Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

PubMed Central

Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

2015-01-01

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. PMID:25905478

42 CFR 417.472 - Basic contract requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Basic contract requirements. 417.472 Section 417.472 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... PREPAYMENT PLANS Medicare Contract Requirements § 417.472 Basic contract requirements. (a) Submittal of...

42 CFR 93.204 - Contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Contract. 93.204 Section 93.204 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES PUBLIC HEALTH SERVICE POLICIES ON RESEARCH...

42 CFR 93.204 - Contract.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Contract. 93.204 Section 93.204 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES PUBLIC HEALTH SERVICE POLICIES ON RESEARCH...

Buying results? Contracting for health service delivery in developing countries.

PubMed

Loevinsohn, Benjamin; Harding, April

To achieve the health-related Millennium Development Goals, the delivery of health services will need to improve. Contracting with non-state entities, including non-governmental organisations (NGOs), has been proposed as a means for improving health care delivery, and the global experience with such contracts is reviewed here. The ten investigated examples indicate that contracting for the delivery of primary care can be very effective and that improvements can be rapid. These results were achieved in various settings and services. Many of the anticipated difficulties with contracting were either not observed in practice or did not compromise contracting's effectiveness. Seven of the nine cases with sufficient experience (greater than 3 years' elapsed experience) have been sustained and expanded. Provision of a package of basic services by contractors costs between roughly US3 dollars and US6 dollars per head per year in low-income countries. Contracting for health service delivery should be expanded and future efforts must include rigorous evaluations.

Defense Health Care: Evaluation of TRICARE Pharmacy Services Contract Structure is Warranted

DTIC Science & Technology

2013-09-01

involves providing coordinated health care interventions and communications to patients who have chronic conditions, such as diabetes or asthma ...DEFENSE HEALTH CARE Evaluation of TRICARE Pharmacy Services Contract Structure Is Warranted Report to the...COVERED 00-00-2013 to 00-00-2013 4. TITLE AND SUBTITLE Defense Health Care : Evaluation of TRICARE Pharmacy Services Contract Structure Is

42 CFR 67.102 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Definitions. 67.102 Section 67.102 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING AGENCY FOR HEALTH CARE POLICY AND RESEARCH GRANTS AND CONTRACTS Peer Review of Contracts for Health Services...

Adverse or acceptable: negotiating access to a post-apartheid health care contract.

PubMed

Harris, Bronwyn; Eyles, John; Penn-Kekana, Loveday; Thomas, Liz; Goudge, Jane

2014-05-15

As in many fragile and post-conflict countries, South Africa's social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering - negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Although South Africa's right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion - (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services.

Service quality in contracted facilities.

PubMed

Rabbani, Fauziah; Pradhan, Nousheen Akber; Zaidi, Shehla; Azam, Syed Iqbal; Yousuf, Farheen

2015-01-01

The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). The study shows that contracting out initiatives have the potential to improve MNH care. This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.

42 CFR 405.415 - Requirements of the private contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements of the private contract. 405.415 Section 405.415 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.415...

42 CFR 405.455 - Application to Medicare+Choice contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Application to Medicare+Choice contracts. 405.455 Section 405.455 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.455...

Principal-agent relationships in general practice: the first wave of English Personal Medical Services pilot contracts.

PubMed

Sheaff, R; Lloyd-Kendall, A

2000-07-01

To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal-agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Content analysis of 71 first-wave PMS contracts. Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. First-wave PMS contracts do not appear to embody a strong principal-agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the 'institutional embedding' of independent general practice in the wider management systems of the NHS.

42 CFR 137.248 - What effect will a retrocession have on a retroceding Self-Governance Tribe's rights to contract...

Code of Federal Regulations, 2010 CFR

2010-10-01

... retroceding Self-Governance Tribe's rights to contract or compact under the Act? 137.248 Section 137.248 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Retrocession § 137.248 What effect will a...

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed Central

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-01-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance. PMID:17143460

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-11-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance.

25 CFR 900.186 - Is it necessary for a self-determination contract to include any clauses about Federal Tort...

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... services contracts with the contractor to provide health care services) are deemed to be employees of the Federal government while performing work under this contract. This status is not changed by the source of...

78 FR 13677 - Office of the Assistant Secretary for Financial Resources, Office of Grants and Acquisition...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Assistant Secretary for Financial Resources... of the Department of Health and Human Services FY 2011 Service Contract Inventory AGENCY: Department of Health and Human Services. ACTION: Notice of Public Availability of FY 2011 Service Contract...

76 FR 5814 - Office of the Assistant Secretary for Financial Resources, Office of Grants and Acquisition...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Assistant Secretary for Financial Resources... of the Department of Health and Human Services FY 2010 Service Contract Inventory AGENCY: Department of Health and Human Services. ACTION: Notice of public availability of FY 2010 Service Contract...

Contracting for health and curative care use in Afghanistan between 2004 and 2005

PubMed Central

Arur, Aneesa; Peters, David; Hansen, Peter; Mashkoor, Mohammad Ashraf; Steinhardt, Laura C.; Burnham, Gilbert

2010-01-01

Afghanistan has used several approaches to contracting as part of its national strategy to increase access to basic health services. This study compares changes in the utilization of outpatient curative services from 2004 to 2005 between the different approaches for contracting-out services to non-governmental service providers, contracting-in technical assistance at public sector facilities, and public sector facilities that did not use contracting. We find that both contracting-in and contracting-out approaches are associated with substantial double difference increases in service use from 2004 to 2005 compared with non-contracted facilities. The double difference increase in contracting-out facilities for outpatient visits is 29% (P < 0.01), while outpatient visits from female patients increased 41% (P < 0.01), use by the poorest quintile increased 68% (P < 0.01) and use by children aged under 5 years increased 27% (P < 0.05). Comparing the individual contracting-out approaches, we find similar increases in outpatient visits when contracts are managed directly by the Ministry of Public Health compared with when contracts are managed by an experienced international non-profit organization. Finally, contracting-in facilities show even larger increases in all the measures of utilization other than visits from children under 5. Although there are minor differences in the results between contracting-out approaches, these differences cannot be attributed to a specific contracting-out approach because of factors limiting the comparability of the groups. It is nonetheless clear that the government was able to manage contracts effectively despite early concerns about their lack of experience, and that contracting has helped to improve utilization of basic health services. PMID:19850664

Contracts to devolve health services in fragile states and developing countries: do ethics matter?

PubMed

Jayasinghe, S

2009-09-01

Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts involve devolution of health services to NSPs and proposes procedures to prevent or resolve these ethical dilemmas. Ethical issues were identified by examining processes of contracting out. Health needs could be used to select areas to be contracted out and to identify service needs. Health needs comprise "disease-burden-related needs", "health-service needs", and "urgency of health-service needs". The mix of services should include an analysis of cost-effectiveness. NSPs should be selected fairly, without bias, and conflicts of interest during their work must be avoided. The population's views must be respected and accountability structures established. Devolved health services should ensure equity of access to healthcare. The services ought to be sustainable and evaluated objectively. Of these issues, conflicts of interest among NSPs and sustainability of health services have not attracted attention in the literature on ethics of health policy. Fair procedures could address these ethical issues-for example, public consultation on issues; decisions based on the public consultation and made on evidence; principles of decisions stated and reasonable; decisions given adequate publicity; a mechanism established to challenge decisions; assurance that mechanisms meet the above conditions; and regular review of the policies. These procedures are complemented by improving self-governance of NSPs, countries' development of guidelines for devolving health services, and measures to educate the public of the client countries on these issues.

42 CFR 438.356 - State contract options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false State contract options. 438.356 Section 438.356 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.356 State contract options...

Adverse or acceptable: negotiating access to a post-apartheid health care contract

PubMed Central

2014-01-01

Background As in many fragile and post-conflict countries, South Africa’s social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Methods Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering – negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Results Although South Africa’s right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Conclusions Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion – (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services. PMID:24885882

42 CFR 137.239 - If the withdrawing Indian Tribe elects to operate PSFAs carried out under a compact or funding...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., is the resulting contract considered a mature contract under section 4(h) of the Act [25 U.S.C. 450b(h)]? 137.239 Section 137.239 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Withdrawal...

42 CFR 137.239 - If the withdrawing Indian Tribe elects to operate PSFAs carried out under a compact or funding...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., is the resulting contract considered a mature contract under section 4(h) of the Act [25 U.S.C. 450b(h)]? 137.239 Section 137.239 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Withdrawal...

Contracting for health services in New Zealand: a transaction cost analysis.

PubMed

Ashton, T

1998-02-01

The splitting of the functions of purchaser and provider in the New Zealand health system in 1993 necessitated the use of explicit contracts between the two parties. This paper examines contracting experiences during the first two years of operation. The study focuses on four services: rest homes, primary care clinics, surgical services, and acute mental health services. The insights of transaction cost economics form the theoretical framework. The objective of this study was to examine whether the transaction costs associated with contracting vary across the four different services, and whether different types of contracts and contractual relationships are emerging as transactors attempt to reduce these costs. Information was collected in a series of 53 interviews with purchasers and providers, together with any relevant documentation. The results suggest that the costs of contracting are indeed greater for some services than for others. Other variables such as the style of negotiations, the type and specificity of contracts and the degree of monitoring also differ across the four services. At this early stage of the reform process, there was little evidence that purchasers and providers were attempting to reduce transaction costs by negotiating more flexible, longer-term, relational contracts. The main benefit from contracting to date has been improved accountability of service providers.

Health Care: Franchise Business Activity Contracts for Medical Services

DTIC Science & Technology

2003-06-30

Health Care Department of Defense Office of the Inspector General June 30, 2003 AccountabilityIntegrityQuality Franchise Business Activity Contracts...control number. 1. REPORT DATE 30 JUN 2003 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Health Care: Franchise Business...services should be interested in the issue of acquiring medical services through the Department of the Treasury, Franchise Business Activity contracts. 15

42 CFR 460.70 - Contracted services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Contracted services. 460.70 Section 460.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE...

42 CFR 460.70 - Contracted services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Contracted services. 460.70 Section 460.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE...

42 CFR 422.220 - Exclusion of services furnished under a private contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Exclusion of services furnished under a private contract. 422.220 Section 422.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Relationships With...

42 CFR 475.107 - QIO contract award.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.107 QIO contract award. CMS, in awarding QIO contracts, will take...

42 CFR 67.104 - Confidentiality.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Confidentiality. 67.104 Section 67.104 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING AGENCY FOR HEALTH CARE POLICY AND RESEARCH GRANTS AND CONTRACTS Peer Review of Contracts for Health...

Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries.

PubMed

Odendaal, Willem A; Ward, Kim; Uneke, Jesse; Uro-Chukwu, Henry; Chitama, Dereck; Balakrishna, Yusentha; Kredo, Tamara

2018-04-03

Contracting out of governmental health services is a financing strategy that governs the way in which public sector funds are used to have services delivered by non-governmental health service providers (NGPs). It represents a contract between the government and an NGP, detailing the mechanisms and conditions by which the latter should provide health care on behalf of the government. Contracting out is intended to improve the delivery and use of healthcare services. This Review updates a Cochrane Review first published in 2009. To assess effects of contracting out governmental clinical health services to non-governmental service provider/s, on (i) utilisation of clinical health services; (ii) improvement in population health outcomes; (iii) improvement in equity of utilisation of these services; (iv) costs and cost-effectiveness of delivering the services; and (v) improvement in health systems performance. We searched CENTRAL, MEDLINE, Embase, NHS Economic Evaluation Database, EconLit, ProQuest, and Global Health on 07 April 2017, along with two trials registers - ClinicalTrials.gov and the International Clinical Trials Registry Platform - on 17 November 2017. Individually randomised and cluster-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies, comparing government-delivered clinical health services versus those contracted out to NGPs, or comparing different models of non-governmental-delivered clinical health services. Two authors independently screened all records, extracted data from the included studies and assessed the risk of bias. We calculated the net effect for all outcomes. A positive value favours the intervention whilst a negative value favours the control. Effect estimates are presented with 95% confidence intervals. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and we prepared a Summary of Findings table. We included two studies, a cluster-randomised trial conducted in Cambodia, and a controlled before-after study conducted in Guatemala. Both studies reported that contracting out over 12 months probably makes little or no difference in (i) immunisation uptake of children 12 to 24 months old (moderate-certainty evidence), (ii) the number of women who had more than two antenatal care visits (moderate-certainty evidence), and (iii) female use of contraceptives (moderate-certainty evidence).The Cambodia trial reported that contracting out may make little or no difference in the mortality over 12 months of children younger than one year of age (net effect = -4.3%, intervention effect P = 0.36, clustered standard error (SE) = 3.0%; low-certainty evidence), nor to the incidence of childhood diarrhoea (net effect = -16.2%, intervention effect P = 0.07, clustered SE = 19.0%; low-certainty evidence). The Cambodia study found that contracting out probably reduces individual out-of-pocket spending over 12 months on curative care (net effect = $ -19.25 (2003 USD), intervention effect P = 0.01, clustered SE = $ 5.12; moderate-certainty evidence). The included studies did not report equity in the use of clinical health services and in adverse effects. This update confirms the findings of the original review. Contracting out probably reduces individual out-of-pocket spending on curative care (moderate-certainty evidence), but probably makes little or no difference in other health utilisation or service delivery outcomes (moderate- to low-certainty evidence). Therefore, contracting out programmes may be no better or worse than government-provided services, although additional rigorously designed studies may change this result. The literature provides many examples of contracting out programmes, which implies that this is a feasible response when governments fail to provide good clinical health care. Future contracting out programmes should be framed within a rigorous study design to allow valid and reliable measures of their effects. Such studies should include qualitative research that assesses the views of programme implementers and beneficiaries, and records implementation mechanisms. This approach may reveal enablers for, and barriers to, successful implementation of such programmes.

42 CFR 417.440 - Entitlement to health care services from an HMO or CMP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE... Contract § 417.440 Entitlement to health care services from an HMO or CMP. (a) Basic rules. (1) Subject to... not converted to the risk portion of the contract, may enroll in a special supplemental plan, if...

Parallel NGO networks for HIV control: risks and opportunities for NGO contracting.

PubMed

Zaidi, Shehla; Gul, Xaher; Nishtar, Noureen Aleem

2012-12-27

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy measures that facilitate in bringing NGOs groups to a shared understanding of health issues and responses.

42 CFR 455.236 - Renewal of a contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Integrity Program § 455.236 Renewal of a contract. (a) CMS specifies the initial contract term in the Medicaid integrity audit program...

Strengthening district health service management and delivery through internal contracting: lessons from pilot projects in Cambodia.

PubMed

Khim, Keovathanak; Annear, Peter Leslie

2013-11-01

Following a decade of piloting different models of contracting, in mid-2009 the Cambodian Ministry of Health began to test a form of 'internal contracting' for health care delivery in selected health districts (including hospitals and health centers) contracted by the provincial health department as Special Operating Agencies (SOAs) and provided with greater management autonomy. This study assesses the internal contracting approach as a means for improving the management of district health services and strengthening service delivery. While the study may contribute to the emerging field now known as performance-based financing, the lessons deal more broadly with the impact of management reform and increased autonomy in contrast to traditional public sector line-management and budgeting. Carried out during 2011, the study was based on: (i) a review of the literature and of operational documents; (ii) primary data from semi-structured key informant interviews with 20 health officials in two provinces involved in four SOA pilot districts; and (iii) routine data from the 2011 SOA performance monitoring report. Five prerequisites were identified for effective contract management and improved service delivery: a clear understanding of roles and responsibilities by the contracting parties; implementation of clear rules and procedures; effective management of performance; effective monitoring of the contract; and adequate and timely provision of resources. Both the level and allocation of incentives and management bottlenecks at various levels continue to impede implementation. We conclude that, in contracted arrangements like these, the clear separation of contracting functions (purchasing, commissioning, monitoring and regulating), management autonomy where responsibilities are genuinely devolved and accepted, and the provision of resources adequate to meet contract demands are necessary conditions for success. Copyright © 2013 Elsevier Ltd. All rights reserved.

Different approaches to contracting in health systems.

PubMed Central

Perrot, Jean

2006-01-01

Contracting is one of the tools increasingly being used to enhance the performance of health systems in both developed and developing countries; it takes different forms and cannot be limited to the mere purchase of services. Actors adopt contracting to formalize all kinds of relations established between them. A typology for this approach will demonstrate its diversity and provide a better understanding of the various issues raised by contracting. In recent years the way health systems are organized has changed significantly. To remedy the under-performance of their health systems, most countries have undertaken reforms that have resulted in major institutional overhaul, including decentralization of health and administrative services, autonomy for public service providers, separation of funding bodies and service providers, expansion of health financing options and the development of the profit or nonprofit private sector. These institutional reshuffles lead not only to multiplication and diversification of the actors involved, but also to greater separation of the service provision and administrative functions. Health systems are becoming more complex and can no longer operate in isolation. Actors are gradually realizing that they need to forge relations. The simplest way to do that is through dialogue, although some prefer a more formal commitment. Interaction between actors may take various forms and be on different scales. There are several types of contractual relations: some are based on the nature of the contract (public or private), others on the parties involved and yet others on the scope of the contract. Here they are classified into three categories according to the object of the contract: delegation of responsibility, act of purchase of services, or cooperation. PMID:17143459

Assessing the pro-poor effect of different contracting schemes for health services on health facilities in rural Afghanistan.

PubMed

Alonge, Olakunle; Gupta, Shivam; Engineer, Cyrus; Salehi, Ahmad Shah; Peters, David H

2015-12-01

Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan. Contracts to NGOs were made to deliver a common set of primary care services in each province, with the funding agencies determining contract terms. The contracting approaches could be classified into three contracting out types (CO-1, CO-2 and CO-3) and a contracting-in (CI) approach based on the contract terms, design and implementation. Exit interviews of patients attending randomly sampled primary health facilities were collected through systematic sampling across 28 provinces at two time points. The outcome, the odds that a client attending a health facility is poor, was modelled using logistic regression with a robust variance estimator, and the effect of contracting was estimated using the difference-in-difference approach combined with stratified analyses. The sample covered 5960 interviews from 306 health facilities in 2005 and 2008. The adjusted odds of a poor client attending a health facility over time increased significantly for facilities under CO-1 and CO-2, with odds ratio of 2.82 (1.49, 5.36) P-value 0.001 and 2.00 (1.33, 3.02) P-value 0.001, respectively. The odds ratios for those under CO-3 and CI were not statistically significantly different over time. When compared with the non-contracting facilities, the adjusted ratio of odds ratios of poor status among clients was significantly higher for only those under CO-1, ratio of 2.50 (1.32, 4.74) P-value 0.005. CO-1 arrangement which allows contractors to decide on how funds are allocated within a fixed lump sum with non-negotiable deliverables, and actively managed through an independent government agency, is effective in improving equity of health services provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Direct contracting: a Minnesota case study.

PubMed

Burrows, S N; Moravec, R C

1997-08-01

During 1996, HealthEast Care, Inc., a healthcare provider-owned and governed direct-contracting company, successfully responded to a request for proposal from the metropolitan Minneapolis-St. Paul-based Buyers Health Care Action Group (BHCAG), a coalition of self-insured employers, to provide healthcare services to members of BHCAG's Choice Plus health plan. HealthEast Care developed a care system proposal for BHCAG that balanced consumer and purchaser expectations with historical healthcare costs. Providers are reimbursed for contracted healthcare services according to a unique fee-for-service, budget-based payment model. BHCAG chose to contract with HealthEast Care and 23 other care systems in the metropolitan Minneapolis-St. Paul area and other parts of Minnesota to serve more than 117,500 Choice Plus enrollees.

47 CFR 54.604 - Existing contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers § 54.604 Existing contracts. (a) Existing... health care provider as defined under § 54.601 and a telecommunications carrier shall be exempt from the...

42 CFR 136.23 - Persons to whom contract health services will be provided.

Code of Federal Regulations, 2010 CFR

2010-10-01

... economic and social ties with that tribe or tribes. (b) Students and transients. Subject to the provisions of this subpart, contract health services will be made available to students and transients who would... health service delivery area, but are temporarily absent from their residence as follows: (1) Student...

25 CFR 900.111 - What activities of construction programs are contractible?

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...? The Secretary shall, upon the request of any Indian tribe or tribal organization authorized by tribal resolution, enter into a self-determination contract to plan, conduct, and administer construction programs...

25 CFR 900.54 - Should the property management system prescribe internal controls?

Code of Federal Regulations, 2012 CFR

2012-04-01

... organization's self-determination contract(s) until the property is declared excess to the needs of the... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.111 - What activities of construction programs are contractible?

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...? The Secretary shall, upon the request of any Indian tribe or tribal organization authorized by tribal resolution, enter into a self-determination contract to plan, conduct, and administer construction programs...

25 CFR 900.54 - Should the property management system prescribe internal controls?

Code of Federal Regulations, 2014 CFR

2014-04-01

... organization's self-determination contract(s) until the property is declared excess to the needs of the... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.111 - What activities of construction programs are contractible?

Code of Federal Regulations, 2013 CFR

2013-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...? The Secretary shall, upon the request of any Indian tribe or tribal organization authorized by tribal resolution, enter into a self-determination contract to plan, conduct, and administer construction programs...

25 CFR 900.111 - What activities of construction programs are contractible?

Code of Federal Regulations, 2012 CFR

2012-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...? The Secretary shall, upon the request of any Indian tribe or tribal organization authorized by tribal resolution, enter into a self-determination contract to plan, conduct, and administer construction programs...

25 CFR 900.54 - Should the property management system prescribe internal controls?

Code of Federal Regulations, 2013 CFR

2013-04-01

... organization's self-determination contract(s) until the property is declared excess to the needs of the... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.136 - Do tribal employment rights ordinances apply to construction contracts and subcontracts?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Do tribal employment rights ordinances apply to... OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER... rights ordinances apply to construction contracts and subcontracts? Yes. Tribal employment rights...

48 CFR 342.302 - Contract administration functions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... functions. 342.302 Section 342.302 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Administration Office Functions 342.302 Contract administration... services), will take place on HHS-owned or controlled properties. The clause shall not be included if...

48 CFR 342.302 - Contract administration functions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... functions. 342.302 Section 342.302 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Administration Office Functions 342.302 Contract administration... services), will take place on HHS-owned or controlled properties. The clause shall not be included if...

48 CFR 342.302 - Contract administration functions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... functions. 342.302 Section 342.302 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Administration Office Functions 342.302 Contract administration... services), will take place on HHS-owned or controlled properties. The clause shall not be included if...

48 CFR 342.302 - Contract administration functions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... functions. 342.302 Section 342.302 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Administration Office Functions 342.302 Contract administration... services), will take place on HHS-owned or controlled properties. The clause shall not be included if...

The impact of contracting-out on health system performance: a conceptual framework.

PubMed

Liu, Xingzhu; Hotchkiss, David R; Bose, Sujata

2007-07-01

Despite the increased popularity of contracting-out of health services in developing countries, its effectiveness on overall health system performance is not yet conclusive. Except for substantial evidence of contracting-out's positive effect on access to health services and some evidence on improved equity in access, there is little evidence of contracting-out's impact on quality and efficiency. Most studies on the subject evaluate specific contracting-out projects against narrowly specified project objectives, not against more broadly defined health system goals. For this reason, conclusions of positive effects pertaining to project level may not hold at system level. This paper presents a conceptual framework that is expected to facilitate comprehensive, rigorous, and standardized evaluation of contracting-out at health system level. Specifically, this framework supports: full and standardized description of contracting-out interventions, study of the determinants of effectiveness, examination of provider and purchaser responses, assessment of the impact of contracting-out on all dimensions of health system performance, and cross-project analyses.

Parallel NGO Networks for HIV Control: Risks and Opportunities for NGO Contracting

PubMed Central

Zaidi, Shehla; Gul, Xaher; Nishtar, Noureen

2013-01-01

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy and system measures that overcome silos in NGO working by facilitating a common construct on the health issue, cohesive priorities and integrated working. PMID:23445705

Constraints and Benefits of Child Welfare Contracts with Behavioral Health Providers: Conditions that Shape Service Access.

PubMed

Bunger, Alicia C; Cao, Yiwen; Girth, Amanda M; Hoffman, Jill; Robertson, Hillary A

2016-09-01

This qualitative study examines worker perceptions of how public child welfare agencies' purchase of service contracts with private behavioral health organizations can both facilitate and constrain referral making and children's access to services. Five, 90-min focus groups were conducted with workers (n = 50) from an urban public child welfare agency in the Midwest. Using a modified grounded theory approach, findings suggest that contracts may expedite service linkages, but contract benefits are conditioned upon design and implementation. Results also suggest the critical role of front line workers in carrying out contractual relationships. Implications for research and interventions for enhancing contracting are discussed.

The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence.

PubMed

Liu, Xingzhu; Hotchkiss, David R; Bose, Sujata

2008-01-01

The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown. Moreover, little is known about the system-wide effects of contracting-out, which could be either positive or negative. Although the study results leave open the question of how contracting-out can be used as a policy tool to improve overall health system performance, the results indicate that the context in which contracting-out is implemented and the design features of the interventions are likely to greatly influence the chances for success.

The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries.

PubMed Central

Palmer, N.

2000-01-01

Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries. PMID:10916919

42 CFR 475.105 - Prohibition against contracting with health care facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... facilities. 475.105 Section 475.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.105 Prohibition against contracting...

Framing the decision to contract out elderly care and primary health care services – perspectives of local level politicians and civil servants in Finland

PubMed Central

2012-01-01

Background In the literature there are only few empirical studies that analyse the decision makers’ reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens’ access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Methods Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Results Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. Conclusions This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state. PMID:22805167

Framing the decision to contract out elderly care and primary health care services - perspectives of local level politicians and civil servants in Finland.

PubMed

Tynkkynen, Liina-Kaisa; Lehto, Juhani; Miettinen, Sari

2012-07-17

In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.

Physician Personal Services Contract Enforceability: The Influence of the Thirteenth Amendment.

PubMed

Fasko, Steven A; Kerr, Bernard J; Alvarez, M Raymond; Westrum, Andrew

We explore the influence of the Thirteenth Amendment to the US Constitution on the enforceability of personal services contracts for physicians. This influence extends from the ambiguous definition to the legal interpretation of personal services contracts. The courts have struggled with determining contracts to be a personal service and whether to grant injunctions for continued performance. The award or denial of damages due to a breach of contract is vested in these enforceability complications. Because of the Thirteenth Amendment's influence, courts and contracting parties will continue to struggle with physician personal services contract enforceability; although other points of view may exist. Possible solutions are offered for health care contract managers dealing with challenges attributable to physician personal services contracts.

42 CFR 423.643 - Effect of contract determination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of contract determination. 423.643 Section 423.643 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Determinations and Appeals § 423.643 Effect of contract determination. The contract determination is final and...

42 CFR 422.646 - Effect of contract determination.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of contract determination. 422.646 Section 422.646 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Appeals § 422.646 Effect of contract determination. The contract determination is final and binding unless...

5 CFR 890.205 - Nonrenewal of contracts of health benefits plans.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans § 890.205 Nonrenewal of contracts of health benefits plans. (a) Either OPM or the carrier may terminate... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Nonrenewal of contracts of health...

5 CFR 890.205 - Nonrenewal of contracts of health benefits plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans § 890.205 Nonrenewal of contracts of health benefits plans. (a) Either OPM or the carrier may terminate... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Nonrenewal of contracts of health...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

Provision of ambulatory health services in Poland: a case study from Krakow.

PubMed

Chawla, Mukesh; Berman, Peter; Windak, Adam; Kulis, Marzena

2004-01-01

This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.

25 CFR 900.191 - Are employees of self-determination contractors providing health services under the self...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false Are employees of self-determination contractors providing health services under the self-determination contract protected by FTCA? 900.191 Section 900.191 Indians... HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Federal Tort...

25 CFR 900.191 - Are employees of self-determination contractors providing health services under the self...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Are employees of self-determination contractors providing health services under the self-determination contract protected by FTCA? 900.191 Section 900.191 Indians... HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Federal Tort...

25 CFR 900.191 - Are employees of self-determination contractors providing health services under the self...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false Are employees of self-determination contractors providing health services under the self-determination contract protected by FTCA? 900.191 Section 900.191 Indians... HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Federal Tort...

25 CFR 900.191 - Are employees of self-determination contractors providing health services under the self...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false Are employees of self-determination contractors providing health services under the self-determination contract protected by FTCA? 900.191 Section 900.191 Indians... HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Federal Tort...

25 CFR 900.191 - Are employees of self-determination contractors providing health services under the self...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Are employees of self-determination contractors providing health services under the self-determination contract protected by FTCA? 900.191 Section 900.191 Indians... HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Federal Tort...

42 CFR 475.101 - Eligibility requirements for QIO contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 475.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.101 Eligibility requirements for QIO contracts. In...

42 CFR 475.106 - Prohibition against contracting with payor organizations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... organizations. 475.106 Section 475.106 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.106 Prohibition against contracting...

42 CFR 52h.10 - What matters must be reviewed for solicited contract proposals?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false What matters must be reviewed for solicited contract proposals? 52h.10 Section 52h.10 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... CONTRACT PROJECTS § 52h.10 What matters must be reviewed for solicited contract proposals? (a) Subject to...

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

PubMed

Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

2014-11-13

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.

25 CFR 900.255 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2012 CFR

2012-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... provided under the contract which has a per item current fair market value, less the cost of improvements...

25 CFR 900.255 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2013 CFR

2013-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... provided under the contract which has a per item current fair market value, less the cost of improvements...

25 CFR 900.255 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2014 CFR

2014-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... provided under the contract which has a per item current fair market value, less the cost of improvements...

25 CFR 900.255 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... provided under the contract which has a per item current fair market value, less the cost of improvements...

25 CFR 900.255 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... provided under the contract which has a per item current fair market value, less the cost of improvements...

What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract.

PubMed

Heflinger, C A; Northrup, D A

2000-11-01

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.

42 CFR 600.415 - Contracting qualifications and requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... protecting the privacy and security of personally identifiable information, and other applicable contract... 42 Public Health 5 2014-10-01 2014-10-01 false Contracting qualifications and requirements. 600.415 Section 600.415 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

PubMed

Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

2015-02-27

The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the transition of the policy. The innovative fund raising measures could be taken by relatively developed counties of China to conduct public health services. Policymakers could take systems thinking as a useful tool to design plans and predict the unintended outcomes during the process of public health reforms.

Evaluating the impact of contracting out basic health care services in the state of São Paulo, Brazil

PubMed Central

Greve, Jane; Schattan Ruas Pereira Coelho, Vera

2017-01-01

Abstract As a means of dealing with shortcomings in the coverage, quality and efficiency of the public health care sector, several municipalities in the state of São Paulo, Brazil, have started to contract pre-certified non-profit or non-governmental organizations to take part in the delivery of health care services. This paper explores the impact of introducing these contracts in the primary health care sector. Using data on the 645 municipalities in the state of São Paulo and difference-in-differences methods, we estimate the effect of contracting out in the primary health care sector on various dimensions of mortality and health care use. The results show that implementation of the contracting out strategy significantly increases the number of primary health care appointments by approximately one appointment per user of the national health care system per year. Point estimates indicate a reducing effect on hospitalization for preventable diseases. PMID:28419264

41 CFR 101-4.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Health and insurance benefits and services. 101-4.440 Section 101-4.440 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 4-NONDISCRIMINATION...

Lovelace simplifies, saves big with single-source imaging equipment service contract.

PubMed

1997-11-01

Lovelace Health System traded in its disorganized mess of service contracts for imaging and cardiology equipment for one umbrella contract--and is now saving more than $200,000 a year as a result. Find out how to achieve similar savings.

41 CFR 101-5.304 - Type of occupational health services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... health services. 101-5.304 Section 101-5.304 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.304 Type of occupational health services. The type of occupational health services made available to occupying agencies will be as...

41 CFR 101-5.304 - Type of occupational health services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... health services. 101-5.304 Section 101-5.304 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.304 Type of occupational health services. The type of occupational health services made available to occupying agencies will be as...

41 CFR 101-5.307 - Public Health Service.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 2 2014-07-01 2012-07-01 true Public Health Service... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.307 Public Health Service. (a) The only authorized contact point for assistance of and consultation with the Public Health Service is the Federal...

41 CFR 101-5.307 - Public Health Service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Public Health Service... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.307 Public Health Service. (a) The only authorized contact point for assistance of and consultation with the Public Health Service is the Federal...

41 CFR 101-5.307 - Public Health Service.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 2 2012-07-01 2012-07-01 false Public Health Service... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.307 Public Health Service. (a) The only authorized contact point for assistance of and consultation with the Public Health Service is the Federal...

41 CFR 101-5.304 - Type of occupational health services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... health services. 101-5.304 Section 101-5.304 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.304 Type of occupational health services. The type of occupational health services made available to occupying agencies will be as...

41 CFR 101-5.307 - Public Health Service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Public Health Service... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.307 Public Health Service. (a) The only authorized contact point for assistance of and consultation with the Public Health Service is the Federal...

41 CFR 101-5.307 - Public Health Service.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 2 2013-07-01 2012-07-01 true Public Health Service... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.307 Public Health Service. (a) The only authorized contact point for assistance of and consultation with the Public Health Service is the Federal...

Perceived outcomes of public health privatization: a national survey of local health department directors.

PubMed

Keane, C; Marx, J; Ricci, E

2001-01-01

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.

Perceived Outcomes of Public Health Privatization: A National Survey of Local Health Department Directors

PubMed Central

Keane, Christopher; Marx, John; Ricci, Edmund

2001-01-01

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises. PMID:11286093

25 CFR 900.110 - What does this subpart cover?

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT... contracts under this subpart are: design and architectural/engineering services, construction project...

42 CFR 136.121 - Indian preference in training and employment.

Code of Federal Regulations, 2011 CFR

2011-10-01

....121 Section 136.121 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Grants for Development... connection with the administration of such grant, or contract or subgrant made under such grant, shall be...

42 CFR 136.121 - Indian preference in training and employment.

Code of Federal Regulations, 2010 CFR

2010-10-01

....121 Section 136.121 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Grants for Development... connection with the administration of such grant, or contract or subgrant made under such grant, shall be...

42 CFR 136.353 - Reports and records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Reports and records. 136.353 Section 136.353 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Indian Health Care Improvement Act Programs Subdivision J-6-Contracts with Urban Indian Organizations...

42 CFR 136.353 - Reports and records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Reports and records. 136.353 Section 136.353 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Indian Health Care Improvement Act Programs Subdivision J-6-Contracts with Urban Indian Organizations...

42 CFR 136.353 - Reports and records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Reports and records. 136.353 Section 136.353 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Indian Health Care Improvement Act Programs Subdivision J-6-Contracts with Urban Indian Organizations...

48 CFR 342.7001 - Contract monitoring responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Contract monitoring responsibilities. 342.7001 Section 342.7001 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7001 Contract monitoring...

48 CFR 342.7001 - Contract monitoring responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract monitoring responsibilities. 342.7001 Section 342.7001 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7001 Contract monitoring...

48 CFR 342.7001 - Contract monitoring responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Contract monitoring responsibilities. 342.7001 Section 342.7001 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7001 Contract monitoring...

48 CFR 342.7001 - Contract monitoring responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Contract monitoring responsibilities. 342.7001 Section 342.7001 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7001 Contract monitoring...

42 CFR 136.23 - Persons to whom contract health services will be provided.

Code of Federal Regulations, 2011 CFR

2011-10-01

...—during their full-time attendance at programs of vocational, technical, or academic education, including normal school breaks (such as vacations, semester or other scheduled breaks occurring during their... who were eligible for contract health services at the time of the court order shall continue to be...

25 CFR 900.145 - On what basis may the Secretary deny a waiver request?

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... written finding. The finding must clearly demonstrate (or be supported by controlling legal authority... resources is not assured; (c) The proposed project or function to be contracted for cannot be properly...

42 CFR 52h.9 - What matters must be reviewed for unsolicited contract proposals?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false What matters must be reviewed for unsolicited contract proposals? 52h.9 Section 52h.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... PROJECTS § 52h.9 What matters must be reviewed for unsolicited contract proposals? (a) Except as otherwise...

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

25 CFR 900.44 - What minimum general standards apply to all Indian tribe or tribal organization financial...

Code of Federal Regulations, 2014 CFR

2014-04-01

... or tribal organization financial management systems when carrying out a self-determination contract... organization financial management systems when carrying out a self-determination contract? The fiscal control... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...

25 CFR 900.44 - What minimum general standards apply to all Indian tribe or tribal organization financial...

Code of Federal Regulations, 2013 CFR

2013-04-01

... or tribal organization financial management systems when carrying out a self-determination contract... organization financial management systems when carrying out a self-determination contract? The fiscal control... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...

25 CFR 900.44 - What minimum general standards apply to all Indian tribe or tribal organization financial...

Code of Federal Regulations, 2012 CFR

2012-04-01

... or tribal organization financial management systems when carrying out a self-determination contract... organization financial management systems when carrying out a self-determination contract? The fiscal control... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...

25 CFR 900.44 - What minimum general standards apply to all Indian tribe or tribal organization financial...

Code of Federal Regulations, 2011 CFR

2011-04-01

... or tribal organization financial management systems when carrying out a self-determination contract... organization financial management systems when carrying out a self-determination contract? The fiscal control... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...

25 CFR 900.44 - What minimum general standards apply to all Indian tribe or tribal organization financial...

Code of Federal Regulations, 2010 CFR

2010-04-01

... or tribal organization financial management systems when carrying out a self-determination contract... organization financial management systems when carrying out a self-determination contract? The fiscal control... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...

42 CFR 67.11 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Definitions. 67.11 Section 67.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING AGENCY FOR HEALTH CARE POLICY AND RESEARCH GRANTS AND CONTRACTS Research Grants for Health Services Research...

42 CFR 67.11 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Definitions. 67.11 Section 67.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING AGENCY FOR HEALTH CARE POLICY AND RESEARCH GRANTS AND CONTRACTS Research Grants for Health Services Research...

Population-based contracting (population health): part II.

PubMed

Jacofsky, D J

2017-11-01

Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4. ©2017 The British Editorial Society of Bone & Joint Surgery.

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.

PubMed

Glinos, Irene A; Baeten, Rita; Maarse, Hans

2010-05-01

Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Who contracts for primary care?

PubMed

Lewis, R; Gillam, S; Gosden, T; Sheaff, R

1999-12-01

The implications of the 1997 NHS (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. This paper describes a content analysis of a sample of Personal Medical Services (PMS) pilot contracts. In the first year little attention has been given to achieving cost savings or greater efficiency and few contracts promote clinical guidelines. The difficulties of specifying services sensitive to local health needs are highlighted and the national Statement of Fees and Allowances (the 'Red Book') may not be swiftly supplanted. However, the pilots have introduced innovations such as salaried general practitioners, nurse-led services and NHS trust-managed care. The development of local contracts provides a valuable learning experience for general practitioners and health authorities in advance of the establishment of Primary Care Trusts.

48 CFR 1602.170-1 - Carrier.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms... cost of health care services under group insurance policies or contracts, medical or hospital service... hospital and health service corporation, or any other entity providing a plan of health insurance, health...

Evaluating the impact of contracting out basic health care services in the state of São Paulo, Brazil.

PubMed

Greve, Jane; Schattan Ruas Pereira Coelho, Vera

2017-09-01

As a means of dealing with shortcomings in the coverage, quality and efficiency of the public health care sector, several municipalities in the state of São Paulo, Brazil, have started to contract pre-certified non-profit or non-governmental organizations to take part in the delivery of health care services.This paper explores the impact of introducing these contracts in the primary health care sector. Using data on the 645 municipalities in the state of São Paulo and difference-in-differences methods, we estimate the effect of contracting out in the primary health care sector on various dimensions of mortality and health care use. The results show that implementation of the contracting out strategy significantly increases the number of primary health care appointments by approximately one appointment per user of the national health care system per year. Point estimates indicate a reducing effect on hospitalization for preventable diseases. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

48 CFR 342.7003 - Withholding of contract payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Withholding of contract payments. 342.7003 Section 342.7003 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003 Withholding of contract payments. ...

48 CFR 342.7003 - Withholding of contract payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Withholding of contract payments. 342.7003 Section 342.7003 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003 Withholding of contract payments. ...

48 CFR 342.7003 - Withholding of contract payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Withholding of contract payments. 342.7003 Section 342.7003 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003 Withholding of contract payments. ...

48 CFR 342.7003 - Withholding of contract payments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Withholding of contract payments. 342.7003 Section 342.7003 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003 Withholding of contract payments. ...

48 CFR 342.7003 - Withholding of contract payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Withholding of contract payments. 342.7003 Section 342.7003 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003 Withholding of contract payments. ...

48 CFR 342.7102 - Contract modifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Contract modifications. 342.7102 Section 342.7102 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7102 Contract modifications...

48 CFR 342.7101 - Contract administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Contract administration. 342.7101 Section 342.7101 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7101 Contract administration. ...

48 CFR 342.7101 - Contract administration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract administration. 342.7101 Section 342.7101 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7101 Contract administration. ...

48 CFR 342.7102 - Contract modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract modifications. 342.7102 Section 342.7102 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7102 Contract modifications...

42 CFR 38.4 - Contracts.

Code of Federal Regulations, 2012 CFR

2012-10-01

... FOR CRISIS COUNSELING AND TRAINING § 38.4 Contracts. (a) Eligibility. Public agencies and private... professional mental health crisis counseling services or mental health training of disaster workers needed as a...

42 CFR 38.4 - Contracts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOR CRISIS COUNSELING AND TRAINING § 38.4 Contracts. (a) Eligibility. Public agencies and private... professional mental health crisis counseling services or mental health training of disaster workers needed as a...

42 CFR 38.4 - Contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR CRISIS COUNSELING AND TRAINING § 38.4 Contracts. (a) Eligibility. Public agencies and private... professional mental health crisis counseling services or mental health training of disaster workers needed as a...

42 CFR 38.4 - Contracts.

Code of Federal Regulations, 2013 CFR

2013-10-01

... FOR CRISIS COUNSELING AND TRAINING § 38.4 Contracts. (a) Eligibility. Public agencies and private... professional mental health crisis counseling services or mental health training of disaster workers needed as a...

42 CFR 38.4 - Contracts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR CRISIS COUNSELING AND TRAINING § 38.4 Contracts. (a) Eligibility. Public agencies and private... professional mental health crisis counseling services or mental health training of disaster workers needed as a...

The organization and financing of cervical cancer prevention carried out by midwives in primary health care.

PubMed

Sobczyk, Karolina; Woźniak-Holecka, Joanna; Holecki, Tomasz; Szałabska, Dorota

2016-01-01

The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.

Marginal-cost contracting in the NHS: results of a preliminary survey.

PubMed

Beddow, A J; Cohen, D R

2001-05-01

Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an 'internal market' in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery.

42 CFR 417.600 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Medicare-covered health care services to them. (3) Section 234 of the MMA requires section 1876 contractors... contract's service area. (b) Applicability. (1) The rights, procedures, and requirements relating to...

42 CFR 414.914 - Terms of contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disabled, the hearing impaired, and Spanish-speaking inquirers in all customer service operations. (9) Meet... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for Drugs and Biologicals...

42 CFR 405.440 - Emergency and urgent care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section 405.440 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.440...

41 CFR 101-5.304 - Type of occupational health services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... services within the competence of the professional staff (1) To appraise and report work environment health... health services. 101-5.304 Section 101-5.304 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.304 Type of occupational...

41 CFR 101-5.304 - Type of occupational health services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... services within the competence of the professional staff (1) To appraise and report work environment health... health services. 101-5.304 Section 101-5.304 Public Contracts and Property Management Federal Property... FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.304 Type of occupational...

48 CFR 342.7000 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Purpose. 342.7000 Section 342.7000 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7000 Purpose. Contract monitoring is an essential element of contract...

48 CFR 342.7000 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Purpose. 342.7000 Section 342.7000 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7000 Purpose. Contract monitoring is an essential element of contract...

48 CFR 342.7000 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Purpose. 342.7000 Section 342.7000 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7000 Purpose. Contract monitoring is an essential element of contract...

48 CFR 342.7000 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Purpose. 342.7000 Section 342.7000 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7000 Purpose. Contract monitoring is an essential element of contract...

When the fine print isn't so fine: reviewing contracts of health plan service providers.

PubMed

Simon, T; Hamelburg, M

2001-09-01

Most employers delegate responsibilities for health plan administration to one or more service providers or vendors. Recent legal developments make it increasingly important for employers to ensure that the contracts with their vendors provide appropriate protections against liability, hold vendors accountable for performing the services they agree to provide and enable plans to comply with an ever-expanding list of federal and state law requirements.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients-innovation in the commissioning of primary dental care service delivery and organisation in the UK.

PubMed

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-09-17

In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards 'blended contracts' that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

5 CFR 890.205 - Nonrenewal of contracts of health benefits plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Nonrenewal of contracts of health benefits plans. 890.205 Section 890.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans...

5 CFR 890.205 - Nonrenewal of contracts of health benefits plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Nonrenewal of contracts of health benefits plans. 890.205 Section 890.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans...

5 CFR 890.205 - Nonrenewal of contracts of health benefits plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Nonrenewal of contracts of health benefits plans. 890.205 Section 890.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans...

Contracting out of clinical services in Zimbabwe.

PubMed

McPake, B; Hongoro, C

1995-07-01

Contracting is increasingly recommended to developing countries as a way of improving the efficiency of the health sector. However, empirical evidence regarding its effectiveness in this respect is almost completely absent. In Zimbabwe, a long standing contract exists between the Ministry of Health and Wankie Colliery to provide clinical services in the Colliery's 400 bed hospital. This paper details a study of the Zimbabweans' experience with the contract. Its success is assessed using comparisons with a neighbouring government hospital of the price of services (vs the cost in the government hospital); the situation of hospital workers; and the quality of services delivered. The Colliery has established a monopoly position for hospital services in the district. However, it appears to offer services of at least as good quality at prices which are lower than the unit costs of the government hospital when capital costs are included. Nevertheless, the contract cannot be considered a success due to the failure to contain its total cost. Approximately 70% of provincial non-salary recurrent expenditure is consumed by the contract while only a minority of the province's population have access to the Colliery hospital. Screening patients, both with respect to their ability to pay and to their need for secondary level services does not take place with the result that utilization levels are not controlled. The study highlights a number of important issues affecting contracting in developing country setting: First, contracted institutions attain powerful bargaining positions if there are no viable competitors and the government does not itself retain capacity to offer an alternative service. Second, specific skills are needed for the management of contracts at all levels. If the process of contract development responds to a crisis driven agenda resulting from civil service retrenchment and public expenditure cuts, it is unlikely that adequate consideration will be given to the development of such skills and the retention of key personnel. If such details are neglected, otherwise feasible efficiency gains will prove elusive.

Demand and Signing of General Practitioner Contract Service among the Urban Elderly: A Population-Based Analysis in Zhejiang Province, China.

PubMed

Zhao, Yanrong; Lin, Junfen; Qiu, Yinwei; Yang, Qing; Wang, Xinyi; Shang, Xiaopeng; Xu, Xiaoping

2017-03-29

This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05-1.68); urban resident basic medical insurance (URBMI) vs. urban employee basic medical insurance (UEBMI) (OR = 1.96, 95% CI, 1.46-2.61); and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50-0.90 for RMB 1001-3000; OR = 0.59, 95% CI, 0.39-0.90 for RMB 3001-5000). Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09-17.27). Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.

75 FR 21508 - Health and Human Services Acquisition Regulation; Corrections

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

..., and other activities involving live vertebrate animals conducted under contract (see Public Health... live vertebrate animals. * * * * * 0 44. Section 370.404 is revised to read as follows: 370.404 Contract clause. The Contracting Officer shall insert the clause in 352.270-5(b), Care of Live Vertebrate...

32 CFR 728.54 - U.S. Public Health Service (USPHS), other than members of the uniformed services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false U.S. Public Health Service (USPHS), other than... FACILITIES Beneficiaries of Other Federal Agencies § 728.54 U.S. Public Health Service (USPHS), other than... 43 (Contract Health Service Purchase Order for Hospital Services Rendered) or HRSA form 64 (Purchase...

32 CFR 728.54 - U.S. Public Health Service (USPHS), other than members of the uniformed services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false U.S. Public Health Service (USPHS), other than... FACILITIES Beneficiaries of Other Federal Agencies § 728.54 U.S. Public Health Service (USPHS), other than... 43 (Contract Health Service Purchase Order for Hospital Services Rendered) or HRSA form 64 (Purchase...

32 CFR 728.54 - U.S. Public Health Service (USPHS), other than members of the uniformed services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false U.S. Public Health Service (USPHS), other than... FACILITIES Beneficiaries of Other Federal Agencies § 728.54 U.S. Public Health Service (USPHS), other than... 43 (Contract Health Service Purchase Order for Hospital Services Rendered) or HRSA form 64 (Purchase...

32 CFR 728.54 - U.S. Public Health Service (USPHS), other than members of the uniformed services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false U.S. Public Health Service (USPHS), other than... FACILITIES Beneficiaries of Other Federal Agencies § 728.54 U.S. Public Health Service (USPHS), other than... 43 (Contract Health Service Purchase Order for Hospital Services Rendered) or HRSA form 64 (Purchase...

32 CFR 728.54 - U.S. Public Health Service (USPHS), other than members of the uniformed services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false U.S. Public Health Service (USPHS), other than... FACILITIES Beneficiaries of Other Federal Agencies § 728.54 U.S. Public Health Service (USPHS), other than... 43 (Contract Health Service Purchase Order for Hospital Services Rendered) or HRSA form 64 (Purchase...

25 CFR 900.72 - Who is the guardian of the fund and may the funds be invested?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Indian tribe or tribal organization subject to the terms of the lease or the self-determination contract. ... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... the fund and may the funds be invested? (a) The Indian tribe or tribal organization is the guardian of...

25 CFR 900.72 - Who is the guardian of the fund and may the funds be invested?

Code of Federal Regulations, 2010 CFR

2010-04-01

... Indian tribe or tribal organization subject to the terms of the lease or the self-determination contract. ... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... the fund and may the funds be invested? (a) The Indian tribe or tribal organization is the guardian of...

25 CFR 900.72 - Who is the guardian of the fund and may the funds be invested?

Code of Federal Regulations, 2013 CFR

2013-04-01

... Indian tribe or tribal organization subject to the terms of the lease or the self-determination contract. ... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... the fund and may the funds be invested? (a) The Indian tribe or tribal organization is the guardian of...

25 CFR 900.72 - Who is the guardian of the fund and may the funds be invested?

Code of Federal Regulations, 2012 CFR

2012-04-01

... Indian tribe or tribal organization subject to the terms of the lease or the self-determination contract. ... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... the fund and may the funds be invested? (a) The Indian tribe or tribal organization is the guardian of...

42 CFR 421.212 - Railroad Retirement Board contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Railroad Retirement Board contracts. 421.212... SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE CONTRACTING Carriers § 421.212 Railroad Retirement Board contracts. In accordance with this subpart C, the Railroad Retirement Board contracts with DMEPOS regional...

48 CFR 342.7003-1 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provisions and contract clauses. 342.7003-1 Section 342.7003-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-1 Solicitation...

48 CFR 342.7003-1 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Solicitation provisions and contract clauses. 342.7003-1 Section 342.7003-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-1 Solicitation...

48 CFR 342.7003-1 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Solicitation provisions and contract clauses. 342.7003-1 Section 342.7003-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-1 Solicitation...

48 CFR 342.7003-1 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Solicitation provisions and contract clauses. 342.7003-1 Section 342.7003-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-1 Solicitation...

48 CFR 342.7003-1 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Solicitation provisions and contract clauses. 342.7003-1 Section 342.7003-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-1 Solicitation...

48 CFR 335.071 - Special determinations and findings affecting research and development contracting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... findings affecting research and development contracting. 335.071 Section 335.071 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 335.071 Special determinations and findings affecting research and development contracting. OPDIV...

Private Health Plans’ Contracts with Managed Behavioral Healthcare Organizations

PubMed Central

Garnick, Deborah W.; Horgan, Constance M.; Merrick, Elizabeth L.; Hodgkin, Dominic; Reif, Sharon; Quinn, Amity E.; Stewart, Maureen; Creedon, Timothy B.

2015-01-01

Contracts between health plans and managed behavioral health care organizations (MBHOs) influence access and quality of behavioral health care. This report presents information on performance requirements, information sharing, and financial risk from a nationally representative survey of private health plans. Most contracts include geographic access to providers (93.3%) and NCQA’s performance standards (84.2%). Health plans and MBHOs share data (99.0%), generally by the MBHO sending information to the health plan (96.3%). About a quarter of contracts impose financial penalties (23.0%), but few include incentives related to performance standards (<1.0%). Contract terms can shape the provision of behavioral health services in response to changes such as parity legislation or health reform. If current trends continue towards increases in value-based purchasing in the privately financed behavioral health sector, the focus on quality in contracts between health plans and MBHOs will be critical to understand. PMID:26276421

[The contracting process and outsourcing in health: the scenario for dispute between public and private interests].

PubMed

Albuquerque, Maria do Socorro Veloso; Morais, Heloísa Maria Mendonça de; Lima, Luci Praciano

2015-06-01

This research analyzed the public-private composition in the municipal health network and aspects of the contracting/outsourcing process for services over the period from 2001 to 2008. The research method used was a case study with documentary research and interviews. The interviewees were former secretaries of health, directors of regulation and district managers. The categories of analysis used were public funds, care networks and public control. The results showed that the contracting was restricted to philanthropic units. With respect to the other private establishments linked to the public care network, non-compliance with programmatic aspects was detected, such as the lack of regulation of bidding processes required for contracting. Management authorities did not actively pursue building up state public services, or the formation of care networks. The contracted establishments conducted their activities without effective external and internal control mechanisms, which are paramount for the proper use of public resources. The authors conclude that the contracting process does not significantly alter the standard of buying and selling of services and indeed does not enhance the empowering process of the role of the public domain.

Medicare program; offset of Medicare payments to individuals to collect past-due obligations arising from breach of scholarship and loan contracts--HCFA. Final rule.

PubMed

1992-05-04

This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.

48 CFR 330.201 - Contract requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract requirements. 330.201 Section 330.201 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS CAS Program Requirements 330.201 Contract requirements. ...

Contracting with private providers for primary care services: evidence from urban China.

PubMed

Wang, Yan; Eggleston, Karen; Yu, Zhenjie; Zhang, Qiong

2013-01-17

Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

Contracting with private providers for primary care services: evidence from urban China

PubMed Central

2013-01-01

Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services. PMID:23327666

[Evaluation of occupational medicine service tasks in the context of the Occupational Medicine Service Act, article 12, on the basis of statistical indicators in the Pomorskie voivodship].

PubMed

Parszuto, Jacek; Jaremin, Bogdan; Tukalska-Parszuto, Maria

2009-01-01

Occupational health service is based on legal regulations. We have made an attempt to estimate the implementation of the tasks resulting from article 12 of the Occupational Medicine Service Act introduced in 1998. In this paper we analyzed statistical data concerning the number of prophylactic health contracts, economic entities and health insurance payers. The data come from the Nofer Institute of Occupational Medicine, Central Statistical Office and Social Insurance Institution. Contract Coverage Rate (CCR) has been introduced for the purpose of this research. The data show that in 2007, the Contract Coverage Rate (CCR) for the Pomorskie voivodeship (province) accounted for 45.7%, with the median value of 14.4% for all voivodeships in Poland. According to the gathered statistical data, it should be concluded that the implementation of article 12 is insufficient. The amendment to the Act introducing the provision on written contracts is an opportunity to provide an effective mechanism, by which the present situation can be improved and the rates raised to a satisfactory level.

42 CFR 422.508 - Modification or termination of contract by mutual consent.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Application Procedures and Contracts for Medicare Advantage Organizations § 422.508 Modification or termination of contract...

Does contracting of health care in Afghanistan work? Public and service-users' perceptions and experience

PubMed Central

2011-01-01

Background In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Methods Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. Results The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Conclusions Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan. PMID:22376191

Does contracting of health care in Afghanistan work? Public and service-users' perceptions and experience.

PubMed

Cockcroft, Anne; Khan, Amir; Md Ansari, Noor; Omer, Khalid; Hamel, Candyce; Andersson, Neil

2011-12-21

In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce. Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors. The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption. Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.

48 CFR 304.804-70 - Contract closeout audits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Contract closeout audits. 304.804-70 Section 304.804-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE MATTERS Government Contract Files 304.804-70 Contract closeout audits. (a) Contracting Officers...

48 CFR 304.804-70 - Contract closeout audits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Contract closeout audits. 304.804-70 Section 304.804-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE MATTERS Government Contract Files 304.804-70 Contract closeout audits. (a) Contracting Officers...

48 CFR 304.804-70 - Contract closeout audits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Contract closeout audits. 304.804-70 Section 304.804-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE MATTERS Government Contract Files 304.804-70 Contract closeout audits. (a) Contracting Officers...

42 CFR 417.413 - Qualifying condition: Operating experience and enrollment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.413..., as appropriate. (b) Standard: Enrollment and operating experience for HMOs or CMPs to contract on a...

48 CFR 315.404 - Proposal analysis.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Proposal analysis. 315.404 Section 315.404 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 315.404 Proposal analysis. ...

48 CFR 315.404 - Proposal analysis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Proposal analysis. 315.404 Section 315.404 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 315.404 Proposal analysis. ...

Universal coverage and its impact on reproductive health services in Thailand.

PubMed

Tangcharoensathien, Viroj; Tantivess, Sripen; Teerawattananon, Yot; Auamkul, Nanta; Jongudoumsuk, Pongpisut

2002-11-01

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

25 CFR 900.246 - What does reassumption mean?

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT..., in whole or in part, of a contract and assuming or resuming control or operation of the contracted...

Why is the General Ophthalmic Services (GOS) Contract that underpins primary eye care in the U.K. contrary to the public health interest?

PubMed

Shickle, D; Davey, C J; Slade, S V

2015-07-01

The model for delivery of primary eye care in Europe varies from country to country with differing reliance on ophthalmologists, optometrists and dispensing opticians. Comparative analysis of models has tended to focus on interprofessional working arrangements, training and regulatory issues, rather than on whether a particular model is effective for delivering public health goals for that country. National Health Service (NHS) primary eye care services in the UK are predominantly provided under a General Ophthalmic Services (GOS) Contract between the NHS and practice owners (Contractors). Over two-thirds of sight tests conducted in England, Wales and Northern Ireland and all in Scotland are performed under a GOS Contract, however many people entitled to a GOS sight test do not take up their entitlement. The fee paid for sight tests conducted under a GOS Contract in England, Wales and Northern Ireland does not cover the full cost of conducting the examination. The shortfall must be made up through profits of sale of optical appliances but this business model can be a deterrent to establishing practices within socioeconomically deprived communities, and can also be a barrier to uptake of sight tests, even though many people are entitled to a NHS optical voucher towards the cost of spectacles or contact lenses. This paper critiques the GOS Contracts within the UK. We argue that aspects of the way the GOS Contract is implemented are contrary to the public health interest and that different approaches are needed to address eye health inequalities and to reduce preventable sight loss. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The impact of contracting out on health outcomes and use of health services in low and middle-income countries.

PubMed

Lagarde, Mylene; Palmer, Natasha

2009-10-07

Recent literature on the lack of efficiency and acceptability of publicly provided health services has led to an interest in the use of partnerships with the private sector to deliver public services. To assess the effectiveness of contracting out healthcare services in improving access to care in low and middle-income countries and, where possible, health outcomes. We searched a wide range of international databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, in addition to development studies and economic databases. We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature. The original searches were conducted between November 2005 and April 2006. An updated search in MEDLINE was carried out in May 2009. Contracting out health services is defined as the provision of healthcare services on behalf of the government by non-state providers. Studies had to include an objective measure of at least one of the following outcomes: health care utilisation, health expenditure, health outcomes or equity outcomes. Studies also needed to use one of the following study designs: randomised controlled trial, non-randomised controlled trial, interrupted time series analysis or controlled before and after study. We made an attempt to present results from the different studies in a systematic way, however due to the diversity of sources, contexts and methods used, we undertook a narrative synthesis. Three studies met our inclusion criteria (one after re-analysis of data). These studies suggest that contracting out services to non-state providers can increase access and utilisation of health services. One study found a reduction in out-of-pocket expenditures and improvement in some health outcomes. However, methodological weaknesses and particularities of the reported programme settings limit the strength and generalisability of their conclusions. Three studies suggest that contracting out may be an appropriate response to scale up service delivery in particular settings, such as post-conflict or fragile states. Evidence was not presented on whether this approach was more effective than making a similar investment in the public sector, as there was not an exact control available in any of the settings. In addition, the introduction of non-state providers into some settings and not others also brings many potentially confounding variables, such as the presence of additional management expertise or expatriate doctors, which may improve drug supply or increase utilisation.

Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care.

PubMed

Hulme, C; Robinson, P G; Saloniki, E C; Vinall-Collier, K; Baxter, P D; Douglas, G; Gibson, B; Godson, J H; Meads, D; Pavitt, S H

2016-09-08

To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). Non-randomised controlled study. Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. 550 new adult patients. A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

42 CFR 414.422 - Terms of contracts.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Competitive Bidding for Certain... exercised by CMS, for the full duration of the contract period. (b) Recompeting competitive bidding contracts. CMS recompetes competitive bidding contracts at least once every 3 years. (c) Nondiscrimination...

42 CFR 414.422 - Terms of contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Competitive Bidding for Certain... exercised by CMS, for the full duration of the contract period. (b) Recompeting competitive bidding contracts. CMS recompetes competitive bidding contracts at least once every 3 years. (c) Nondiscrimination...

Effectively engaging the private sector through vouchers and contracting - A case for analysing health governance and context.

PubMed

Nachtnebel, Matthias; O'Mahony, Ashleigh; Pillai, Nandini; Hort, Kris

2015-11-01

Health systems of low and middle income countries in the Asia Pacific have been described as mixed, where public and private sector operate in parallel. Gaps in the provision of primary health care (PHC) services have been picked up by the private sector and led to its growth; as can an enabling regulatory environment. The question whether governments should purchase services from the private sector to address gaps in service provision has been fiercely debated. This purposive review draws evidence from systematic reviews, and additional published and grey literature, for input into a policy brief on purchasing PHC-services from the private sector for underserved areas in the Asia Pacific region. Additional published and grey literature on vouchers and contracting as mechanisms to engage the private sector was used to supplement the conclusions from systematic reviews. We analysed the literature through a policy lens, or alternatively, a 'bottom-up' approach which incorporates components of a realist review. Evidence indicates that both vouchers and contracting can improve health service outcomes in underserved areas. These outcomes however are strongly influenced by (1) contextual factors, such as roles and functions attributable to a shared set of key actors (2) the type of delivered services and community demand (3) design of the intervention, notably provider autonomy and trust (4) governance capacity and provision of stewardship. Examining the experience of vouchers and contracting to expand health services through engagement with private sector providers in the Asia Pacific found positive effects with regards to access and utilisation of health services, but more importantly, highlighted the significance of contextual factors, appropriate selection of mechanism for services provided, and governance arrangements and stewardship capacity. In fact, for governments seeking to engage the private sector, analysis of context and capacities are potentially a more useful frame than generalizable outcomes of effectiveness. Copyright © 2015 Elsevier Ltd. All rights reserved.

Defining Medically Necessary Services To Protect Children. Protecting Consumer Rights in Public Systems: Managed Mental Health Care Policy. A Series of Issue Papers on Contracting for Managed Behavioral Health Care, #5.

ERIC Educational Resources Information Center

Bazelon Center for Mental Health Law, Washington, DC.

This issue paper is designed to help families, advocates and policymakers ensure that "medically necessary" standards in public-sector contracts for managed mental health care protect children's rights, particularly the rights of children who have serious emotional disturbance. Fundamental principles for developing sound contracts for…

42 CFR 417.414 - Qualifying condition: Range of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.414 Qualifying condition...

78 FR 70863 - Copayment for Extended Care Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Government contracts, Grant programs-health, Grant programs-veterans, Health care, Health facilities, Health professions... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO59 Copayment for Extended Care Services...

77 FR 50121 - Office of Direct Service and Contracting Tribes National Indian Health Outreach and Education...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-20

... Contracting Tribes National Indian Health Outreach and Education Program Funding Opportunity Announcement Type... Education (NIHOE-III) program funding opportunity that includes outreach and education activities on the... Health Care and Education Reconciliation Act of 2010, Public Law 111- 152, collectively known as the...

The use of standard contracts in the English National Health Service: a case study analysis.

PubMed

Petsoulas, Christina; Allen, Pauline; Hughes, David; Vincent-Jones, Peter; Roberts, Jennifer

2011-07-01

The use of contracts is vital to market transactions. The introduction of market reforms in health care in the U.K. and other developed countries twenty years ago meant greater use of contracts. In the U.K., health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting. Copyright © 2011 Elsevier Ltd. All rights reserved.

45 CFR 5b.2 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PRIVACY ACT REGULATIONS § 5b.2... Federal functions, such as intermediaries and carriers performing functions under contracts and agreements... year) or intermittent services have been procured by the Department by contract pursuant to 3109 of...

48 CFR 37.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

...), social services, health and mental health care, child (day) care, education (whether or not directly... on an individual or organizational basis. Some of the areas in which service contracts are found...

25 CFR 900.118 - Do these “construction contract” regulations apply to construction management services?

Code of Federal Regulations, 2013 CFR

2013-04-01

... management services, these services shall be limited to: (1) Coordination and exchange of information between... construction management services? 900.118 Section 900.118 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...

25 CFR 900.118 - Do these “construction contract” regulations apply to construction management services?

Code of Federal Regulations, 2010 CFR

2010-04-01

... management services, these services shall be limited to: (1) Coordination and exchange of information between... construction management services? 900.118 Section 900.118 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...

25 CFR 900.118 - Do these “construction contract” regulations apply to construction management services?

Code of Federal Regulations, 2012 CFR

2012-04-01

... management services, these services shall be limited to: (1) Coordination and exchange of information between... construction management services? 900.118 Section 900.118 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...

25 CFR 900.118 - Do these “construction contract” regulations apply to construction management services?

Code of Federal Regulations, 2011 CFR

2011-04-01

... management services, these services shall be limited to: (1) Coordination and exchange of information between... construction management services? 900.118 Section 900.118 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN...

Managed Care: The Key to Affordable College Health Insurance.

ERIC Educational Resources Information Center

Gallese, Lucile O.; Steele, Brenton H.

1994-01-01

Notes that rapid escalation of health care costs is growing concern for college health administrators charged with negotiating contracts for student health and accident insurance policies. Argues that student health service can serve same function as health maintenance organization, offering students range of services available and referring to…

78 FR 23702 - Copayment for Extended Care Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-22

... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse, Government contracts, Grant programs--health, Grant programs--veterans, Health care, Health facilities... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO59 Copayment for Extended Care Services...

Relationships among providing maternal, child, and adolescent health services; implementing various financial strategy responses; and performance of local health departments.

PubMed

Issel, L Michele; Olorunsaiye, Comfort; Snebold, Laura; Handler, Arden

2015-04-01

We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health.

Honestly, can one organization do it all?

PubMed

Norwood, C

1998-02-01

The Gay Men's Health Crisis (GMHC) has a contract for citywide legal services; however, they have never adequately represented the people in the Bronx. The diversity of the AIDS community in New York makes it impossible for a single organization to provide multilingual support and service to all segments of the population. The author, executive director of Health Force: Women and Men Against AIDS, proposes that GMHC either be forced to live up to its contractual obligations to serve people in the Bronx, or contract the services for that area to a local organization.

48 CFR 852.237-7 - Indemnification and medical liability insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF VETERANS AFFAIRS CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of... expressly agreed and understood that this is a non-personal services contract, as defined in Federal... professional aspects of the services rendered, including by example, the Contractor's or its health-care...

The psychological contract: is the UK National Health Service a model employer?

PubMed

Fielden, Sandra; Whiting, Fiona

2007-05-01

The UK National Health Service (NHS) is facing recruitment challenges that mean it will need to become an 'employer of choice' if it is to continue to attract high-quality employees. This paper reports the findings from a study focusing on allied health professional staff (n = 67), aimed at establishing the expectations of the NHS inherent in their current psychological contract and to consider whether the government's drive to make the NHS a model employer meets those expectations. The findings show that the most important aspects of the psychological contract were relational and based on the investment made in the employment relationship by both parties. The employment relationship was one of high involvement but also one where transactional contract items, such as pay, were still of some importance. Although the degree of employee satisfaction with the relational content of the psychological contract was relatively positive, there was, nevertheless, a mismatch between levels of importance placed on such aspects of the contract and levels of satisfaction, with employees increasingly placing greater emphasis on those items the NHS is having the greatest difficulty providing. Despite this apparent disparity between employee expectation and the fulfilment of those expectations, the overall health of the psychological contract was still high.

42 CFR 417.400 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.400 Basis and scope. (a) Statutory basis. The... CMPs that contract with CMS to furnish covered services to Medicare beneficiaries. (b) Scope. (1) This...

48 CFR 323.7002 - Actions required.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Actions required. 323.7002 Section 323.7002 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SOCIOECONOMIC PROGRAMS... WORKPLACE Safety and Health 323.7002 Actions required. (a) Contracting activities. The Contracting Officer...

Access to Specialty Health Care for Rural American Indians in Two States

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; Hollow, Walter B.; Casey, Susan; Hart, L. Gary; Larson, Eric H.; Moore, Kelly; Lewis, Ervin; Andrilla, C. Holly A.; Grossman, David C.

2008-01-01

Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by…

77 FR 69865 - 60-Day Proposed Information Collection; Request for Public Comment: Indian Health Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... information to certify that the health care services requested and authorized by the IHS have been performed... care services performed by such providers; and to serve as a legal document for health and medical care authorized by IHS and rendered by health care providers under contract with the IHS. Affected Public...

41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-741.25 Section 60-741.25 Public Contracts and Property Management... Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service...

42 CFR 457.955 - Conditions necessary to contract as a managed care entity (MCE).

Code of Federal Regulations, 2012 CFR

2012-10-01

... separate child health program has administrative and management arrangements or procedures designed to... 42 Public Health 4 2012-10-01 2012-10-01 false Conditions necessary to contract as a managed care entity (MCE). 457.955 Section 457.955 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

42 CFR 457.955 - Conditions necessary to contract as a managed care entity (MCE).

Code of Federal Regulations, 2014 CFR

2014-10-01

... separate child health program has administrative and management arrangements or procedures designed to... 42 Public Health 4 2014-10-01 2014-10-01 false Conditions necessary to contract as a managed care entity (MCE). 457.955 Section 457.955 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

48 CFR 801.602-84 - Documents to submit for business clearance reviews.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Development, Contracting Authority, and Responsibilities 801.602-84 Documents to submit for business clearance reviews. A contracting officer must submit to Acquisition Resources Service (Office of Construction and... the vendor is not suspended, debarred, or on the Department of Health and Human Services Exclusionary...

48 CFR 801.602-84 - Documents to submit for business clearance reviews.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Development, Contracting Authority, and Responsibilities 801.602-84 Documents to submit for business clearance reviews. A contracting officer must submit to Acquisition Resources Service (Office of Construction and... the vendor is not suspended, debarred, or on the Department of Health and Human Services Exclusionary...

48 CFR 801.602-84 - Documents to submit for business clearance reviews.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Development, Contracting Authority, and Responsibilities 801.602-84 Documents to submit for business clearance reviews. A contracting officer must submit to Acquisition Resources Service (Office of Construction and... the vendor is not suspended, debarred, or on the Department of Health and Human Services Exclusionary...

48 CFR 801.602-84 - Documents to submit for business clearance reviews.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Development, Contracting Authority, and Responsibilities 801.602-84 Documents to submit for business clearance reviews. A contracting officer must submit to Acquisition Resources Service (Office of Construction and... the vendor is not suspended, debarred, or on the Department of Health and Human Services Exclusionary...

42 CFR 417.402 - Effective date of initial regulations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.402 Effective date of... implementing regulations. (b) No new cost plan contracts are accepted by CMS. CMS will, however, accept and...

Federal employees health benefits acquisition regulation: Board of Contract Appeals. Final rule.

PubMed

2008-10-08

The Office of Personnel Management (OPM) is adopting as final,without change, the proposed rule published April 7, 2008 to remove the designation of the Armed Services Board of Contract Appeals (ASBCA)from the Federal Employees Health Benefits Acquisition Regulation(FEHBAR).

42 CFR 421.304 - Medicare integrity program contractor functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... services for which Medicare payment may be made either directly or indirectly. (b) Auditing, settling and.... 421.304 Section 421.304 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE CONTRACTING Medicare Integrity Program...

77 FR 7121 - Notice of Request for Extension of Approval of an Information Collection; PPQ Form 816; Contract...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service [Docket No. APHIS-2011-0131... and Aircraft Acceptance AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Extension of... Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to...

48 CFR 370.304 - Contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract clauses. 370.304 Section 370.304 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES HHS SUPPLEMENTATIONS SPECIAL PROGRAMS AFFECTING ACQUISITION Acquisitions Involving Human Subjects 370.304 Contract clauses. (a...

42 CFR 405.400 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Definitions. 405.400 Section 405.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.400 Definitions. For purposes of this...

42 CFR 405.400 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Definitions. 405.400 Section 405.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.400 Definitions. For purposes of this...

42 CFR 405.450 - Appeals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Appeals. 405.450 Section 405.450 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.450 Appeals. (a) A determination by...

42 CFR 405.400 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Definitions. 405.400 Section 405.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.400 Definitions. For purposes of this...

25 CFR 900.167 - If an Indian tribe or tribal organization objects to the recommended decision, what will the...

Code of Federal Regulations, 2010 CFR

2010-04-01

... recommended decision, what will the Secretary of Health and Human Services or the IBIA do? 900.167 Section 900..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... the Secretary of Health and Human Services or the IBIA do? (a) The Secretary of Health and Human...

25 CFR 900.53 - What kind of records shall the property management system maintain?

Code of Federal Regulations, 2012 CFR

2012-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.53 - What kind of records shall the property management system maintain?

Code of Federal Regulations, 2013 CFR

2013-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.53 - What kind of records shall the property management system maintain?

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.53 - What kind of records shall the property management system maintain?

Code of Federal Regulations, 2014 CFR

2014-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

25 CFR 900.53 - What kind of records shall the property management system maintain?

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management...

42 CFR 405.405 - General rules.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false General rules. 405.405 Section 405.405 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.405 General rules. (a) A...

42 CFR 405.410 - Conditions for properly opting-out of Medicare.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Conditions for properly opting-out of Medicare. 405.410 Section 405.410 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts...

42 CFR 52h.1 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Applicability. 52h.1 Section 52h.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS § 52h.1 Applicability. (a) This part...

Negotiating the new health system: purchasing publicly accountable managed care.

PubMed

Rosenbaum, S

1998-04-01

The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency. Second, most contracts fail to address the legal and structural issues arising from the relationship between the managed care service system and the public health system, including such key matters as access to care for communicable diseases and contractors' relationship to state public health laboratories. Third, many contracts are silent on health agencies' access to data for surveillance and community health measurement purposes. Finally, many contracts may be developed with only a limited understanding of the key public health-related issues facing the community from which the members will be drawn. The CDC and state and local public health agencies must expand their activities in the area of managed care contract specifications. For several years the CDC has been involved in an ongoing effort to develop quality of care measures to be collected from all companies through the HEDIS process. As important as this effort is, it represents only an attempt to measure what managed care does rather than an a priori effort to shape the underlying policy and organizational structure of managed care itself. Integrating managed care with public health policy will require this type of affirmative effort with both Medicaid agencies as well as other managed care purchasers.

Development of the Choctaw Health Delivery System.

ERIC Educational Resources Information Center

Nguyen, Binh N.

The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…

41 CFR 50-204.6 - Medical services and first aid.

Code of Federal Regulations, 2012 CFR

2012-07-01

... plant health. (b) In the absence of an infirmary, clinic or hospital in near proximity to the work place... 41 Public Contracts and Property Management 1 2012-07-01 2009-07-01 true Medical services and first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating...

41 CFR 50-204.6 - Medical services and first aid.

Code of Federal Regulations, 2011 CFR

2011-07-01

... plant health. (b) In the absence of an infirmary, clinic or hospital in near proximity to the work place... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Medical services and first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating...

41 CFR 50-204.6 - Medical services and first aid.

Code of Federal Regulations, 2013 CFR

2013-07-01

... plant health. (b) In the absence of an infirmary, clinic or hospital in near proximity to the work place... 41 Public Contracts and Property Management 1 2013-07-01 2013-07-01 false Medical services and first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating...

41 CFR 50-204.6 - Medical services and first aid.

Code of Federal Regulations, 2014 CFR

2014-07-01

... plant health. (b) In the absence of an infirmary, clinic or hospital in near proximity to the work place... 41 Public Contracts and Property Management 1 2014-07-01 2014-07-01 false Medical services and first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating...

41 CFR 50-204.6 - Medical services and first aid.

Code of Federal Regulations, 2010 CFR

2010-07-01

... first aid. 50-204.6 Section 50-204.6 Public Contracts and Property Management Other Provisions Relating... SUPPLY CONTRACTS General Safety and Health Standards § 50-204.6 Medical services and first aid. (a) The... trained to render first aid. First aid supplies approved by the consulting physician shall be readily...

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study.

PubMed

Willging, Cathleen E; Aarons, Gregory A; Trott, Elise M; Green, Amy E; Finn, Natalie; Ehrhart, Mark G; Hecht, Debra B

2016-09-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives.

Contracting out of health services in developing countries.

PubMed

McPake, B; Banda, E E

1994-03-01

Contracting out is emerging as a common policy issue in a number of developing countries. The theoretical case for contracting out suggests many advantages in combining public finance with private provision. However, practical difficulties such as those of ensuring that competition takes place between potential contractors, that competition leads to efficiency and that contracts and the process of contracting are effectively managed, suggest that such advantages may not always be realized. Most countries are likely only to contemplate restricted contracting of small-scale non-clinical services in the short term. Prerequisites of more extensive models appear to be the development of information systems and human resources to that end. Some urban areas of larger countries may have the existing preconditions for more successful large-scale contracting.

42 CFR 417.420 - Basic rules on enrollment and entitlement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.420... HMO or CMP that has in effect a contract with CMS under subpart L of this part. (b) Entitlement. If a...

42 CFR 417.458 - Recoupment of uncollected deductible and coinsurance amounts.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS... Medicare Contract § 417.458 Recoupment of uncollected deductible and coinsurance amounts. An HMO or CMP... previous contract period except in the following circumstances: (a) The HMO or CMP failed to collect the...

42 CFR 417.422 - Eligibility to enroll in an HMO or CMP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.422... entered into a contract under subpart L of this part; (d) During an enrollment period of the HMO or CMP...

42 CFR 438.6 - Contract requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., disability, ongoing health care needs, or catastrophic claims, using risk adjustment, risk sharing, or other... or need for health care services, discriminate against individuals eligible to enroll. (4) The MCO... for health care services. (5) Provide that enrollees have the right to disenroll from their PCCM in...

42 CFR 438.6 - Contract requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., disability, ongoing health care needs, or catastrophic claims, using risk adjustment, risk sharing, or other... or need for health care services, discriminate against individuals eligible to enroll. (4) The MCO... for health care services. (5) Provide that enrollees have the right to disenroll from their PCCM in...

48 CFR 334.203 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provisions and contract clauses. 334.203 Section 334.203 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management System 334.203...

48 CFR 334.203 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Solicitation provisions and contract clauses. 334.203 Section 334.203 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management System 334.203...

48 CFR 334.203 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Solicitation provisions and contract clauses. 334.203 Section 334.203 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management System 334.203...

48 CFR 334.203 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Solicitation provisions and contract clauses. 334.203 Section 334.203 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management System 334.203...

48 CFR 315.304 - Evaluation factors and significant subfactors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Evaluation factors and significant subfactors. 315.304 Section 315.304 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 315.304...

48 CFR 334.203 - Solicitation provisions and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Solicitation provisions and contract clauses. 334.203 Section 334.203 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management System 334.203...

An investigation into the variability of primary care oral surgery contracts and tariffs in England and Wales (2014/2015).

PubMed

Hierons, R J; Gerrard, G; Jones, R

2017-06-09

Primary care oral surgery services vary markedly throughout the country but until now there has been a paucity of data on these services. The British Association of Oral Surgeons (BAOS) primary care group (the authors) were tasked to gather data around primary care oral surgery contracts and tariffs and provide evidence-based recommendations on the commissioning of these services. Following a freedom of information (FOI) request, data were obtained for 27 English local area teams and seven Welsh local health boards. The data demonstrated both regional and national variability with respect to primary care oral surgery contracts, concerning both contract type and level of remuneration. These differences are discussed and the authors make recommendations for standardising oral surgery contracts and tariffs.

Using the results of a satisfaction survey to demonstrate the impact of a new library service model.

PubMed

Powelson, Susan E; Reaume, Renee D

2012-09-01

 In 2005, the University of Calgary entered into a contract to provide library services to the staff and physicians of Alberta Health Services Calgary Zone (AHS CZ), creating the Health Information Network Calgary (HINC).  A user satisfaction survey was contractually required to determine whether the new library service model created through the agreement with the University of Calgary was successful. Our additional objective was to determine whether information and resources provided through the HINC were making an impact on patient care.  A user satisfaction survey of 18 questions was created in collaboration with AHS CZ contract partners and distributed using the snowball or convenience sample method.  Six hundred and ninety-four surveys were returned. Of respondents, 75% use the HINC library services. More importantly, 43% of respondents indicated that search results provided by library staff had a direct impact on patient care decisions.  Alberta Health Services Calgary Zone staff are satisfied with the new service delivery model, they are taking advantage of the services offered, and using library provided information to improve patient care. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Context matters in NGO-government contracting for health service delivery: a case study from Pakistan.

PubMed

Zaidi, Shehla; Mayhew, Susannah H; Cleland, John; Green, Andrew T

2012-10-01

Contracting non-governmental organizations (NGOs) for health service provision is gaining increasing importance in low- and middle-income countries. However, the role of the wider context in influencing the effectiveness of contracting is not well studied and is of relevance given that contracting has produced mixed results so far. This paper applies a policy analysis approach to examine the influence of policy and political factors on contracting origin, design and implementation. Evidence is drawn from a country case study of Pakistan involving extensive NGO contracting for human immunodeficiency virus (HIV) prevention services supported by international donor agencies. A multilevel study was conducted using 84 in-depth interviews, 22 semi-structured interviews, document review and direct observation to examine the national policy design, provincial management of contracting and local contract implementation. There were three main findings. First, contracting origin and implementation was an inherently political process affected by the wider policy context. Although in Pakistan a combination of situational events successfully managed to introduce extensive and sophisticated contracting, it ran into difficulties during implementation due to ownership and capacity issues within government. Second, wide-scale contracting was mis-matched with the capacity of local NGOs, which resulted in sub-optimal contract implementation challenging the reliance on market simulation through contracting. Third, we found that contracting can have unintended knock-on effects on both providers and purchasers. As a result of public sector contracts, NGOs became more distanced from their grounded attributes. Effects on government purchasers were more unpredictable, with greater identification with contracting in supportive governance contexts and further distancing in unsupportive contexts. A careful approach is needed in government contracting of NGOs, taking into account acceptance of contracting NGOs, local NGO capacities and potential distancing of NGOs from their traditional attributes under contracts. Political factors and knock-on effects are likely to be heightened in the sudden and aggressive use of contracting in unprepared settings.

Social contract theory and just decision making: lessons from genetic testing for the BRCA mutations.

PubMed

Williams-Jones, Bryn; Burgess, Michael M

2004-06-01

Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection--e.g., patents--of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniel's and Sabin's "accountability for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation.

42 CFR 420.1 - Scope and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Scope and purpose. 420.1 Section 420.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... and control information. It also deals with access to records pertaining to certain contracts entered...

42 CFR 420.1 - Scope and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Scope and purpose. 420.1 Section 420.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... and control information. It also deals with access to records pertaining to certain contracts entered...

42 CFR 420.1 - Scope and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Scope and purpose. 420.1 Section 420.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... and control information. It also deals with access to records pertaining to certain contracts entered...

42 CFR 417.520 - Effect on HMO and CMP contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 417.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND... these provisions, references to “M+C organizations” must be read as references to “HMOs and CMPs”. (c...

42 CFR 438.108 - Cost sharing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cost sharing. 438.108 Section 438.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.108 Cost sharing. The contract must...

42 CFR 434.78 - Right to reconsideration of disallowance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Right to reconsideration of disallowance. 434.78 Section 434.78 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS CONTRACTS Federal Financial Participation § 434.78 Right...

48 CFR 304.804-70 - Contract closeout audits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Contract closeout audits. 304.804-70 Section 304.804-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL...-reimbursement contracts with colleges and universities, hospitals, non-profit organizations, and State and local...

48 CFR 304.804-70 - Contract closeout audits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract closeout audits. 304.804-70 Section 304.804-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL...-reimbursement contracts with colleges and universities, hospitals, non-profit organizations, and State and local...

45 CFR 98.11 - Administration under contracts and agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Administration under contracts and agreements. 98.11 Section 98.11 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.11 Administration under contracts and...

45 CFR 98.11 - Administration under contracts and agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Administration under contracts and agreements. 98.11 Section 98.11 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.11 Administration under contracts and...

Health Careers Opportunity Program (HCOP). Section 787 (Public Health Service Act). Program Guide.

ERIC Educational Resources Information Center

Department of Health and Human Services, Washington, DC.

This document summarizes the requirements and guidelines for the Health Careers Opportunity Program (HCOP). This program is authorized by Section 787 of the Public Health Service Act to make grants to and contracts with postsecondary institutions to carry out programs which assist individuals from disadvantaged backgrounds to enter and graduate…

42 CFR 405.435 - Failure to maintain opt-out.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Failure to maintain opt-out. 405.435 Section 405.435 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.435 Failure to...

41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... VETERANS, AND ARMED FORCES SERVICE MEDAL VETERANS Discrimination Prohibited § 60-300.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

42 CFR 405.420 - Requirements of the opt-out affidavit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Requirements of the opt-out affidavit. 405.420 Section 405.420 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.420...

42 CFR 405.445 - Renewal and early termination of opt-out.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Renewal and early termination of opt-out. 405.445 Section 405.445 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.445...

42 CFR 405.430 - Failure to properly opt-out.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Failure to properly opt-out. 405.430 Section 405.430 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.430 Failure to...

42 CFR 405.425 - Effects of opting-out of Medicare.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Effects of opting-out of Medicare. 405.425 Section 405.425 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.425...

42 CFR 52h.12 - Other regulations that apply.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Other regulations that apply. 52h.12 Section 52h.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS § 52h.12 Other...

Specification Section 01065S ES&H for Service Contracts

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

Kirsch, Greg C.

2014-07-01

Section Includes: Requirements and guidelines in performance of work concerning protection of environment and property, and the safety and health of Contractors, Sandia National Laboratories (SNL) and Department of Energy (DOE) employees, visitors to SNL, and members of the public. This Section is applicable only to Service Contracts that do not involve construction or construction-like activities. Construction and construction-like activities are covered by Section 01065, Environment, Safety and Health (ES&H) for Construction Contracts. The entire ES&H program shall focus on safe-by-design intent, understanding the technical basis for the work, identifying and controlling energy sources, unacceptable consequences, risk assessments, and positivemore » verification.« less

Evaluating opportunities for direct contracting between employers and physician-hospital organizations.

PubMed

Straley, P F; Swaim, C R

1994-01-01

Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting.

42 CFR 417.444 - Special rules for certain enrollees of risk HMOs and CMPs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS... Medicare Contract § 417.444 Special rules for certain enrollees of risk HMOs and CMPs. (a) Applicability...: (1) On February 1, 1985, was enrolled— (i) In an HMO or CMP that had in effect a cost contract...

42 CFR 420.1 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Scope and purpose. 420.1 Section 420.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... control information. It also deals with access to records pertaining to certain contracts entered into by...

42 CFR 420.1 - Scope and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Scope and purpose. 420.1 Section 420.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... control information. It also deals with access to records pertaining to certain contracts entered into by...

5 CFR 890.807 - When do enrollments terminate, cancel or suspend?

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits for Former Spouses... on whose service the health benefits are based. (2) OPM may authorize a longer time frame for the... individual contract for health benefits. (4) A former spouse who cancels his or her enrollment for any reason...

5 CFR 890.807 - When do enrollments terminate, cancel or suspend?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits for Former Spouses... on whose service the health benefits are based. (2) OPM may authorize a longer time frame for the... individual contract for health benefits. (4) A former spouse who cancels his or her enrollment for any reason...

5 CFR 890.807 - When do enrollments terminate, cancel or suspend?

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits for Former Spouses... on whose service the health benefits are based. (2) OPM may authorize a longer time frame for the... individual contract for health benefits. (4) A former spouse who cancels his or her enrollment for any reason...

42 CFR 52h.5 - Conflict of interest.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS § 52h.5 Conflict of interest. (a... Government Ethics Standards of Ethical Conduct for Employees of the Executive Branch (5 CFR part 2635), and...

42 CFR 438.100 - Enrollee rights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Enrollee rights. 438.100 Section 438.100 Public...).) (iv) Participate in decisions regarding his or her health care, including the right to refuse... scope of the PAHP's contracted services) has the right to be furnished health care services in...

42 CFR 438.100 - Enrollee rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Enrollee rights. 438.100 Section 438.100 Public...).) (iv) Participate in decisions regarding his or her health care, including the right to refuse... scope of the PAHP's contracted services) has the right to be furnished health care services in...

42 CFR 438.100 - Enrollee rights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Enrollee rights. 438.100 Section 438.100 Public...).) (iv) Participate in decisions regarding his or her health care, including the right to refuse... scope of the PAHP's contracted services) has the right to be furnished health care services in...

42 CFR 438.100 - Enrollee rights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Enrollee rights. 438.100 Section 438.100 Public...).) (iv) Participate in decisions regarding his or her health care, including the right to refuse... scope of the PAHP's contracted services) has the right to be furnished health care services in...

78 FR 41932 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... organizational capacity to provide health care services. Medicaid enrollees use the information collected and reported to make informed choices regarding health care, including how to access health care services and... contracting process with managed care entities, as well as its compliance oversight role. We use the...

25 CFR 900.2 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Privacy Act. (f) Information collection. The Office of Management and Budget has approved, under 44 U.S.C... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... contracts by the Department of Health and Human Services (DHHS) and the Department of the Interior (DOI) in...

School-Based Mental Health Services under Medicaid Managed Care: Policy Report.

ERIC Educational Resources Information Center

Robinson, Gail K.; Barrett, Marihelen; Tunkelrott, Traci; Kim, John

This document reviews how schools and providers of school-based mental health programs have implemented managed care contracts with Medicaid managed care organizations. Observations were made at three sites (Albuquerque, NM; Baltimore, MD; New London, CT) where school-based mental health services were provided by Medicaid organizations. Following…

Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

PubMed

Addicott, Rachael

2016-01-01

For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

[Collective versus selective contracts from a legal point of view].

PubMed

Schirmer, Horst Dieter

2006-01-01

The historically proven organisational model of service relations between sickness funds and healthcare providers are collective contracts. A collective contract as a standards treaty ("Normenvertrag") is particularly pronounced concerning the panel doctor law ("Vertragsarztrecht") defining medical care on the basis of the principle of benefits in kind governing benefit claims of the insured in case of illness. The collective contract is a suitable instrument for ensuring both consistent and exhaustive provision of care and for organising the conditions of care, especially the quality and reimbursement of professional medical services. For several years the legislator has been "experimenting" with parallel contract design patterns such as the contract of integrated care in the form of selective contracts between health insurances or their associations and healthcare providers or groups of healthcare providers. More recently, allowances for conclusion of such contracts have been supposed to lead to competition between the contractual systems. It is doubtful whether this "push-start" will contribute to overcoming the systematic legal disadvantages of selective contracting as an organisational model for the provision of healthcare services to the insured.

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Procedures to be followed when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2...

48 CFR 334.203-70 - HHS solicitation provisions and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provisions and contract clauses. 334.203-70 Section 334.203-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management... Value Management System—Pre-Award IBR, in solicitations that will require the contractor to use an EVMS...

48 CFR 334.203-70 - HHS solicitation provisions and contract clauses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... provisions and contract clauses. 334.203-70 Section 334.203-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management... Value Management System—Pre-Award IBR, in solicitations that will require the contractor to use an EVMS...

48 CFR 334.203-70 - HHS solicitation provisions and contract clauses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... provisions and contract clauses. 334.203-70 Section 334.203-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management... Value Management System—Pre-Award IBR, in solicitations that will require the contractor to use an EVMS...

48 CFR 334.203-70 - HHS solicitation provisions and contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provisions and contract clauses. 334.203-70 Section 334.203-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management... Value Management System—Pre-Award IBR, in solicitations that will require the contractor to use an EVMS...

48 CFR 315.605 - Content of unsolicited proposals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Content of unsolicited proposals. 315.605 Section 315.605 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Unsolicited Proposals 315.605 Content of unsolicited proposals. (d) Certification by...

48 CFR 332.704 - Limitation of cost or funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Limitation of cost or funds. 332.704 Section 332.704 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 332.704 Limitation of cost or funds. See subpart...

48 CFR 334.203-70 - HHS solicitation provisions and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... provisions and contract clauses. 334.203-70 Section 334.203-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Earned Value Management... Value Management System—Pre-Award IBR, in solicitations that will require the contractor to use an EVMS...

48 CFR 327.404-70 - Solicitation provision and contract clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provision and contract clause. 327.404-70 Section 327.404-70 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Data and Copyrights 327...

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study

PubMed Central

Willging, Cathleen E.; Aarons, Gregory A.; Trott, Elise M.; Green, Amy E.; Finn, Natalie; Ehrhart, Mark G.; Hecht, Debra B.

2016-01-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives. PMID:26386977

25 CFR 900.252 - In an emergency reassumption, what is the Secretary required to do?

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF...; (b) Assume control or operation of all or part of the program; and (c) Give written notice to the...

25 CFR 900.252 - In an emergency reassumption, what is the Secretary required to do?

Code of Federal Regulations, 2011 CFR

2011-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF...; (b) Assume control or operation of all or part of the program; and (c) Give written notice to the...

25 CFR 900.223 - When does an Indian tribe or tribal organization get the decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...” depends upon the size and complexity of your claim, and upon the adequacy of the information you have...

25 CFR 900.223 - When does an Indian tribe or tribal organization get the decision?

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND...” depends upon the size and complexity of your claim, and upon the adequacy of the information you have...

Risk transfer and accountability in managed care organizations' carve-out contracts.

PubMed

Garnick, D W; Horgan, C M; Hodgkin, D; Merrick, E L; Goldin, D; Ritter, G; Skwara, K C

2001-11-01

This study examined characteristics of contracts between managed care organizations (MCOs) and managed behavioral health organizations (MBHOs) in terms of delegation of functions, financial arrangements between the MCO and the MBHO, and the use of performance standards. Nationally representative administrative and clinical information about the three largest types of commercial products offered by 434 MCOs in 60 market areas was gathered by telephone survey. These products comprised services provided by health maintenance organizations, preferred provider organizations, and point-of-service plans. Chi square tests were performed between pairings of all three types of products to ascertain differences in the degree to which claims processing, maintenance of provider networks, utilization management, case management, and quality improvement were delegated to MBHOs through specialty contracts among the various types of products. Contractual specifications about capitation arrangements, risk sharing, the use of performance standards, and final utilization review decisions were also compared. For all types of products, almost all the major functions were contracted by the MCO to the MBHO. Although most contracts assigned some risk for the costs of services to the MBHO, the degree of this risk varied by product type. Except in the case of preferred-provider organizations, a large number of performance standards were identified in MCOs' contracts with MBHOs, although financial incentives were rarely tied to such standards. MCOs that contract with MBHOs place major responsibility, both financial and administrative, on the vendors.

The Application of Operational Art to Health Service Support: A Case Study of the Korean and Vietnam Wars

DTIC Science & Technology

2017-05-25

The Application of Operational Art to Health Service Support: A Case Study of the Korean and Vietnam Wars A Monograph by MAJ Brian M. Downs...of Operational Art to Health Service Support: A Case Study of the Korean and Vietnam Wars 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...ABSTRACT Health Service Support (HSS) planners have endured static healthcare operations over the last 15 years during operations in Iraq and

Nature and determinants of customer expectations of service recovery in health care.

PubMed

Dasu, S; Rao, J

1999-01-01

Service recovery refers to the service provider's response to a dissatisfied customer. This article proposes a model of customer expectations of service recovery in health care services. The model discusses two types of service recovery expectations: will and should. An exploratory study indicates that industry reputation and personal experiences drive customers' "will-expectations" of service recovery while "should-expectations" can be explained via norm, fairness, social contract and hospitality theories.

Outsourcing primary health care services--how politicians explain the grounds for their decisions.

PubMed

Laamanen, Ritva; Simonsen-Rehn, Nina; Suominen, Sakari; Øvretveit, John; Brommels, Mats

2008-12-01

To explore outsourcing of primary health care (PHC) services in four municipalities in Finland with varying amounts and types of outsourcing: a Southern municipality (SM) which contracted all PHC services to a not-for-profit voluntary organization, and Eastern (EM), South-Western (SWM) and Western (WM) municipalities which had contracted out only a few services to profit or public organizations. A mail survey to all municipality politicians (response rate 52%, N=101) in 2004. Data were analyzed using cross-tabulations, Spearman correlation and linear regression analyses. Politicians were willing to outsource PHC services only partially, and many problems relating to outsourcing were reported. Politicians in all municipalities were least likely to outsource preventive services. A multiple linear regression model showed that reported preference to outsource in EM and in SWM was lower than in SM, and also lower among politicians from "leftist" political parties than "rightist" political parties. Perceived difficulties in local health policy issues were related to reduced preference to outsource. The model explained 27% of the variance of the inclination to outsource PHC services. The findings highlight how important it is to take into account local health policy issues when assessing service-provision models.

42 CFR 411.7 - Services that must be furnished at public expense under a Federal law or Federal Government...

Code of Federal Regulations, 2010 CFR

2010-10-01

... under a Federal law or Federal Government contract. 411.7 Section 411.7 Public Health CENTERS FOR....7 Services that must be furnished at public expense under a Federal law or Federal Government contract. (a) Basic rule. Except as provided in paragraph (b) of this section, payment may not be made for...

Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care

PubMed Central

Hulme, C; Robinson, P G; Saloniki, E C; Vinall-Collier, K; Baxter, P D; Douglas, G; Gibson, B; Godson, J H; Meads, D; Pavitt, S H

2016-01-01

Objective To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). Design Non-randomised controlled study. Setting Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. Participants 550 new adult patients. Interventions A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. Main outcome measures Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. Results At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. Conclusions This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies. PMID:27609858

42 CFR 417.470 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Basis and scope. 417.470 Section 417.470 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... section 1876(c), (g), (h), and (i) of the Act that pertain to the contract between CMS and an HMO or CMP...

The psychological contracts of National Health Service nurses.

PubMed

Purvis, Lynne J; Cropley, Mark

2003-03-01

Following the psychological contract model of the employee-employer exchange relationship is offered as a means of understanding the expectations of a UK sample of 223 National Health Service (NHS) nurses in association with their leaving intentions. A pilot study involving 21 NHS nurses, using the repertory grid technique was conducted to elicit contract expectations. Twenty-nine categories of expectation were identified through content analysis. The study proper, employed a survey developed on the basis of results from the pilot study to identify contract profiles among 223 nurses from three London/South-east NHS hospitals, using the Q-sort method. Type of contract held (relational/transactional), satisfaction (job and organization), and leaving intentions were also examined. Q-analysis yielded four contract profiles among the nurses sampled: 'self-development and achievement'; 'belonging and development'; 'competence and collegiality' and 'autonomy and development'. Correlation analysis demonstrated that leaving intentions were associated with a need for personal autonomy and development, and the violation of expectations for being appreciated, valued, recognized and rewarded for effort, loyalty, hard-work and achievement, negative endorsement of a relational contract, positive endorsement of a transactional contract, and job and organizational dissatisfaction. Findings illustrate the diagnostic utility of the term psychological contract for understanding the expectations of NHS nurses. The potential significance of these findings for managing nurse retention is highlighted.

42 CFR 423.509 - Termination of contract by CMS.

Code of Federal Regulations, 2014 CFR

2014-10-01

...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan sponsor in writing at least 45... experiences financial difficulties so severe that its ability to make necessary health services available is...) CMS notifies the Part D plan sponsor in writing that its contract will be terminated on a date...

48 CFR 339.7103 - Solicitation and contract clause.

Code of Federal Regulations, 2011 CFR

2011-10-01

... clause. 339.7103 Section 339.7103 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Information Security Management...-72, Security Requirements for Federal Information Technology Resources, in solicitations and...

48 CFR 339.7103 - Solicitation and contract clause.

Code of Federal Regulations, 2014 CFR

2014-10-01

... clause. 339.7103 Section 339.7103 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Information Security Management...-72, Security Requirements for Federal Information Technology Resources, in solicitations and...

48 CFR 339.7103 - Solicitation and contract clause.

Code of Federal Regulations, 2013 CFR

2013-10-01

... clause. 339.7103 Section 339.7103 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Information Security Management...-72, Security Requirements for Federal Information Technology Resources, in solicitations and...

48 CFR 339.7103 - Solicitation and contract clause.

Code of Federal Regulations, 2012 CFR

2012-10-01

... clause. 339.7103 Section 339.7103 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Information Security Management...-72, Security Requirements for Federal Information Technology Resources, in solicitations and...

The Lesotho Hospital PPP experience: catalyst for integrated service delivery.

PubMed

Coelho, Carla Faustino; O'Farrell, Catherine Commander

2011-01-01

For many years, Lesotho urgently needed to replace its main public hospital, Queen Elizabeth II. The project was initially conceived as a single replacement hospital, but eventually included the design and construction of a new 425 bed public hospital and adjacent primary care clinic, the renovation and expansion of three strategically located primary care clinics in the region and the management of all facilities, equipment and delivery of all clinical services in the health network by a private operator under contract for 18 years. The project's design was influenced by the recognition that a new facility alone would not address the underlying issues in service provision. The creation of this PPP health network and the contracting mechanism has increased accountability for service quality, shifted Government to a more strategic role and may also benefit other public facilities and providers in Lesotho. The county is considering the PPP approach for other health facilities.

Professionalism and medicine's social contract with society.

PubMed

Cruess, Sylvia R

2006-08-01

Medicine's relationship with society has been described as a social contract: an "as if" contract with obligations and expectations on the part of both society and medicine, "each of the other". The term is often used without elaboration by those writing on professionalism in medicine. Based on the literature, society's expectations of medicine are: the services of the healer, assured competence, altruistic service, morality and integrity, accountability, transparency, objective advice, and promotion of the public good. Medicine's expectations of society are: trust, autonomy, self-regulation, a health care system that is value-driven and adequately funded, participation in public policy, shared responsibility for health, a monopoly, and both non-financial and financial rewards. The recognition of these expectations is important as they serve as the basis of a series of obligations which are necessary for the maintenance of medicine as a profession. Mutual trust and reasonable demands are required of both parties to the contract.

Indian Health Service: Community Health

MedlinePlus

... Community Health Representatives (CHRs) Office of Environmental Health & Engineering (OEHE) Environmental Health Support Center Training (EHSCT) IHS ... Contracting Tribes - 08E17 Office of Environmental Health and Engineering - 10N14C Office of Finance and Accounting - 10E54 Office ...

25 CFR 900.245 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2012 CFR

2012-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... improvements borne by the Indian tribe or tribal organization, in excess of $5,000 at the time of the...

25 CFR 900.245 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... improvements borne by the Indian tribe or tribal organization, in excess of $5,000 at the time of the...

25 CFR 900.245 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... improvements borne by the Indian tribe or tribal organization, in excess of $5,000 at the time of the...

25 CFR 900.245 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2014 CFR

2014-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... improvements borne by the Indian tribe or tribal organization, in excess of $5,000 at the time of the...

25 CFR 900.245 - What obligation does the Indian tribe or tribal organization have with respect to returning...

Code of Federal Regulations, 2013 CFR

2013-04-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND... improvements borne by the Indian tribe or tribal organization, in excess of $5,000 at the time of the...

48 CFR 352.202-1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 352.202-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS... Department of Health and Human Services; and the term “his/her duly authorized representative” means any...), add the following paragraph (h): “(h) The term “Contracting Officer's Technical Representative” means...

Administrative Preparedness Strategies: Expediting Procurement and Contracting Cycle Times During an Emergency.

PubMed

Hurst, David; Sharpe, Sharon; Yeager, Valerie A

We assessed whether administrative preparedness processes that were intended to expedite the acquisition of goods and services during a public health emergency affect estimated procurement and contracting cycle times. We obtained data from 2014-2015 applications to the Hospital Preparedness Program and Public Health Emergency Preparedness (HPP-PHEP) cooperative agreements. We compared the estimated procurement and contracting cycle times of 61 HPP-PHEP awardees that did and did not have certain administrative processes in place. Certain processes, such as statutes allowing for procuring and contracting on the open market, had an effect on reducing the estimated cycle times for obtaining goods and services. Other processes, such as cooperative purchasing agreements, also had an effect on estimated procurement time. For example, awardees with statutes that permitted them to obtain goods and services in the open market had an average procurement cycle time of 6 days; those without such statutes had a cycle time of 17 days ( P = .04). PHEP awardees should consider adopting these or similar processes in an effort to reduce cycle times.

Contracting for directorships.

PubMed

Knapp, Donna K

2013-05-01

Hospitals are required to have a medical director of respiratory care as a condition of their participation in the Federal Medicare and Medicaid programs. This gives physicians opportunities to improve the quality of care for the patients in their community, to diversify income streams, and to assist hospitals to meet regulatory requirements for quality. The contracts for these positions are usually provided by the hospital, so it is imperative that physicians know how to protect their interests, what is expected of them, if they are being paid fairly, and that the contract is compliant with all regulatory issues. The directorship relationship with the hospital that provides designated health services and the "stand in the shoes" definition of direct compensation also gives physicians and physician practices guidance to determine if their group and individual physicians are compliant with Stark and antikickback regulations. This article guides physicians through the process of reviewing a contract for medical directorship or service line management services. Information on compensation in the directorship market can be found in at least two standard surveys. Duties and compensation vary among entities and frequently include incentive-based compensation for improving quality measures and operations. Directorships are evolving to service line management as more of the hospital's reimbursement is linked to clinical quality and patient satisfaction. This article does not offer legal advice, nor is it meant to be all inclusive. Physicians should consult a health-care attorney for any questions before signing any contract.

From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study.

PubMed

Jacobs, Bart; Thomé, Jean-Marc; Overtoom, Rob; Sam, Sam Oeun; Indermühle, Lorenz; Price, Neil

2010-05-01

Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study period-notably the development of performance indicators and targets and the performance monitoring.

Air Force Contingency Contracting: Reachback and Other Opportunities for Improvement

DTIC Science & Technology

2011-01-01

electrical, mechanical, air conditioning, food service , lodging management, laundry plant operation, fire protection emergency management, professional...public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INFRASTRUCTURE AND...information, including suggestions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports

21 CFR 25.30 - General.

Code of Federal Regulations, 2013 CFR

2013-04-01

... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT... compliance with all Federal, State, and local requirements. (e) Extramural contracts, other agreements, or... environment. (f) Extramural contracts, other agreements, and grants for research for such purposes as to...

21 CFR 25.30 - General.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT... compliance with all Federal, State, and local requirements. (e) Extramural contracts, other agreements, or... environment. (f) Extramural contracts, other agreements, and grants for research for such purposes as to...

21 CFR 25.30 - General.

Code of Federal Regulations, 2014 CFR

2014-04-01

... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT... compliance with all Federal, State, and local requirements. (e) Extramural contracts, other agreements, or... environment. (f) Extramural contracts, other agreements, and grants for research for such purposes as to...

21 CFR 25.30 - General.

Code of Federal Regulations, 2012 CFR

2012-04-01

... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT... compliance with all Federal, State, and local requirements. (e) Extramural contracts, other agreements, or... environment. (f) Extramural contracts, other agreements, and grants for research for such purposes as to...

48 CFR 304.602 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false General. 304.602 Section 304.602 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE MATTERS Contract Reporting 304.602 General. HHS' Departmental Contracts Information System (DCIS) captures...

A transaction costs analysis of changing contractual relations in the English NHS.

PubMed

Marini, Giorgia; Street, Andrew

2007-09-01

The English National Health Service has replaced locally negotiated block contracting arrangements with a system of national prices to pay for hospital activity. This paper applies a transaction costs approach to quantify and analyse the nature of how contracting costs have changed as a consequence. Data collection was based on semi-structured interviews with key stakeholders from hospitals and Primary Care Trusts, which purchase hospital services. Replacing block contracting with activity based funding has led to lower costs of price negotiation, but these are outweighed by higher costs associated with volume control, of data collection, contract monitoring, and contract enforcement. There was consensus that the new contractual arrangements were preferable, but the benefits will have to be demonstrated formally in future.

42 CFR 52h.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... areas under review, to give expert advice on the scientific and technical merit of grant applications or... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS § 52h.2 Definitions. As used in this...

42 CFR 52h.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... areas under review, to give expert advice on the scientific and technical merit of grant applications or... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT CONTRACT PROJECTS § 52h.2 Definitions. As used in this...

Indian Health Service

MedlinePlus

... Executive Secretariat Staff - 08E86 Office of the Director/Public Affairs Staff - 08E73 Office of Direct Service and Contracting Tribes - 08E17 Office of Environmental Health and Engineering - 10N14C Office of Finance and Accounting - 10E54 Office of Human Resources - 11E53A ...

41 CFR 101-4.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Health and insurance... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 101-4.440 Health and insurance benefits and services. Subject to § 101-4.235(d), in providing a medical, hospital, accident, or...

42 CFR 423.509 - Termination of contract by CMS.

Code of Federal Regulations, 2010 CFR

2010-10-01

...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan in writing 90 days before the... difficulties so severe that its ability to make necessary health services available is impaired to the point of... writing that its contract will be terminated on a date specified by CMS. If a termination in is effective...

42 CFR 423.509 - Termination of contract by CMS.

Code of Federal Regulations, 2011 CFR

2011-10-01

...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan in writing 90 days before the... difficulties so severe that its ability to make necessary health services available is impaired to the point of... writing that its contract will be terminated on a date specified by CMS. If a termination in is effective...

25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

Code of Federal Regulations, 2010 CFR

2010-04-01

... standards that apply to a tribal organization carrying out a self-determination contract? 900.43 Section 900... organization carrying out a self-determination contract? A tribal organization shall expend and account for..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

Code of Federal Regulations, 2012 CFR

2012-04-01

... standards that apply to a tribal organization carrying out a self-determination contract? 900.43 Section 900... organization carrying out a self-determination contract? A tribal organization shall expend and account for..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

Code of Federal Regulations, 2014 CFR

2014-04-01

... standards that apply to a tribal organization carrying out a self-determination contract? 900.43 Section 900... organization carrying out a self-determination contract? A tribal organization shall expend and account for..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

Code of Federal Regulations, 2011 CFR

2011-04-01

... standards that apply to a tribal organization carrying out a self-determination contract? 900.43 Section 900... organization carrying out a self-determination contract? A tribal organization shall expend and account for..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.43 - What are the general financial management system standards that apply to a tribal organization...

Code of Federal Regulations, 2013 CFR

2013-04-01

... standards that apply to a tribal organization carrying out a self-determination contract? 900.43 Section 900... organization carrying out a self-determination contract? A tribal organization shall expend and account for..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.100 - May the Secretary elect to reacquire excess BIA or IHS property whose title has been transferred...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... organization? Yes. When a self-determination contract or grant agreement, or portion—thereof, is retroceded... property; (a) Except as provided in paragraph (b) of this section when a self-determination contract or...

25 CFR 900.100 - May the Secretary elect to reacquire excess BIA or IHS property whose title has been transferred...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... organization? Yes. When a self-determination contract or grant agreement, or portion—thereof, is retroceded... property; (a) Except as provided in paragraph (b) of this section when a self-determination contract or...

25 CFR 900.100 - May the Secretary elect to reacquire excess BIA or IHS property whose title has been transferred...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... organization? Yes. When a self-determination contract or grant agreement, or portion—thereof, is retroceded... property; (a) Except as provided in paragraph (b) of this section when a self-determination contract or...

25 CFR 900.100 - May the Secretary elect to reacquire excess BIA or IHS property whose title has been transferred...

Code of Federal Regulations, 2014 CFR

2014-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... organization? Yes. When a self-determination contract or grant agreement, or portion—thereof, is retroceded... property; (a) Except as provided in paragraph (b) of this section when a self-determination contract or...

25 CFR 900.100 - May the Secretary elect to reacquire excess BIA or IHS property whose title has been transferred...

Code of Federal Regulations, 2013 CFR

2013-04-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION... organization? Yes. When a self-determination contract or grant agreement, or portion—thereof, is retroceded... property; (a) Except as provided in paragraph (b) of this section when a self-determination contract or...

42 CFR 417.452 - Liability of Medicare enrollees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.452...

48 CFR 305.502 - Authority.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Authority. 305.502 Section 305.502 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Paid Advertisements 305.502 Authority. The Contracting Officer may...

48 CFR 305.502 - Authority.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Authority. 305.502 Section 305.502 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Paid Advertisements 305.502 Authority. The Contracting Officer may...

48 CFR 305.502 - Authority.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Authority. 305.502 Section 305.502 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Paid Advertisements 305.502 Authority. The Contracting Officer may...

48 CFR 305.502 - Authority.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Authority. 305.502 Section 305.502 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Paid Advertisements 305.502 Authority. The Contracting Officer may...

48 CFR 305.502 - Authority.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Authority. 305.502 Section 305.502 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Paid Advertisements 305.502 Authority. The Contracting Officer may...

Agency and Market Area Factors Affecting Home Health Agency Supply Changes

PubMed Central

Porell, Frank W; Liu, Korbin; Brungo, David P

2006-01-01

Objective To use the natural experiment created by the Medicare interim payment system (IPS) to study supply change behavior of home health agencies (HHAs) in local market areas. Data Sources One hundred percent Medicare home health claims for 1996 and 1999, linked with Medicare Provider of Service and Denominator files, and the Area Resource File. Study Design Medicare home health care (HHC) claims data were used to distinguish HHAs that changed the local market supply of Medicare HHC by their market exit or by significant expansion or contraction of their geographic service area between 1996 and 1999 from other HHAs. Multinomial logit models were estimated to analyze how characteristics of agencies and the market areas in which they served were associated with these different agency-level supply changes. Principal Findings Changes in local HHA supply stemming from geographic service area expansions and contractions rivaled those owing to agency closures and market entries. Agencies at greater risk of closure and service area contraction tended to be smaller, newer, freestanding agencies, operating with more visit-intensive practice styles in markets with more competitor agencies. Except for having much less visit-intensive practice styles, similar attributes characterized agencies that increased local supply through service area expansion. Conclusions Supply changes by HHAs largely reflected rational market responses by agencies to significant changes in financial incentives associated with the Medicare IPS. Recently certified agencies were among the most dynamic providers. Supply changes were more likely among agencies operating in more competitive market environments. PMID:16987305

Agency and market area factors affecting home health agency supply changes.

PubMed

Porell, Frank W; Liu, Korbin; Brungo, David P

2006-10-01

To use the natural experiment created by the Medicare interim payment system (IPS) to study supply change behavior of home health agencies (HHAs) in local market areas. One hundred percent Medicare home health claims for 1996 and 1999, linked with Medicare Provider of Service and Denominator files, and the Area Resource File. Medicare home health care (HHC) claims data were used to distinguish HHAs that changed the local market supply of Medicare HHC by their market exit or by significant expansion or contraction of their geographic service area between 1996 and 1999 from other HHAs. Multinomial logit models were estimated to analyze how characteristics of agencies and the market areas in which they served were associated with these different agency-level supply changes. Changes in local HHA supply stemming from geographic service area expansions and contractions rivaled those owing to agency closures and market entries. Agencies at greater risk of closure and service area contraction tended to be smaller, newer, freestanding agencies, operating with more visit-intensive practice styles in markets with more competitor agencies. Except for having much less visit-intensive practice styles, similar attributes characterized agencies that increased local supply through service area expansion. Supply changes by HHAs largely reflected rational market responses by agencies to significant changes in financial incentives associated with the Medicare IPS. Recently certified agencies were among the most dynamic providers. Supply changes were more likely among agencies operating in more competitive market environments.

Asymmetric Information in Iranian’s Health Insurance Market: Testing of Adverse Selection and Moral Hazard

PubMed Central

Lotfi, Farhad; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Hadian, Mohammad

2015-01-01

Background: Asymmetric information is one of the most important issues in insurance market which occurred due to inherent characteristics of one of the agents involved in insurance contracts; hence its management requires designing appropriate policies. This phenomenon can lead to the failure of insurance market via its two consequences, namely, adverse selection and moral hazard. Objective: This study was aimed to evaluate the status of asymmetric information in Iran’s health insurance market with respect to the demand for outpatient services. Materials/sPatients and Methods: This research is a cross sectional study conducted on households living in Iran. The data of the research was extracted from the information on household’s budget survey collected by the Statistical Center of Iran in 2012. In this study, the Generalized Method of Moment model was used and the status of adverse selection and moral hazard was evaluated through calculating the latent health status of individuals in each insurance category. To analyze the data, Excel, Eviews and stata11 software were used. Results: The estimation of parameters of the utility function of the demand for outpatient services (visit, medicine, and Para-clinical services) showed that households were more risk averse in the use of outpatient care than other goods and services. After estimating the health status of households based on their health insurance categories, the results showed that rural-insured people had the best health status and people with supplementary insurance had the worst health status. In addition, the comparison of the conditional distribution of latent health status approved the phenomenon of adverse selection in all insurance groups, with the exception of rural insurance. Moreover, calculation of the elasticity of medical expenses to reimbursement rate confirmed the existence of moral hazard phenomenon. Conclusions: Due to the existence of the phenomena of adverse selection and moral hazard in most of health insurances categories, policymakers need to adjust contracts so that to reduce these phenomena. Given the importance of financing, the presence of such problems can lead to less coverage of health insurance provided by insurers, loss of contracts with health care institutions and service providers, and lower quality of health services. PMID:26153155

42 CFR 417.418 - Qualifying condition: Quality assurance program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.418...

Defense Health Care: Department of Defense Needs a Strategic Approach to Contracting for Health Care Professionals

DTIC Science & Technology

2013-05-01

DOD identify, develop, and implement joint medical personnel standards for shared services .22 While DOD concurred with our recommendation, as of...a defense health agency in part to assume the responsibility for creating and managing shared services , and leave the military chain of command...intact with the military departments in control of their military treatment facilities. This option would include a shared services concept to

48 CFR 52.222-41 - Service Contract Act of 1965.

Code of Federal Regulations, 2010 CFR

2010-10-01

... subcontractor which are unsanitary, hazardous, or dangerous to the health or safety of the service employees. The Contractor or subcontractor shall comply with the safety and health standards applied under 29 CFR... avoid serious impairment of the conduct of Government business. (1) Apprentices, student-learners, and...

25 CFR 900.52 - What type of property is the property management system required to track?

Code of Federal Regulations, 2012 CFR

2012-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems... required to track? The property management system of the Indian tribe or tribal organization shall track...

25 CFR 900.52 - What type of property is the property management system required to track?

Code of Federal Regulations, 2014 CFR

2014-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems... required to track? The property management system of the Indian tribe or tribal organization shall track...

25 CFR 900.52 - What type of property is the property management system required to track?

Code of Federal Regulations, 2011 CFR

2011-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems... required to track? The property management system of the Indian tribe or tribal organization shall track...

25 CFR 900.52 - What type of property is the property management system required to track?

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems... required to track? The property management system of the Indian tribe or tribal organization shall track...

25 CFR 900.52 - What type of property is the property management system required to track?

Code of Federal Regulations, 2013 CFR

2013-04-01

... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems... required to track? The property management system of the Indian tribe or tribal organization shall track...

Contracting in specialists for emergency obstetric care- does it work in rural India?

PubMed

Randive, Bharat; Chaturvedi, Sarika; Mistry, Nerges

2012-12-31

Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India. Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped. Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility. Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.

Contracting in specialists for emergency obstetric care- does it work in rural India?

PubMed Central

2012-01-01

Background Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India. Methods Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped. Results Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility. Conclusions Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration. PMID:23276148

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service.

PubMed

van Meeuwen, Dorine Pd; van Walt Meijer, Quirine J; Simonse, Lianne Wl

2015-03-24

With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service.

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service

PubMed Central

2015-01-01

Background With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. Objective The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. Methods This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. Results We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. Conclusions For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service. PMID:25831094

[Health status comparative analysis of the emercom of Russia Federal fire service employees and contract servicemen in the Russian Army].

PubMed

Koteev, P K; Kireev, S G; Golovinova, V Iu

2013-08-01

Results of health status comparative analysis of the emercom of Russia Federal fire service employees and contract servicemen in the Russian Army are submitted as following. The emercom of russia firemen's average annual rate of primary morbidity is 459,1, that of labor losses' days 8430,8, of disability 0,9, and mortality cases 0,7. The russian army contract servicemen's average annual rate of primary morbidity during the covered period comes to 410,3, that of discharges 7,4, and mortality cases 1,3. The results of comparative analysis show that the rate of contract servicemen's primary morbidity is lower than that of emercom of Russia firemen below 10.6% (p < 0.001), whereas their discharge level is higher above 87% (p < 0.001). In the course of comparison of the emercom of Russia Federal fire service employees' and the Russian Army contract servicemen's primary morbidity structure it was revealed that the indexes of the diseases of respiratory system, traumas and poisoning are higher among the first ones. On the contrary, their indexes were lower in the sphere of circulatory system, skin and hypodermic cellulose diseases. The indexes of circulatory system diseases in the disability (discharge level) structure of the emercom of Russia Federal fire service employees were higher than those of other diseases. It is expedient to use the results of this research in forming of priority assignments and conducting of a complex of curative and prophylactic measures organized by the medical service of the emercom of Russia.

Driving to contract management in health care institutes of developing countries.

PubMed

Vatankhah, S; Barati, O; Maleki, M R; Tofighi, Sh; Rafii, S

2012-04-01

Public hospitals can privatize management activities by contracting with a private organization or person to perform the work. Management contract is a method which uses private sector for major government projects like hospitals. This study evaluates contract management in health care institutes of developing countries. Information has been collected by reviewing the management contract condition of selected countries. Different forms of public private partnership for private participation in hospitals were surveyed. The effects of management contract is expanding market opportunities to include public sector clients, capturing a market to be protected from competitors and providing a reliable and timely source of revenue. Contracting with non-governmental entities will provide better results than government provision of the same services. Contracting initiatives must be regulated and monitored at the highest level of government by experienced and astute policy makers, economists and operational personnel.

A management-control system to assist with the development, contracting, and monitoring of new services for older people: you can always get what you want (with apologies to the Rolling Stones).

PubMed

Jacobs, Stephen

2007-10-01

Implementing community services can be a very complex process where people end up "not seeing the wood for the trees" and then accepting a compromise nobody wants. Neither agency theory nor stewardship theory is particularly robust when explaining the reality that funders and managers of community health service for older people face in managing contracts. There are particular difficulties with goal divergence between policy directives and implementation practices, which result from goals not being well understood and performance requirements being ambiguously defined and infrequently monitored. This leads to accountability issues for public managers, and raises efficiency and effectiveness issues. This paper provides an interim report on a project developing a management-control system to provide a process for health planners and funders to use when developing and contracting services. A major focus is inviting stakeholders into a process of communication that ensures that they have shared understandings of where they want to get to, and what has to be done to get there.

77 FR 68737 - Procurement List, Proposed Deletions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

...: Janitorial/Custodial, Defense Logistics Agency: Point Pleasant Depot, Defense National Stockpile Zone, 2601 Madison Avenue, Point Pleasant, WV. NPA: Prestera Center for Mental Health Services, Inc., Huntington, WV. Contracting Activity: Defense Logistics Agency Support Services-- DSS, Fort Belvoir, VA. Service Type/Location...

48 CFR 342.7101-2 - Procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Procedures. 342.7101-2 Section 342.7101-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7101-2 Procedures. (a) Upon...

48 CFR 339.101 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Policy. 339.101 Section 339.101 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY General 339.101 Policy. (d)(1) The Contracting Officer shall...

Health authority commissioning for quality in contraception services

PubMed Central

Newman, M.; Bardsley, M.; Morgan, D.; Jacobson, B.

1998-01-01

OBJECTIVE: To compare the commissioning of contraception services by London health authorities with accepted models of good practice. DESIGN: Combined interview and postal surveys of all health authorities and National Health Service (NHS) trusts responsible for running family planning clinics in the Greater London area. MAIN OUTCOME MEASURES: Health authority commissioning was assessed on the presence of four key elements of good practice--strategies, coordination, service specifications, and quality standards in contracts--by monitoring activity and quality. RESULTS: Less than half the health authorities surveyed had written strategies or service specifications for contraception services. Arrangements for coordination of services were limited and monitoring was underdeveloped. CONCLUSION: The process of commissioning services for contraception seems to be relatively underdeveloped despite the importance of health problems associated with unplanned pregnancy in London. These findings raise questions about the capacity of health authorities to improve the quality of these services through the commissioning process. PMID:10185140

47 CFR 54.644 - Multi-year commitments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.644 Multi-year commitments. (a) Participants in the Healthcare Connect Fund are permitted to enter into multi-year contracts...

47 CFR 54.644 - Multi-year commitments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.644 Multi-year commitments. (a) Participants in the Healthcare Connect Fund are permitted to enter into multi-year contracts...

41 CFR 102-75.1135 - May this delegation of authority to the Secretary of the Interior, the Secretary of Health and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Education be redelegated? Yes, the Secretary of the Interior, the Secretary of Health and Human Services... authority to the Secretary of the Interior, the Secretary of Health and Human Services, and the Secretary of Education be redelegated? 102-75.1135 Section 102-75.1135 Public Contracts and Property Management Federal...

42 CFR 422.527 - Agreements with Federally qualified health centers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Application Procedures and Contracts for Medicare Advantage Organizations § 422.527 Agreements with Federally qualified health centers...

78 FR 19721 - Request For Public Comment: 60-Day Proposed Information Collection: Indian Health Service Medical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... contract) several categories of health care providers including: Physicians (M.D. and D.O.), dentists... and dentists to be members of the health care facility medical staff where they practice. Health care...

48 CFR 342.7100 - Scope of subpart.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Scope of subpart. 342.7100 Section 342.7100 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7100 Scope of subpart. This subpart...

48 CFR 317.105-1 - Uses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Uses. 317.105-1 Section 317.105-1 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND... certification or, alternatively, one familiar with the application of this contracting method. (3) Availability...

45 CFR 98.67 - Fiscal requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...) Unless otherwise specified in this part, contracts that entail the expenditure of CCDF funds shall comply with the laws and procedures generally applicable to expenditures by the contracting agency of its own...

45 CFR 98.67 - Fiscal requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...) Unless otherwise specified in this part, contracts that entail the expenditure of CCDF funds shall comply with the laws and procedures generally applicable to expenditures by the contracting agency of its own...

45 CFR 98.67 - Fiscal requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...) Unless otherwise specified in this part, contracts that entail the expenditure of CCDF funds shall comply with the laws and procedures generally applicable to expenditures by the contracting agency of its own...

45 CFR 98.11 - Administration under contracts and agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

....11 Section 98.11 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.11 Administration under contracts and... priorities for the expenditure of CCDF funds; (2) Promulgate all rules and regulations governing overall...

45 CFR 98.67 - Fiscal requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...) Unless otherwise specified in this part, contracts that entail the expenditure of CCDF funds shall comply with the laws and procedures generally applicable to expenditures by the contracting agency of its own...

45 CFR 98.67 - Fiscal requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND...) Unless otherwise specified in this part, contracts that entail the expenditure of CCDF funds shall comply with the laws and procedures generally applicable to expenditures by the contracting agency of its own...

45 CFR 98.11 - Administration under contracts and agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

....11 Section 98.11 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND General Application Procedures § 98.11 Administration under contracts and... priorities for the expenditure of CCDF funds; (2) Promulgate all rules and regulations governing overall...

48 CFR 342.7100 - Scope of subpart.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Scope of subpart. 342.7100 Section 342.7100 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7100 Scope of subpart. This subpart...

48 CFR 342.7100 - Scope of subpart.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Scope of subpart. 342.7100 Section 342.7100 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7100 Scope of subpart. This subpart...

48 CFR 342.7100 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Scope of subpart. 342.7100 Section 342.7100 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Administrative Actions for Cost Overruns 342.7100 Scope of subpart. This subpart...

Academic psychiatry and managed care: a case study.

PubMed

Wetzler, S; Schwartz, B J; Sanderson, W; Karasu, T B

1997-08-01

An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.

25 CFR 900.120 - How does an Indian tribe or tribal organization find out about a construction project?

Code of Federal Regulations, 2013 CFR

2013-04-01

... THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE..., engineering reports, design reports, plans of requirements, cost estimates, environmental assessments, or environmental impact reports and archeological reports. (b) An Indian tribe or tribal organization is not...

25 CFR 900.120 - How does an Indian tribe or tribal organization find out about a construction project?

Code of Federal Regulations, 2012 CFR

2012-04-01

... THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE..., engineering reports, design reports, plans of requirements, cost estimates, environmental assessments, or environmental impact reports and archeological reports. (b) An Indian tribe or tribal organization is not...

25 CFR 900.120 - How does an Indian tribe or tribal organization find out about a construction project?

Code of Federal Regulations, 2011 CFR

2011-04-01

... THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE..., engineering reports, design reports, plans of requirements, cost estimates, environmental assessments, or environmental impact reports and archeological reports. (b) An Indian tribe or tribal organization is not...

25 CFR 900.120 - How does an Indian tribe or tribal organization find out about a construction project?

Code of Federal Regulations, 2014 CFR

2014-04-01

... THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE..., engineering reports, design reports, plans of requirements, cost estimates, environmental assessments, or environmental impact reports and archeological reports. (b) An Indian tribe or tribal organization is not...

25 CFR 900.231 - What is an organizational conflict of interest?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false What is an organizational conflict of interest? 900.231 Section 900.231 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

25 CFR 900.231 - What is an organizational conflict of interest?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false What is an organizational conflict of interest? 900.231 Section 900.231 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION...

42 CFR 447.51 - Requirements and options.

Code of Federal Regulations, 2013 CFR

2013-10-01

... populations in accordance with sections 1916(c), (d), (g), and (i) of the Act: (i) A pregnant woman or an... Opportunity Act; and (2) An Indian who either is eligible to receive or has received an item or service furnished by an Indian health care provider or through referral under contract health services. (b) The plan...

25 CFR 900.94 - Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

Code of Federal Regulations, 2010 CFR

2010-04-01

... tribe or tribal organization holds title eligible for facilities operation and maintenance funding from... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF... Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

25 CFR 900.94 - Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

Code of Federal Regulations, 2011 CFR

2011-04-01

... tribe or tribal organization holds title eligible for facilities operation and maintenance funding from... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF... Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

25 CFR 900.94 - Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

Code of Federal Regulations, 2012 CFR

2012-04-01

... tribe or tribal organization holds title eligible for facilities operation and maintenance funding from... INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF... Is contractor-purchased real property to which an Indian tribe or tribal organization holds title...

Medical service provider networks.

PubMed

Mougeot, Michel; Naegelen, Florence

2018-05-17

In many countries, health insurers or health plans choose to contract either with any willing providers or with preferred providers. We compare these mechanisms when two medical services are imperfect substitutes in demand and are supplied by two different firms. In both cases, the reimbursement is higher when patients select the in-network provider(s). We show that these mechanisms yield lower prices, lower providers' and insurer's profits, and lower expense than in the uniform-reimbursement case. Whatever the degree of product differentiation, a not-for-profit insurer should prefer selective contracting and select a reimbursement such that the out-of-pocket expense is null. Although all providers join the network under any-willing-provider contracting in the absence of third-party payment, an asymmetric equilibrium may exist when this billing arrangement is implemented. Copyright © 2018 John Wiley & Sons, Ltd.

The Early Impact Of The ‘Alternative Quality Contract’ On Mental Health Service Use And Spending In Massachusetts

PubMed Central

Barry, Colleen L.; Stuart, Elizabeth A.; Donohue, Julie M.; Greenfield, Shelly F.; Kouri, Elena; Duckworth, Kenneth; Song, Zirui; Mechanic, Robert E.; Chernew, Michael E.; Huskamp, Haiden A.

2016-01-01

Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in organizations participating in the AQC were slightly less likely to use mental health services and had small declines in total health care spending, but no change was found in mental health spending among all users. The declines in probability of use of mental health services and in total health spending attributable to the AQC were concentrated among enrollees in AQC organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program’s initial years, but organizations are now at varying stages of efforts to improve integration. PMID:26643628

Financing geriatric programs in community health centers.

PubMed Central

Yeatts, D E; Ray, S; List, N; Duggar, B

1991-01-01

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization. PMID:1908588

Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar.

PubMed

Marek, T; Diallo, I; Ndiaye, B; Rakotosalama, J

1999-12-01

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

25 CFR 900.39 - What is the difference between a standard and a system?

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.39...

25 CFR 900.39 - What is the difference between a standard and a system?

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.39...

25 CFR 900.39 - What is the difference between a standard and a system?

Code of Federal Regulations, 2010 CFR

2010-04-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.39...

25 CFR 900.39 - What is the difference between a standard and a system?

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.39...

25 CFR 900.39 - What is the difference between a standard and a system?

Code of Federal Regulations, 2014 CFR

2014-04-01

... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.39...

5 CFR 890.106 - Delegation of authority for resolving certain contract disputes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Delegation of authority for resolving... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administration and General Provisions § 890.106 Delegation of authority for resolving certain contract disputes. For...

41 CFR 101-5.306 - Economic feasibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Economic feasibility. 101-5.306 Section 101-5.306 Public Contracts and Property Management Federal Property Management... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.306 Economic feasibility. (a) The studies...

25 CFR 900.35 - What is the purpose of this subpart?

Code of Federal Regulations, 2012 CFR

2012-04-01

... Indian tribes or tribal organizations when carrying out self-determination contracts. It provides..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.35 What is the...

25 CFR 900.35 - What is the purpose of this subpart?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Indian tribes or tribal organizations when carrying out self-determination contracts. It provides..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.35 What is the...

25 CFR 900.35 - What is the purpose of this subpart?

Code of Federal Regulations, 2014 CFR

2014-04-01

... Indian tribes or tribal organizations when carrying out self-determination contracts. It provides..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.35 What is the...

25 CFR 900.35 - What is the purpose of this subpart?

Code of Federal Regulations, 2013 CFR

2013-04-01

... Indian tribes or tribal organizations when carrying out self-determination contracts. It provides..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.35 What is the...

25 CFR 900.35 - What is the purpose of this subpart?

Code of Federal Regulations, 2010 CFR

2010-04-01

... Indian tribes or tribal organizations when carrying out self-determination contracts. It provides..., DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems General § 900.35 What is the...

41 CFR 101-5.306 - Economic feasibility.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 2 2014-07-01 2012-07-01 true Economic feasibility. 101-5.306 Section 101-5.306 Public Contracts and Property Management Federal Property Management... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.306 Economic feasibility. (a) The studies...

41 CFR 101-5.306 - Economic feasibility.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 2 2013-07-01 2012-07-01 true Economic feasibility. 101-5.306 Section 101-5.306 Public Contracts and Property Management Federal Property Management... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.306 Economic feasibility. (a) The studies...

41 CFR 101-5.306 - Economic feasibility.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Economic feasibility. 101-5.306 Section 101-5.306 Public Contracts and Property Management Federal Property Management... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.306 Economic feasibility. (a) The studies...

41 CFR 101-5.306 - Economic feasibility.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 2 2012-07-01 2012-07-01 false Economic feasibility. 101-5.306 Section 101-5.306 Public Contracts and Property Management Federal Property Management... AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.306 Economic feasibility. (a) The studies...

Behavioral Health Services in the Changing Landscape of Private Health Plans.

PubMed

Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

2016-06-01

Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

Back to the market: yet more reform of the National Health Service.

PubMed

Lewis, Richard; Gillam, Stephen

2003-01-01

Yet more reform of the National Health Service in England has been announced by the Department of Health. In opposition, the Labour Party criticized the creation of an "internal market" for health care by the Conservative government, but five years into the Blair administration, market incentives are to be reinvigorated and the private sector is to be embraced in ways not seen hitherto. New guidance signals the introduction of competitive contracting using cost-per-case currencies, more choice for patients in where they will receive hospital treatment, and the freeing of NHS care providers from the direct political control of ministers. It is intended that the monopolistic features of the NHS in England should give way to greater pluralism, in particular through contracts with privately owned health care organizations. However, there is little evidence to suggest that these policies will be effective, and a number of practical problems may obstruct implementation.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings.

PubMed

Zolna, Mia R; Kavanaugh, Megan L; Hasstedt, Kinsey

Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings

PubMed Central

Zolna, Mia R.; Kavanaugh, Megan L.; Hasstedt, Kinsey

2018-01-01

Introduction Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states’ Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. Methods We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Results Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Conclusions Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. PMID:29108987

32 CFR 107.6 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

...)) shall be responsible for monitoring the personal services contracting program. ... Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PERSONAL SERVICES AUTHORITY FOR DIRECT HEALTH CARE PROVIDERS § 107.6 Responsibilities. (a) The Military Departments...

32 CFR 107.6 - Responsibilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

...)) shall be responsible for monitoring the personal services contracting program. ... Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PERSONAL SERVICES AUTHORITY FOR DIRECT HEALTH CARE PROVIDERS § 107.6 Responsibilities. (a) The Military Departments...

32 CFR 107.6 - Responsibilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

...)) shall be responsible for monitoring the personal services contracting program. ... Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PERSONAL SERVICES AUTHORITY FOR DIRECT HEALTH CARE PROVIDERS § 107.6 Responsibilities. (a) The Military Departments...

32 CFR 107.6 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

...)) shall be responsible for monitoring the personal services contracting program. ... Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PERSONAL SERVICES AUTHORITY FOR DIRECT HEALTH CARE PROVIDERS § 107.6 Responsibilities. (a) The Military Departments...

32 CFR 107.6 - Responsibilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

...)) shall be responsible for monitoring the personal services contracting program. ... Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN PERSONAL SERVICES AUTHORITY FOR DIRECT HEALTH CARE PROVIDERS § 107.6 Responsibilities. (a) The Military Departments...

Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation.

PubMed

Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

2015-02-01

Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly larger and older than private care farms (comprising 88.8% of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users' rehabilitation needs.

Telecommunications, health care, and legal liability

NASA Astrophysics Data System (ADS)

Levy, Chris

1990-06-01

Regulation of health care telecommunications is fragmented in Canada. Further neither the legislative nor the administrative nor the judicial processes have managed to respond successfully to the impact of telecommunications technology. The result is a legal environment that is necessarily speculative for both telecommunications service providers and health care personnel and facilities. Critical issues include ensuring confidentiality for sensitive patient records and health information liability of telecommunications service providers for inaccurate transmission liability of health care providers for use or non-use of telecommunications services. Limitation of legal liability for both telecommunications and health care service providers is likely to be most effective when based on contract but the creation of the necessary contracts is potentially unduly cumbersome both legally and practically. 1. CONSTITUTIONAL ASPECTS Telecommunications systems that are empowered to operate or connect cross provincial or international boundaries are subject to federal regulation bu the scheme is incomplete in respect of a system set up as a provincial agency. Health care on the other hand is very much a matter of provincial rather than federal authority as a matter of strict law but the fiscal strength of the federal government enables it to provide money to the provinces for financing health care and to4 use this as a device for securing compliance with certain federal standards. Nevertheless the political willingness of the federal health authorities to impose standards on the provinces

29 CFR 1925.2 - Safety and health standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 7 2014-07-01 2014-07-01 false Safety and health standards. 1925.2 Section 1925.2 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH STANDARDS FOR FEDERAL SERVICE CONTRACTS § 1925.2 Safety and health standards...

29 CFR 1925.2 - Safety and health standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Safety and health standards. 1925.2 Section 1925.2 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH STANDARDS FOR FEDERAL SERVICE CONTRACTS § 1925.2 Safety and health standards...

29 CFR 1925.2 - Safety and health standards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 7 2012-07-01 2012-07-01 false Safety and health standards. 1925.2 Section 1925.2 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH STANDARDS FOR FEDERAL SERVICE CONTRACTS § 1925.2 Safety and health standards...

29 CFR 1925.2 - Safety and health standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Safety and health standards. 1925.2 Section 1925.2 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH STANDARDS FOR FEDERAL SERVICE CONTRACTS § 1925.2 Safety and health standards...

29 CFR 1925.2 - Safety and health standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 7 2013-07-01 2013-07-01 false Safety and health standards. 1925.2 Section 1925.2 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH STANDARDS FOR FEDERAL SERVICE CONTRACTS § 1925.2 Safety and health standards...

78 FR 40743 - Mine Safety and Health Research Advisory Committee, National Institute for Occupational Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Mine Safety and Health Research Advisory Committee, National Institute for Occupational Safety and Health (MSHRAC, NIOSH... Director, NIOSH, on priorities in mine safety and health research, including grants and contracts for such...

41 CFR 102-75.510 - When must the Department of Education and the Department of Health and Human Services notify the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false When must the Department of Education and the Department of Health and Human Services notify the disposal agency that an...

A Mental Health Consultation Program for Project Head Start.

ERIC Educational Resources Information Center

Kawin, Marjorie R.

The Psychological Center provided a family oriented mental health consultation service to 17 delegate agencies who had contracts with Head Start programs in 1966-67. This paper presents an overview of the services which an interdisciplinary staff of 52 professionals provided to 6,780 families and 1,500 agency staff members. Gerald Caplan's (1964)…

25 CFR 900.232 - What must an Indian tribe or tribal organization do if an organizational conflict of interest...

Code of Federal Regulations, 2011 CFR

2011-04-01

... organizational conflict of interest arises under a contract? 900.232 Section 900.232 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES... What must an Indian tribe or tribal organization do if an organizational conflict of interest arises...

25 CFR 900.232 - What must an Indian tribe or tribal organization do if an organizational conflict of interest...

Code of Federal Regulations, 2010 CFR

2010-04-01

... organizational conflict of interest arises under a contract? 900.232 Section 900.232 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR, AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES... What must an Indian tribe or tribal organization do if an organizational conflict of interest arises...

25 CFR 900.41 - How long must an Indian tribe or tribal organization keep management system records?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false How long must an Indian tribe or tribal organization keep..., AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems...

25 CFR 900.41 - How long must an Indian tribe or tribal organization keep management system records?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false How long must an Indian tribe or tribal organization keep..., AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems...

25 CFR 900.41 - How long must an Indian tribe or tribal organization keep management system records?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false How long must an Indian tribe or tribal organization keep..., AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems...

25 CFR 900.41 - How long must an Indian tribe or tribal organization keep management system records?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false How long must an Indian tribe or tribal organization keep..., AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems...

25 CFR 900.41 - How long must an Indian tribe or tribal organization keep management system records?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false How long must an Indian tribe or tribal organization keep..., AND INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems...

41 CFR 102-75.520 - What must the Department of Education or the Department of Health and Human Services address in...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false What must the Department of Education or the Department of Health and Human Services address in the assignment recommendation... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL...

41 CFR 102-75.520 - What must the Department of Education or the Department of Health and Human Services address in...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What must the Department of Education or the Department of Health and Human Services address in the assignment recommendation... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL...

41 CFR 102-75.520 - What must the Department of Education or the Department of Health and Human Services address in...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false What must the Department of Education or the Department of Health and Human Services address in the assignment recommendation... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL...

41 CFR 102-75.520 - What must the Department of Education or the Department of Health and Human Services address in...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What must the Department of Education or the Department of Health and Human Services address in the assignment recommendation... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL...

78 FR 31943 - Draft Guidance for Industry on Contract Manufacturing Arrangements for Drugs: Quality Agreements...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... documenting the responsibilities of all parties involved in drug manufacturing, testing, or other support... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-D-0558] Draft Guidance for Industry on Contract Manufacturing Arrangements for Drugs: Quality Agreements...

Health worker recruitment and deployment in remote areas of Indonesia.

PubMed

Efendi, Ferry

2012-01-01

Providing health care in remote and very remote areas has long been a major concern in Indonesia. In order to improve access to quality health care for residents in these areas, various policies on recruitment and deployment of health workers have been implemented, among them compulsory service, contracted staff and the Special Assignment of strategic health workers. Indonesia's difficult geography presents great challenges to health service delivery and most health workers prefer to serve in urban areas, resulting in an uneven distribution of health workers and shortages in remote areas. Great efforts have been made to mobilize health human resources more equitably, including placement schemes for strategic health workers and contracted staff, combined with an incentive scheme. While these have partially addressed the severe shortage of health workers in remote areas, current government policies were reviewed in order to clarify the current situation in Indonesia. The Contracted Staff and Special Assignment of Strategic Health Workers programs show have made a significant contribution to improving the availability of health workers in Indonesia's remote areas. As these two programs used financial incentives as the main intervention, other non-financial interventions should also be trialed. For example, incentives such as the promise of a civil servant appointment or the provision of continuing professional education, as well as the recruitment of rural-background health workers may increase the willingness of health staff to serve in the remote and very remote areas of Indonesia.

Cost of employee assistance programs: comparison of national estimates from 1993 and 1995.

PubMed

French, M T; Zarkin, G A; Bray, J W; Hartwell, T D

1999-02-01

The cost and financing of mental health services is gaining increasing importance with the spread of managed care and cost-cutting measures throughout the health care system. The delivery of mental health services through structured employee assistance programs (EAPs) could be undermined by revised health insurance contracts and cutbacks in employer-provided benefits at the workplace. This study uses two recently completed national surveys of EAPs to estimate the costs of providing EAP services during 1993 and 1995. EAP costs are determined by program type, worksite size, industry, and region. In addition, information on program services is reported to determine the most common types and categories of services and whether service delivery changes have occurred between 1993 and 1995. The results of this study will be useful to EAP managers, mental health administrators, and mental health services researchers who are interested in the delivery and costs of EAP services.

Performance-based financing and changing the district health system: experience from Rwanda.

PubMed Central

Soeters, Robert; Habineza, Christian; Peerenboom, Peter Bob

2006-01-01

Evidence from low-income Asian countries shows that performance-based financing (as a specific form of contracting) can improve health service delivery more successfully than traditional input financing mechanisms. We report a field experience from Rwanda demonstrating that performance-based financing is a feasible strategy in sub-Saharan Africa too. Performance-based financing requires at least one new actor, an independent well equipped fundholder organization in the district health system separating the purchasing, service delivery as well as regulatory roles of local health authorities from the technical role of contract negotiation and fund disbursement. In Rwanda, local community groups, through patient surveys, verified the performance of health facilities and monitored consumer satisfaction. A precondition for the success of performance-based financing is that authorities must respect the autonomous management of health facilities competing for public subsidies. These changes are an opportunity to redistribute roles within the health district in a more transparent and efficient fashion. PMID:17143462

Can the real opportunity cost stand up: displaced services, the straw man outside the room.

PubMed

Eckermann, Simon; Pekarsky, Brita

2014-04-01

In current literature, displaced services have been suggested to provide a basis for determining a threshold value for the effects of a new technology as part of a reimbursement process when budgets are fixed. We critically examine the conditions under which displaced services would represent an economically meaningful threshold value. We first show that if we assume that the least cost-effective services are displaced to finance a new technology, then the incremental cost-effectiveness ratio (ICER) of the displaced services (d) only coincides with that related to the opportunity cost of adopting that new technology, the ICER of the most cost-effective service in expansion (n), under highly restrictive conditions-namely, complete allocative efficiency in existing provision of health care interventions. More generally, reimbursement of new technology with a fixed budget comprises two actions; adoption and financing through displacement and the effect of reimbursement is the net effect of these two actions. In order for the reimbursement process to be a pathway to allocative efficiency within a fixed budget, the net effect of the strategy of reimbursement is compared with the most cost-effective alternative strategy for reimbursement: optimal reallocation, the health gain maximizing expansion of existing services financed by the health loss minimizing contraction. The shadow price of the health effects of a new technology, βc = (1/n + 1/d - 1/m)(-1), accounts for both imperfect displacement (the ICER of the displaced service, d < m, the ICER of the least cost-effective of the existing services in contraction) and the allocative inefficiency (n < m) characteristic of health systems.

5 CFR 792.212 - What is the definition of a child care contractor?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES' HEALTH AND COUNSELING PROGRAMS Agency Use of... 630 of Public Law 107-67 provides that child care services provided by contract are encompassed by... child care services for which Federal families are eligible. These entities are commonly referred to as...