incurred premiums and cost sharing through a mechanism developed...

7 CFR 3565.10 - Conflict of interest.

Code of Federal Regulations, 2010 CFR

2010-01-01

... accordance with 7 CFR part 1900, subpart D, or successor regulation by Rural Development employees who: (1...; and (3) Do not have any business or personal relationship with any beneficiary or any employee of a...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

Laboratory Characterization of Noroviruses Identified in Specimens from Military Health System Beneficiaries During an Outbreak in Germany, 2016-2017

DTIC Science & Technology

2017-07-01

Specimens from Military Health System Beneficiaries During an Outbreak in Germany, 2016–2017 Nellie D. Darling, MS; Daniela E. Poss, MPH; Krista M...outbreak.7 This study characterizes norovi- rus isolates from Military Health System (MHS) beneficiaries which corresponded temporally and geographically...identified using the Armed Forces Health Longitudinal Technology Appli- cation (AHLTA). Of all samples received by LRMC during this surveillance period

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

A profile of social security child beneficiaries and their families: sociodemographic and economic characteristics.

PubMed

Tamborini, Christopher R; Cupito, Emily; Shoffner, Dave

2011-01-01

Using a rich dataset that links the Census Bureau's Survey of Income and Program Participation calendar-year 2004 file with Social Security benefit records, this article provides a portrait of the sociodemographic and economic characteristics of Social Security child beneficiaries. We find that the incidence ofbenefit receipt in the child population differs substantially across individual and family-level characteristics. Average benefit amounts also vary across subgroups and benefit types. The findings provide a better understanding of the importance of Social Security to families with beneficiary children. Social Security is a major source of family income for many child beneficiaries, particularly among those with low income or family heads with lower education and labor earnings.

38 CFR 70.31 - Deductibles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... found at http://www.va.gov/healtheligibility/Library/pubs/BeneficiaryTravel/BeneficiaryTravel.pdf or by....gov/healtheligibility/Library/pubs/VAIncomeThresholds/VAIncomeThresholds.pdf); or (3) Has...

Subsidized childcare and child development in Colombia: effects of Hogares Comunitarios de Bienestar as a function of timing and length of exposure.

PubMed

Bernal, Raquel; Fernández, Camila

2013-11-01

Rigorous evidence regarding the impact of early care and education on children's development comes primarily from high-income nations. A few studies from Latin America and the Caribbean have identified benefits of conditional cash transfer and home visiting programs on children's development. However, there is still controversy around the impact and cost-effectiveness of childcare approaches. Further research is needed to understand how scaled-up childcare settings may support the development of low-income children in Latin America. To that end, the present study sought to identify the effects of exposure to a subsidized childcare program in Colombia on children's nutritional status, cognitive and socioemotional development. This community-based program, known as Hogares Comunitarios de Bienestar (HCB), serves 800 thousand low-income children under age 6, delivering home-based childcare, supplementary nutrition, and psychosocial stimulation. We analyzed data on 10,173 program beneficiary children (ages 3-6) collected in 2007. We compared beneficiary children who had been in the program for a long time with beneficiary children who had been in the program for a month or less, by age group, to estimate program exposure effects. We used a matching estimator to correct for self-selection into different exposure levels. Results indicated that cognitive development improved 0.15 to 0.3 of a standard deviation (SD) after at least 15 months of exposure for children between 3 and 6 years of age. Socioemotional skills improved 0.12 to 0.3 SD for children older than 3 after at least 15 months of program exposure. No significant gains were found for nutritional status. The estimated benefit-cost ratio ranged from 1.0 to 2.7, depending upon varying discount rates. Findings lend support for a potentially effective strategy to promote the development of low-income children in Colombia and other developing nations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Inequity in ecosystem service delivery: Socioeconomic gaps in the public-private conservation network

USGS Publications Warehouse

Villamagna, Amy M.; Mogollón, Beatriz; Angermeier, Paul L.

2017-01-01

Conservation areas, both public and private, are critical tools to protect biodiversity and deliver important ecosystem services (ES) to society. Although societal benefits from such ES are increasingly used to promote public support of conservation, the number of beneficiaries, their identity, and the magnitude of benefits are largely unknown for the vast majority of conservation areas in the United States public-private conservation network. The location of conservation areas in relation to people strongly influences the direction and magnitude of ES flows as well as the identity of beneficiaries. We analyzed benefit zones, the areas to which selected ES could be conveyed to beneficiaries, to assess who benefits from a typical conservation network. Better knowledge of ES flows and beneficiaries will help land conservationists make a stronger case for the broad collateral benefits of conservation and help to address issues of social-environmental justice. To evaluate who benefits the most from the current public-private conservation network, we delineated the benefit zones for local ES (within 16 km) that are conveyed along hydrological paths from public (federal and state) and private (easements) conservation lands in the states of North Carolina and Virginia, USA. We also discuss the challenges and demonstrate an approach for delineating nonhydrological benefits that are passively conveyed to beneficiaries. We mapped and compared the geographic distribution of benefit zones within and among conservation area types. We further compared beneficiary demographics across benefit zones of the conservation area types and found that hydrological benefit zones of federal protected areas encompass disproportionately fewer minority beneficiaries compared to statewide demographic patterns. In contrast, benefit zones of state protected areas and private easements encompassed a much greater proportion of minority beneficiaries (~22–25%). Benefit zones associated with private conservation lands included beneficiaries of significantly greater household income than benefit zones of other types of conservation areas. Our analysis of ES flows revealed significant socioeconomic gaps in how the current public-private conservation network benefits the public. These gaps warrant consideration in regional conservation plans and suggest that private conservation initiatives may be best suited for responding to the equity challenge. Enhancing the ecosystem benefits and the equity of benefit delivery from private conservation networks could build public and political support for long-term conservation strategies and ultimately enhance conservation efficacy.

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

PubMed

Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

2016-04-01

The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P < .001) and home health aide visits (OR, 1.27; 95% CI, 1.13-1.43; P < .001) compared with Medicare beneficiaries without glaucoma. Furthermore, patients with glaucoma with self-reported visual disability were more likely to report depression (OR, 1.47; 95% CI, 1.26-1.71; P < .001), falls (OR, 1.34; 95% CI, 1.09-1.66; P = .006), and difficulty walking (OR, 1.22; 95% CI, 1.02-1.45; P = .03) compared with those without self-reported visual disability. In the risk-adjusted model, Medicare beneficiaries with glaucoma incurred an additional $2903 (95% CI, $2247-$3558; P < .001) annual total health care costs and $2599 (95% CI, $1985-$3212; P < .001) higher costs for nonoutpatient services compared with Medicare beneficiaries without glaucoma. Glaucoma is associated with greater use of inpatient and home health aide services and with higher annual total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study.

PubMed

Martins, Ana Paula Bortoletto; Monteiro, Carlos Augusto

2016-08-19

The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil. Representative data from the Household Budget Survey conducted in 2008-2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired 't' tests. Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in natura or minimally processed foods group, the expenditure and the availability of meat, tubers and vegetables were higher among the Bolsa Família Program beneficiaries. The Bolsa Família Program impact on food availability among low-income families was higher food expenditure, higher availability of fresh foods and culinary ingredients, including those foods that increase diet's quality and diversity.

Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic non-cancer pain

PubMed Central

Ringwalt, Chris; Roberts, Andrew W.; Gugelmann, Hallam; Skinner, Asheley Cockrell

2016-01-01

Objective Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic non-cancer pain (CNCP) and the role of physician specialty. Design A retrospective cohort study. Setting We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries dispensed prescriptions for opioids. Subjects The population included White and Black North Carolina Medicaid beneficiaries with CNCP (n=75,458). Methods We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty. Results Compared to White beneficiaries with CNCP (n=49,197), Black beneficiaries (n=26,261) were less likely [OR 0.91 (CI: 0.88–0.94)] to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology [OR 0.78 (CI: 0.67–0.89)] and internal medicine [OR 0.86 (CI: 0.79–0.92)], as well as general practitioners/family medicine physicians [OR 0.91 (CI: 0.85–0.97)]. Conclusions Our findings suggest that, in our study population, Black beneficiaries with CNCP are less likely than Whites to fill prescriptions for opioid analgesics as a function of their provider’s specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty. PMID:25287703

Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries.

PubMed

Khairnar, Rahul; Mishra, Mark V; Onukwugha, Eberechukwu

2018-02-16

Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.