Sample records for services cost sharing

  1. 42 CFR 447.52 - Cost sharing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... agency imposes cost sharing under § 447.54, the process by which hospital emergency room services are... State option, cost sharing imposed for any service (other than for drugs and non-emergency services... group under § 447.56(a), and (iii) For cost sharing imposed for non-emergency services furnished in an...

  2. Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey.

    PubMed

    Richardson, Jeff; Iezzi, Angelo; Chen, Gang; Maxwell, Aimee

    2017-03-01

    This paper suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective, i.e. when more health could be produced by allocating funds to other services. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost. Survey respondents were asked to allocate a budget between cost-effective services that had a small effect upon a large number of relatively well patients and SRDs that benefited a small number of severely ill patients but were not cost effective because of their high cost. Part of the budget was always allocated to the SRDs. The budget share rose with the number sharing the cost. Sharing per se appears to characterise preferences. This has been obscured in studies that focus upon cost per patient rather than cost per person sharing the cost.

  3. Effects of a cost-sharing exemption on use of preventive services at one large employer.

    PubMed

    Busch, Susan H; Barry, Colleen L; Vegso, Sally J; Sindelar, Jody L; Cullen, Mark R

    2006-01-01

    In 2004, Alcoa introduced a new health benefit for a portion of its workforce, which eliminated cost sharing for preventive care while increasing cost sharing for many other services. In this era of increased consumerism, Alcoa's benefit redesign constituted an effort to reduce health care costs while preserving use of targeted services. Taking advantage of a unique natural experiment, we find that Alcoa was able to maintain rates of preventive service use. This evidence suggests that differential cost sharing can be used to preserve the use of critical health care services.

  4. 42 CFR 447.52 - Minimum and maximum income-related charges.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... agency imposes cost sharing under § 447.54, the process by which hospital emergency room services are... option, cost sharing imposed for any service (other than for drugs and non-emergency services furnished... group under § 447.56(a), and (iii) For cost sharing imposed for non-emergency services furnished in an...

  5. 42 CFR 447.70 - General alternative cost sharing protections.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false General alternative cost sharing protections. 447.70 Section 447.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under...

  6. 42 CFR 447.70 - General alternative cost sharing protections.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false General alternative cost sharing protections. 447.70 Section 447.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under...

  7. 42 CFR 447.70 - General alternative cost sharing protections.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false General alternative cost sharing protections. 447.70 Section 447.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under...

  8. 42 CFR 447.70 - General alternative cost sharing protections.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false General alternative cost sharing protections. 447.70 Section 447.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under...

  9. 42 CFR 447.54 - Maximum allowable and nominal charges.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... nonemergency services furnished in a hospital emergency room. (c) Institutional services. For institutional... hospital emergency department. (a) The agency may impose cost sharing for non-emergency services provided... exempt from cost sharing under § 447.56(a), the agency may impose cost sharing for non-emergency use of...

  10. 40 CFR 35.6285 - Recipient payment of response costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... payment of response costs. The recipient may pay for its share of response costs using cash, services... costs in the form of cash. (b) Services. The recipient may provide equipment and services to satisfy its... CFR part 300). (d) Excess cash cost share contributions/overmatch. The recipient may direct EPA to...

  11. Boeing’s Integrated Defense Systems Restructuring: Significant and Preventable Cost Impacts to Army Aviation Programs

    DTIC Science & Technology

    2005-03-18

    IDS, the treatment and handling of Boeing World Headquarters (BWHQ) costs, common or shared systems costs, Shared Services Group costs, fringe...these expenses.15 One such example is the addition of the Shared Services Group (SSG) expense to the Mesa and Philadelphia accounting ledgers. Under

  12. Recent proposals to limit Medigap coverage and modify Medicare cost sharing.

    PubMed

    Linehan, Kathryn

    2012-02-24

    As policymakers look for savings from the Medicare program, some have proposed eliminating or discouraging "first-dollar coverage" available through privately purchased Medigap policies. Medigap coverage, which beneficiaries obtain to protect themselves from Medicare's cost-sharing requirements and its lack of a cap on out-of-pocket spending, may discourage the judicious use of medical services by reducing or eliminating beneficiary cost sharing. It is estimated that eliminating such coverage, which has been shown to be associated with higher Medicare spending, and requiring some cost sharing would encourage beneficiaries to reduce their service use and thus reduce pro­gram spending. However, eliminating first-dollar coverage could cause some beneficiaries to incur higher spending or forego necessary services. Some policy proposals to eliminate first-dollar coverage would also modify Medicare's cost sharing and add an out-of-pocket spending cap for fee-for-service Medicare. This paper discusses Medicare's current cost-sharing requirements, Medigap insurance, and proposals to modify Medicare's cost sharing and eliminate first-dollar coverage in Medigap plans. It reviews the evidence on the effects of first-dollar coverage on spending, some objections to eliminating first-dollar coverage, and results of research that has modeled the impact of eliminating first-dollar coverage, modifying Medicare's cost-sharing requirements, and adding an out-of-pocket limit on beneficiaries' spending.

  13. 42 CFR 447.54 - Maximum allowable and nominal charges.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... nonemergency services furnished in a hospital emergency room. (c) Institutional services. For institutional... Deductible, Coinsurance, Co-Payment Or Similar Cost-Sharing Charge § 447.54 Maximum allowable and nominal... that cost sharing amounts be nominal. Upon approval from CMS, the requirement that cost sharing charges...

  14. 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...

  15. 75 FR 54590 - Notice of 2010 National Organic Certification Cost-Share Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-08

    ...] Notice of 2010 National Organic Certification Cost-Share Program AGENCY: Agricultural Marketing Service... Certification Cost-Share Funds. The AMS has allocated $22.0 million for this organic certification cost-share... National Organic Certification Cost- Share Program is authorized under 7 U.S.C. 6523, as amended by section...

  16. Value-based cost sharing in the United States and elsewhere can increase patients' use of high-value goods and services.

    PubMed

    Thomson, Sarah; Schang, Laura; Chernew, Michael E

    2013-04-01

    This article reviews efforts in the United States and several other member countries of the Organization for Economic Cooperation and Development to encourage patients, through cost sharing, to use goods such as medications, services, and providers that offer better value than other options--an approach known as value-based cost sharing. Among the countries we reviewed, we found that value-based approaches were most commonly applied to drug cost sharing. A few countries, including the United States, employed financial incentives, such as lower copayments, to encourage use of preferred providers or preventive services. Evidence suggests that these efforts can increase patients' use of high-value services--although they may also be associated with high administrative costs and could exacerbate health inequalities among various groups. With careful design, implementation, and evaluation, value-based cost sharing can be an important tool for aligning patient and provider incentives to pursue high-value care.

  17. 42 CFR 417.454 - Charges to Medicare enrollees.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... preventive services (as defined in § 410.152(l)). (e) Services for which cost sharing may not exceed cost...(b)(14)(B) of the Act. (3) Skilled nursing care defined as services provided during a covered stay in a skilled nursing facility during the period for which cost sharing would apply under Original...

  18. 42 CFR 417.454 - Charges to Medicare enrollees.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... preventive services (as defined in § 410.152(l)). (e) Services for which cost sharing may not exceed cost...(b)(14)(B) of the Act. (3) Skilled nursing care defined as services provided during a covered stay in a skilled nursing facility during the period for which cost sharing would apply under Original...

  19. 42 CFR 417.454 - Charges to Medicare enrollees.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... preventive services (as defined in § 410.152(l)). (e) Services for which cost sharing may not exceed cost...(b)(14)(B) of the Act. (3) Skilled nursing care defined as services provided during a covered stay in a skilled nursing facility during the period for which cost sharing would apply under Original...

  20. 76 FR 54999 - Notice of 2011 National Organic Certification Cost-Share Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-06

    ...] Notice of 2011 National Organic Certification Cost-Share Program AGENCY: Agricultural Marketing Service... for the National Organic Certification Cost- Share Program. SUMMARY: This Notice invites all States of...) for the allocation of National Organic Certification Cost-Share Funds. Beginning in Fiscal Year 2008...

  1. 42 CFR 457.555 - Maximum allowable cost-sharing charges on targeted low-income children in families with income...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... maximum amount of $11.35 for services furnished in a hospital emergency room if those services are not... 42 Public Health 4 2012-10-01 2012-10-01 false Maximum allowable cost-sharing charges on targeted... Requirements: Enrollee Financial Responsibilities § 457.555 Maximum allowable cost-sharing charges on targeted...

  2. 42 CFR 457.520 - Cost sharing for well-baby and well-child care services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Cost sharing for well-baby and well-child care services. 457.520 Section 457.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND...

  3. 42 CFR 457.520 - Cost sharing for well-baby and well-child care services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Cost sharing for well-baby and well-child care services. 457.520 Section 457.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND...

  4. 42 CFR 457.520 - Cost sharing for well-baby and well-child care services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Cost sharing for well-baby and well-child care services. 457.520 Section 457.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND...

  5. 42 CFR 457.520 - Cost sharing for well-baby and well-child care services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Cost sharing for well-baby and well-child care services. 457.520 Section 457.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND...

  6. Physician response to the United Mine Workers' cost-sharing program: the other side of the coin.

    PubMed Central

    Fahs, M C

    1992-01-01

    The effect of cost sharing on health services utilization is analyzed from a new perspective, that is, its effects on physician response to cost sharing. A primary data set was constructed using medical records and billing files from a large multispecialty group practice during the three-year period surrounding the introduction of cost sharing to the United Mine Workers Health and Retirement Fund. This same group practice also served an equally large number of patients covered by United Steelworkers' health benefit plans, for which similar utilization data were available. The questions addressed in this interinsurer study are: (1) to what extent does a physician's treatment of medically similar cases vary, following a drop in patient visits as a result of cost sharing? and (2) what is the impact, if any, on costs of care for other patients in the practice (e.g., "spillover effects" such as cost shifting)? Answers to these kinds of questions are necessary to predict the effects of cost sharing on overall health care costs. A fixed-effects model of physician service use was applied to data on episodes of treatment for all patients in a private group practice. This shows that the introduction of cost sharing to some patients in a practice does, in fact, increase the treatment costs to other patients in the same practice who remain under stable insurance plans. The analysis demonstrates that when the economic effects of cost sharing on physician service use are analyzed for all patients within a physician practice, the findings are remarkably different from those of an analysis limited to those patients directly affected by cost sharing. PMID:1563952

  7. 7 CFR 625.9 - 10-year restoration cost-share agreements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false 10-year restoration cost-share agreements. 625.9... CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES HEALTHY FORESTS RESERVE PROGRAM § 625.9 10-year... 10-year cost-share agreement and its terms are incorporated therein. (b) A 10-year cost-share...

  8. 42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  9. 42 CFR 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... defined at § 447.78, track beneficiaries' incurred premiums and cost sharing through a mechanism developed...

  10. 42 CFR 447.68 - Alternative copayments, coinsurance, deductibles, or similar cost sharing charges: State plan...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... defined at § 447.78, track beneficiaries' incurred premiums and cost sharing through a mechanism developed...

  11. 42 CFR 417.454 - Charges to Medicare enrollees.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... § 410.152(l)). (e) Services for which cost sharing may not exceed cost sharing under original Medicare... nursing care defined as services provided during a covered stay in a skilled nursing facility during the...

  12. Potential Savings in Rural Public School Non-Instructional Costs through Shared Services Arrangements: A Regional Study.

    ERIC Educational Resources Information Center

    ECM, Inc., Williamsville, NY.

    A study was undertaken in 16 rural New York school districts to determine the feasibility of sharing noninstructional services as an avenue to achieving cost savings and enhanced services. The districts involved were within the Delaware/Chenango/Madison/Otsego BOCES (Board of Cooperative Educational Services) in a rural mountainous region of…

  13. 78 FR 8456 - Coverage of Certain Preventive Services Under the Affordable Care Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... 2713 of the Public Health Service Act requires coverage without cost sharing of certain preventive... Requirement to Cover Contraceptive Services Without Cost Sharing Under Section 2713 of the Public Health..., non-stock, public benefit, and similar types of corporations. However, for this purpose an...

  14. Standard Terms and Conditions | NREL

    Science.gov Websites

    and Technical Services Subcontracts, Cost-Type (1) Cost Sharing (2) Cost Reimbursement (3) Cost Plus Than Foreign) (1) Cost Sharing (2) Cost Reimbursement (2) Cost Plus Fixed Fee. Appendix B-10 (12/15/16 /15/16) Standard Terms and Conditions for Travel Requirements (1) Cost Sharing (2) Cost Reimbursement

  15. Patient cost sharing and medical expenditures for the Elderly.

    PubMed

    Fukushima, Kazuya; Mizuoka, Sou; Yamamoto, Shunsuke; Iizuka, Toshiaki

    2016-01-01

    Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. The Evolution of the Shared Services Business Unit.

    ERIC Educational Resources Information Center

    Forst, Leland

    2000-01-01

    Explains shared services, where common business practices are applied by a staff unit focused entirely on delivering needed services at the highest value and lowest cost to internal customers. Highlights include accountability; examples of pioneering shared services organizations; customer focus transition; relationship management; expertise…

  17. Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland.

    PubMed

    Huber, Carola A; Rüesch, Peter; Mielck, Andreas; Böcken, Jan; Rosemann, Thomas; Meyer, Peter C

    2012-08-01

    Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care. © 2011 Blackwell Publishing Ltd.

  18. Defense Health Care Reform: Additional Implementation Details Would Increase Transparency of DOD’s Plans and Enhance Accountability

    DTIC Science & Technology

    2013-11-01

    on timelines; and was not required to include information on shared services because the reporting time frame was not applicable. GAO also assessed...implementation costs and aggregated cost-savings estimates for the consolidation of four shared services . However, some key details of a sound business...case were missing, such as the basis for the savings. DOD’s business cases aggregated the separate business lines of its shared services , which

  19. 47 CFR 27.1190 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Termination of cost-sharing obligations. 27.1190 Section 27.1190 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and...

  20. 47 CFR 27.1174 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Termination of cost-sharing obligations. 27.1174 Section 27.1174 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and...

  1. 47 CFR 24.253 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Termination of cost-sharing obligations. 24.253 Section 24.253 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  2. 47 CFR 24.253 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Termination of cost-sharing obligations. 24.253 Section 24.253 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  3. 47 CFR 24.253 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Termination of cost-sharing obligations. 24.253 Section 24.253 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  4. 47 CFR 24.253 - Termination of cost-sharing obligations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Termination of cost-sharing obligations. 24.253 Section 24.253 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  5. 7 CFR 624.7 - Cost-sharing.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Cost-sharing. 624.7 Section 624.7 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WATERSHED PROTECTION § 624.7 Cost-sharing. (a) Except as provided in...

  6. 7 CFR 624.7 - Cost-sharing.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Cost-sharing. 624.7 Section 624.7 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WATERSHED PROTECTION § 624.7 Cost-sharing. (a) Except as provided in...

  7. 7 CFR 624.7 - Cost-sharing.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Cost-sharing. 624.7 Section 624.7 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WATERSHED PROTECTION § 624.7 Cost-sharing. (a) Except as provided in...

  8. 7 CFR 624.7 - Cost-sharing.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Cost-sharing. 624.7 Section 624.7 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WATERSHED PROTECTION § 624.7 Cost-sharing. (a) Except as provided in...

  9. 45 CFR 156.130 - Cost-sharing requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

  10. 45 CFR 156.130 - Cost-sharing requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

  11. 42 CFR 431.57 - Waiver of cost-sharing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-sharing amounts be nominal. (b) For nonemergency services furnished in a hospital emergency room, the... 42 Public Health 4 2010-10-01 2010-10-01 false Waiver of cost-sharing requirements. 431.57 Section... Requirements § 431.57 Waiver of cost-sharing requirements. (a) Sections 1916(a)(3) and 1916(b)(3) of the Act...

  12. 42 CFR 431.57 - Waiver of cost-sharing requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-sharing amounts be nominal. (b) For nonemergency services furnished in a hospital emergency room, the... 42 Public Health 4 2012-10-01 2012-10-01 false Waiver of cost-sharing requirements. 431.57 Section... Requirements § 431.57 Waiver of cost-sharing requirements. (a) Sections 1916(a)(3) and 1916(b)(3) of the Act...

  13. 42 CFR 431.57 - Waiver of cost-sharing requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-sharing amounts be nominal. (b) For nonemergency services furnished in a hospital emergency room, the... 42 Public Health 4 2011-10-01 2011-10-01 false Waiver of cost-sharing requirements. 431.57 Section... Requirements § 431.57 Waiver of cost-sharing requirements. (a) Sections 1916(a)(3) and 1916(b)(3) of the Act...

  14. Eliminating cost-sharing requirements for colon cancer screening in Medicare.

    PubMed

    Howard, David H; Guy, Gery P; Ekwueme, Donatus U

    2014-12-15

    Medicare beneficiaries do not have to pay for screening colonoscopies but must pay coinsurance if a polyp is removed via polypectomy. Likewise, beneficiaries do not have to pay for fecal occult blood tests but are liable for cost-sharing for diagnostic colonoscopies after a positive test. Legislative and regulatory requirements related to colorectal cancer screening are described, and on the basis of Medicare claims, it is estimated that Medicare spending would increase by $48 million annually if Medicare were to waive cost-sharing requirements for these services. The economic impact on Medicare if beneficiaries were not responsible for any cost-sharing requirements related to colorectal cancer screening services is described. © 2014 American Cancer Society.

  15. 75 FR 54591 - Notice of Agricultural Management Assistance Organic Certification Cost-Share Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-08

    ... DEPARTMENT OF AGRICULTURE Agricultural Marketing Service [Doc. No. AMS-NOP-10-0065; NOP-10-06] Notice of Agricultural Management Assistance Organic Certification Cost-Share Program AGENCY: Agricultural Marketing Service, USDA. ACTION: Notice of Funds Availability. Inviting Applications for the...

  16. 47 CFR 27.1162 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Administration of the Cost-Sharing Plan. 27.1162 Section 27.1162 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and...

  17. 47 CFR 27.1188 - Dispute resolution under the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Dispute resolution under the Cost-Sharing Plan. 27.1188 Section 27.1188 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020...

  18. 47 CFR 27.1178 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Administration of the Cost-Sharing Plan. 27.1178 Section 27.1178 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and...

  19. 47 CFR 27.1172 - Dispute Resolution Under the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Dispute Resolution Under the Cost-Sharing Plan. 27.1172 Section 27.1172 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020...

  20. 47 CFR 27.1182 - Reimbursement under the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Reimbursement under the Cost-Sharing Plan. 27.1182 Section 27.1182 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and...

  1. 47 CFR 24.251 - Dispute resolution under the Cost-Sharing Plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Dispute resolution under the Cost-Sharing Plan. 24.251 Section 24.251 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...

  2. 47 CFR 24.251 - Dispute resolution under the Cost-Sharing Plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Dispute resolution under the Cost-Sharing Plan. 24.251 Section 24.251 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...

  3. 47 CFR 24.241 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Administration of the Cost-Sharing Plan. 24.241 Section 24.241 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  4. 47 CFR 24.241 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Administration of the Cost-Sharing Plan. 24.241 Section 24.241 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  5. 47 CFR 24.251 - Dispute resolution under the Cost-Sharing Plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 2 2014-10-01 2014-10-01 false Dispute resolution under the Cost-Sharing Plan. 24.251 Section 24.251 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...

  6. 47 CFR 24.241 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Administration of the Cost-Sharing Plan. 24.241 Section 24.241 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  7. 47 CFR 24.241 - Administration of the Cost-Sharing Plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Administration of the Cost-Sharing Plan. 24.241 Section 24.241 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990...

  8. 47 CFR 24.251 - Dispute resolution under the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Dispute resolution under the Cost-Sharing Plan. 24.251 Section 24.251 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...

  9. Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals.

    PubMed

    Sherry, Melissa; Wolff, Jennifer L; Ballreich, Jeromie; DuGoff, Eva; Davis, Karen; Anderson, Gerard

    2016-12-01

    Health care reform efforts that emphasize value have increased awareness of the importance of nonmedical factors in achieving better care, better health, and lower costs in the care of high-need, high-cost individuals. Programs that care for socioeconomically disadvantaged, high-need, high-cost individuals have achieved promising results in part by bridging traditional service delivery silos. This study examined 5 innovative community-oriented programs that are successfully coordinating medical and nonmedical services to identify factors that stimulate and sustain community-level collaboration and coordinated care across silos of health care, public health, and social services delivery. The authors constructed a conceptual framework depicting community health systems that highlights 4 foundational factors that facilitate community-oriented collaboration: flexible financing, shared leadership, shared data, and a strong shared vision of commitment toward delivery of person-centered care.

  10. Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost.

    PubMed

    Humphries, Debbie L; Hyde, Justeen; Hahn, Ethan; Atherly, Adam; O'Keefe, Elaine; Wilkinson, Geoffrey; Eckhouse, Seth; Huleatt, Steve; Wong, Samuel; Kertanis, Jennifer

    2018-01-01

    Forty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use. To characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA). We interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews. The findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models - independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population. There are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

  11. 47 CFR 27.1160 - Cost-sharing requirements for AWS.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Cost-sharing requirements for AWS. 27.1160 Section 27.1160 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and 2180-2200 MHz...

  12. 42 CFR 422.6 - Cost-sharing in enrollment-related costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM General Provisions § 422.6 Cost-sharing in... for the drug benefit). (c) Applicability. The fee assessment also applies to those demonstrations for...

  13. 36 CFR 230.43 - Cost-share assistance-prohibited practices.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Cost-share assistance-prohibited practices. 230.43 Section 230.43 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Forest Land Enhancement Program § 230.43 Cost-share...

  14. 36 CFR 230.43 - Cost-share assistance-prohibited practices.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Cost-share assistance-prohibited practices. 230.43 Section 230.43 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Forest Land Enhancement Program § 230.43 Cost-share...

  15. 36 CFR 230.43 - Cost-share assistance-prohibited practices.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Cost-share assistance-prohibited practices. 230.43 Section 230.43 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Forest Land Enhancement Program § 230.43 Cost-share...

  16. 36 CFR 230.43 - Cost-share assistance-prohibited practices.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Cost-share assistance-prohibited practices. 230.43 Section 230.43 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Forest Land Enhancement Program § 230.43 Cost-share...

  17. 45 CFR 63.22 - Cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Cost sharing. 63.22 Section 63.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GRANT PROGRAMS ADMINISTERED BY THE OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION Financial Provisions § 63.22 Cost sharing. Policy...

  18. Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

    PubMed

    Perkowski, Patryk; Rodberg, Leonard

    2016-01-01

    Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. © The Author(s) 2015.

  19. Mayo Clinic employees responded to new requirements for cost sharing by reducing possibly unneeded health services use.

    PubMed

    Shah, Nilay D; Naessens, James M; Wood, Douglas L; Stroebel, Robert J; Litchy, William; Wagie, Amy; Fan, Jiaquan; Nesse, Robert

    2011-11-01

    Some health plans have experimented with increasing consumer cost sharing, on the theory that consumers will use less unnecessary health care if they are expected to bear some of the financial responsibility for it. However, it is unclear whether the resulting decrease in use is sustained beyond one or two years. In 2004 Mayo Clinic's self-funded health plan increased cost sharing for its employees and their dependents for specialty care visits (adding a $25 copayment to the high-premium option) and other services such as imaging, testing, and outpatient procedures (adding 10 or 20 percent coinsurance, depending on the option). The plan also removed all cost sharing for visits to primary care providers and for preventive services such as colorectal screening and mammography. The result was large decreases in the use of diagnostic testing and outpatient procedures that were sustained for four years, and an immediate decrease in the use of imaging that later rebounded (possibly to levels below the expected trend). Beneficiaries decreased visits to specialists but did not make greater use of primary care services. These results suggest that implementing relatively low levels of cost sharing can lead to a long-term decrease in utilization.

  20. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  1. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  2. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  3. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  4. Rural Shared Services: General Brochure and Information Sheets.

    ERIC Educational Resources Information Center

    Northwest Regional Educational Lab., Portland, OR.

    The brochure discusses the Shared Services Program of the Northwest Regional Educational Laboratory of Portland, Oregon. The program operates on the premise that it can provide additional programs (frequently of higher quality) to rural school districts at a lower per-capita cost. The shared services are conducted through cooperative efforts…

  5. 7 CFR 625.9 - 10-year restoration cost-share agreements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false 10-year restoration cost-share agreements. 625.9... CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE WATER RESOURCES HEALTHY FORESTS RESERVE PROGRAM § 625.9 10-year restoration cost-share agreements. (a) The restoration plan developed under § 625.12 forms the basis for the...

  6. Rising out-of-pocket costs in disease management programs.

    PubMed

    Chernew, Michael E; Rosen, Allison B; Fendrick, A Mark

    2006-03-01

    To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design. Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs. The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries. Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policymakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.

  7. An economic evaluation of anonymised information sharing in a partnership between health services, police and local government for preventing violence-related injury.

    PubMed

    Florence, Curtis; Shepherd, Jonathan; Brennan, Iain; Simon, Thomas R

    2014-04-01

    To assess the costs and benefits of a partnership between health services, police and local government shown to reduce violence-related injury. Benefit-cost analysis. Anonymised information sharing and use led to a reduction in wounding recorded by the police that reduced the economic and social costs of violence by £6.9 million in 2007 compared with the costs the intervention city, Cardiff UK, would have experienced in the absence of the programme. This includes a gross cost reduction of £1.25 million to the health service and £1.62 million to the criminal justice system in 2007. By contrast, the costs associated with the programme were modest: setup costs of software modifications and prevention strategies were £107 769, while the annual operating costs of the system were estimated as £210 433 (2003 UK pound). The cumulative social benefit-cost ratio of the programme from 2003 to 2007 was £82 in benefits for each pound spent on the programme, including a benefit-cost ratio of 14.80 for the health service and 19.1 for the criminal justice system. Each of these benefit-cost ratios is above 1 across a wide range of sensitivity analyses. An effective information-sharing partnership between health services, police and local government in Cardiff, UK, led to substantial cost savings for the health service and the criminal justice system compared with 14 other cities in England and Wales designated as similar by the UK government where this intervention was not implemented.

  8. Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model.

    PubMed

    Braithwaite, R Scott; Omokaro, Cynthia; Justice, Amy C; Nucifora, Kimberly; Roberts, Mark S

    2010-02-16

    Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (<$100,000 per life-year), would remain unchanged for intermediate- or unknown-value services ($100,000-$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures.

  9. 42 CFR 457.520 - Cost sharing for well-baby and well-child care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Adolescents.” (3) Laboratory tests associated with the well-baby and well-child routine physical examinations... 42 Public Health 4 2010-10-01 2010-10-01 false Cost sharing for well-baby and well-child care... well-baby and well-child care services. (a) A State may not impose copayments, deductibles, coinsurance...

  10. Shared Services for Rural and Small Schools.

    ERIC Educational Resources Information Center

    Hanuske, Sarah

    As school populations decline and costs rise due to inflation, rural and small schools are turning to shared services in order to keep community schools open, meet federal mandates, and improve educational opportunities. Sharing ventures may be for limited purposes, such as sharing a physics teacher or having a joint drama production, or for more…

  11. Implementation of Activity Based Cost Management Aboard Base Installations

    DTIC Science & Technology

    2004-09-01

    Shared Services Concept (After Penn State Briefing) .....................................30 Figure 8. Command Levels and Applicable Tools (From...resulting analysis of this duplication of efforts resulted in what they refer to as the “ Shared Services Concept.” Simply put, there should be “no...more than one of anything in the Base organization.” (Penn State Briefing) This Shared Services concept combined common support services that were

  12. An Analysis of Medical Imaging Costs in Military Treatment Facilities

    DTIC Science & Technology

    2014-09-01

    authority to completely control the medical systems of each service, the DHA 7 was given management responsibility for specific shared services , functions...efficient health operations through enhanced enterprise-wide shared services . • Deliver more comprehensive primary care and integrated health...of shared services that will fall under central control: • facility planning • medical logistics • health information technology • Tricare health

  13. Provision of CT Scanning Capability to VA/DoD (Veterans Administration/ Department of Defense) Health Care Facilities through a Shared Mobile CT Unit: A Feasibility Study

    DTIC Science & Technology

    1984-07-27

    all Federal sectoT facilities. Shared services have long been recna, nzed as one way to reduce costs, throuph optima’ itilizaticn of capacity, but...stock arguments against shared services . A CT scanner may be installed in a mobile van and the service moved in its entirety from hospital to hospital...annually. This severely restricted further acquisition by hospitals in most health service areas (5,9,14). Shared Services : A Response to Regulation

  14. Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 European Union countries.

    PubMed

    Tambor, Marzena; Pavlova, Milena; Woch, Piotr; Groot, Wim

    2011-10-01

    During the past decades, many governments have introduced patient cost-sharing in their public health-care system. This trend in health-care reforms affected the European Union (EU) member states as well. This article presents a review of patient cost-sharing for health-care services in the 27 EU countries, and discusses directions for their improvement. Data are collected based on a review of international data bases, national laws and regulations, as well as scientific and policy reports. The analysis presents a combination of qualitative and quantitative research techniques. Patient cost-sharing arrangements in the EU have been changing considerably over the past two decades (mostly being extended) and are quite diverse at present. There is a relation between patient cost-sharing arrangements and some characteristics of the health-care system in a country. In a few EU countries, a mix of formal and informal charges exists, which creates a double financial burden for health-care consumers. The adequacy of patient cost-sharing arrangements in EU countries needs to be reconsidered. Most importantly, it is essential to deal with informal patient payments (where applicable) and to assure adequate exemption mechanisms to diminish the adverse equity effects of patient cost-sharing. A close communication with the public is needed to clarify the objectives and content of a patient payment policy in a country.

  15. An economic evaluation of anonymised information sharing in a partnership between health services, police and local government for preventing violence-related injury

    PubMed Central

    Florence, Curtis; Shepherd, Jonathan; Brennan, Iain; Simon, Thomas

    2018-01-01

    Objective To assess the costs and benefits of a partnership between health services, police and local government shown to reduce violence related injury. Methods Cost benefit analysis Results Anonymised information sharing and use led to a reduction in wounding recorded by the police that reduced the economic and social costs of violence by £6.9 million in 2007 compared to the costs the intervention city, Cardiff UK, would have experienced in the absence of the programme. This includes a gross cost reduction of £1.25 million to the health service and £1.62 million to the criminal justice system in 2007. In contrast, the costs associated with the programme are modest: setup costs of software modifications and prevention strategies were £107,769, while the annual operating costs of the system were estimated as £210,433 (2003 UK Pound). The cumulative social benefit/cost ratio of the programme from 2003 to 2007 was £82 in benefits for each pound spent on the programme, including a benefit cost ratio of 14.8 for the health service and 19.1 for the criminal justice system. Each of these benefit/cost ratios is above 1 across a wide range of sensitivity analyses. Conclusions An effective information sharing partnership between health services, police, and local government in Cardiff, UK, led to substantial cost savings to the health service and the criminal justice system compared with 14 other cities in England and Wales designated as similar by the UK government where this intervention was not implemented. PMID:24048916

  16. Consumer cost sharing in private health insurance: on the threshold of change.

    PubMed

    Goff, Veronica

    2004-05-14

    Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, co-pays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

  17. 47 CFR 27.1176 - Cost-sharing requirements for AWS in the 2150-2160/62 MHz band.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Cost-sharing requirements for AWS in the 2150... 2150-2160/62 Mhz Band § 27.1176 Cost-sharing requirements for AWS in the 2150-2160/62 MHz band. (a) Frequencies in the 2150-2160/62 MHz band have been reallocated from the Broadband Radio Service (BRS) to AWS...

  18. 47 CFR 27.1176 - Cost-sharing requirements for AWS in the 2150-2160/62 MHz band.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Cost-sharing requirements for AWS in the 2150... 2150-2160/62 Mhz Band § 27.1176 Cost-sharing requirements for AWS in the 2150-2160/62 MHz band. (a) Frequencies in the 2150-2160/62 MHz band have been reallocated from the Broadband Radio Service (BRS) to AWS...

  19. TRICARE; Revision of Nonparticipating Providers Reimbursement Rate; Removal of Cost Share for Dental Sealants; TRICARE Dental Program. Final rule.

    PubMed

    2016-03-07

    This final rule revises the benefit payment provision for nonparticipating providers to more closely mirror industry practices by requiring TDP nonparticipating providers to be reimbursed (minus the appropriate cost-share) at the lesser of billed charges or the network maximum allowable charge for similar services in that same locality (region) or state. This rule also updates the regulatory provisions regarding dental sealants to clearly categorize them as a preventive service and, consequently, eliminate the current 20 percent cost-share applicable to sealants to conform with the language in the regulation to the statute.

  20. 34 CFR 675.45 - Allowable costs, Federal share, and institutional share.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... education, financial self-help, and community service-learning opportunities. (3) Carry out activities in... programs including— (i) Community-based work-learning-service alternatives that expand opportunities for community service and career-related work; and (ii) Alternatives that develop sound citizenship, encourage...

  1. Policy Framework for Covering Preventive Services Without Cost Sharing: Saving Lives and Saving Money?

    PubMed

    Chen, Stephanie C; Pearson, Steven D

    2016-08-01

    The US Affordable Care Act mandates that private insurers cover a list of preventive services without cost sharing. The list is determined by 4 expert committees that evaluate the overall health effect of preventive services. We analyzed the process by which the expert committees develop their recommendations. Each committee uses different criteria to evaluate preventive services and none of the committees consider cost systematically. We propose that the existing committees adopt consistent evidence review methodologies and expand the scope of preventive services reviewed and that a separate advisory committee be established to integrate economic considerations into the final selection of free preventive services. The comprehensive framework and associated criteria are intended to help policy makers in the future develop a more evidence-based, consistent, and ethically sound approach.

  2. Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing.

    PubMed

    Lemaire, Robin H; Bailey, Linda; Leischow, Scott J

    2015-11-01

    We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free.

  3. Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing

    PubMed Central

    Bailey, Linda; Leischow, Scott J.

    2015-01-01

    Objectives. We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). Methods. We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. Results. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. Conclusions. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free. PMID:26447918

  4. Defense Health Care Reform: Actions Needed to Help Realize Potential Cost Savings from Medical Education and Training

    DTIC Science & Technology

    2014-07-01

    services in carrying out their medical missions, manage the military s health plan, oversee the medical operations within and provide 10 shared services , including...oversight of medical education and training. According to DOD, a shared services concept is a combination of common services performed across

  5. 42 CFR 457.555 - Maximum allowable cost-sharing charges on targeted low-income children in families with income...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-emergency use of the emergency room. For Federal FY 2009, for targeted low-income children whose household...-institutional services, up to a maximum amount of $11.35 for services furnished in a hospital emergency room if... 42 Public Health 4 2013-10-01 2013-10-01 false Maximum allowable cost-sharing charges on targeted...

  6. 42 CFR 457.555 - Maximum allowable cost-sharing charges on targeted low-income children in families with income...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-emergency use of the emergency room. For Federal FY 2009, for targeted low-income children whose household...-institutional services, up to a maximum amount of $11.35 for services furnished in a hospital emergency room if... 42 Public Health 4 2014-10-01 2014-10-01 false Maximum allowable cost-sharing charges on targeted...

  7. 47 CFR 27.1160 - Cost-sharing requirements for AWS.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 2 2011-10-01 2011-10-01 false Cost-sharing requirements for AWS. 27.1160...-sharing requirements for AWS. Frequencies in the 2110-2150 MHz and 2160-2180 MHz bands listed in § 101.147 of this chapter have been reallocated from Fixed Microwave Services (FMS) to use by AWS (as reflected...

  8. 47 CFR 27.1160 - Cost-sharing requirements for AWS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Cost-sharing requirements for AWS. 27.1160...-sharing requirements for AWS. Frequencies in the 2110-2150 MHz and 2160-2180 MHz bands listed in § 101.147 of this chapter have been reallocated from Fixed Microwave Services (FMS) to use by AWS (as reflected...

  9. Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

    PubMed

    Kato, Hirotaka; Goto, Rei

    2017-08-15

    Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

  10. Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model

    PubMed Central

    Scott Braithwaite, R.; Omokaro, Cynthia; Justice, Amy C.; Nucifora, Kimberly; Roberts, Mark S.

    2010-01-01

    Background Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. Methods and Findings We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (<$100,000 per life-year), would remain unchanged for intermediate- or unknown-value services ($100,000–$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Conclusion Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures. Please see later in the article for the Editors' Summary PMID:20169114

  11. Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?

    PubMed

    Han, Xuesong; Robin Yabroff, K; Guy, Gery P; Zheng, Zhiyuan; Jemal, Ahmedin

    2015-09-01

    An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use. We evaluated changes in the use of recommended preventive services from 2009 (before the implementation of ACA cost-sharing provision) to 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type. There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population aged 18-64years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01-1.05) for blood pressure check, 1.13 (1.09-1.18) for cholesterol check and 1.04 (1.00-1.08) for flu vaccination (all p-values<0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population. These early observations suggest positive benefits from the ACA policy of eliminating cost-sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Military Health System: Sustained Senior Leadership Needed to Fully Develop Plans for Achieving Cost Savings

    DTIC Science & Technology

    2014-02-26

    left its existing structure in place, approving instead a shared - services directorate to consolidate common MHS functions (e.g., shared information...has seven main goals: (1) consolidate functions ( shared services ) common to DoD, (2) deliver more-integrated health care in areas with more than one

  13. Opportunities for Shared-Use Mobility Services in Rural Disadvantaged Communities in California’s San Joaquin Valley : Existing Conditions and Conceptual Program Development

    DOT National Transportation Integrated Search

    2017-09-01

    Shared-use mobility services largely serve major metropolitan areas. However, increasingly officials, who represent rural communities, want to know whether these types of services may be able to provide more cost-effective access to rural residents t...

  14. First-dollar cost-sharing for skilled nursing facility care in medicare advantage plans.

    PubMed

    Keohane, Laura M; Grebla, Regina C; Rahman, Momotazur; Mukamel, Dana B; Lee, Yoojin; Mor, Vincent; Trivedi, Amal

    2017-08-29

    The initial days of a Medicare-covered skilled nursing facility (SNF) stay may have no cost-sharing or daily copayments depending on beneficiaries' enrollment in traditional Medicare or Medicare Advantage. Some policymakers have advocated imposing first-dollar cost-sharing to reduce post-acute expenditures. We examined the relationship between first-dollar cost-sharing for a SNF stay and use of inpatient and SNF services. We identified seven Medicare Advantage plans that introduced daily SNF copayments of $25-$150 in 2009 or 2010. Copays began on the first day of a SNF admission. We matched these plans to seven matched control plans that did not introduce first-dollar cost-sharing. In a difference-in-differences analysis, we compared changes in SNF and inpatient utilization for the 172,958 members of intervention and control plans. In intervention plans the mean annual number of SNF days per 100 continuously enrolled inpatients decreased from 768.3 to 750.6 days when cost-sharing changes took effect. Control plans experienced a concurrent increase: 721.7 to 808.1 SNF days per 100 inpatients (adjusted difference-in-differences: -87.0 days [95% CI (-112.1,-61.9)]). In intervention plans, we observed no significant changes in the probability of any SNF service use or the number of inpatient days per hospitalized member relative to concurrent trends among control plans. Among several strategies Medicare Advantage plans can employ to moderate SNF use, first-dollar SNF cost-sharing may be one influential factor. Not applicable.

  15. The ACA's Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits.

    PubMed

    Kirby, James B; Davidoff, Amy J; Basu, Jayasree

    2016-12-01

    Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy. In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period. Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits. The Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.

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

    PubMed

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

    2017-12-01

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

  17. Interdisciplinary shared governance: a partnership model for high performance in a managed care environment.

    PubMed

    Anderson, D A; Bankston, K; Stindt, J L; Weybright, D W

    2000-09-01

    Today's managed care environment is forcing hospitals to seek new and innovative ways to deliver a seamless continuum of high-quality care and services to defined populations at lower costs. Many are striving to achieve this goal through the implementation of shared governance models that support point-of-service decision making, interdisciplinary partnerships, and the integration of work across clinical settings and along the service delivery continuum. The authors describe the key processes and strategies used to facilitate the design and successful implementation of an interdisciplinary shared governance model at The University Hospital, Cincinnati, Ohio. Implementation costs and initial benefits obtained over a 2-year period also are identified.

  18. The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008-2012).

    PubMed

    Choi, Young; Kim, Jae-Hyun; Yoo, Ki-Bong; Cho, Kyoung Hee; Choi, Jae-Woo; Lee, Tae Hoon; Kim, Woorim; Park, Eun-Cheol

    2015-10-28

    Private health insurance in South Korea mainly functions as supplementary and complementary health insurance that compensates for insufficient coverage by National Health Insurance. However, full private coverage of public sector cost-sharing led to the problem of encouraging moral hazard-induced utilization, resulting in a policy change that occurred in October 2009. At that time, the Korean government introduced a minimum cost-sharing policy for indemnity health insurance. The purpose of this study was to analyze the effect of cost-sharing in private health insurance on health care utilization. We analyzed data collected from the Korean Health Panel Survey from October 2008 to December 2011. We restricted the two groups to 803 purchasers with indemnity health insurance and 7023 non-purchasers who did not obtain any private health insurance. A difference-in-difference analysis was used to evaluate the effect of the 2009 policy. After the policy change, the utilization of outpatient visits by purchasers gradually decreased more than non-purchasers (0.015 in 2009 [p = 0.758], -0.117 in 2010 [p < 0.016], and -0.140 in 2011 [p = 0.004]). However, utilization of inpatient services was not statistically significant. Notably, the magnitude of the cost-sharing effect in indemnity health insurance was stronger for those receiving medical aid. Among this group, utilization of outpatient services (after the policy change in 2009) decreased more so than non-purchasers. Patients with three or more chronic diseases have not changed their health care utilization. Our results implied meaningful lessons for decision-makers and future health insurance policies in Korea and other countries in terms of cost-sharing in medical care. When policy makers intend to implement the cost-sharing, a different copayment scheme is needed according to the socioeconomic status or disease severity.

  19. 7 CFR 1467.3 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... than a conservation practice that is included in the WRPO or restoration cost-share agreement, as..., or enhanced through an easement, contract, or restoration cost-share agreement. Agreement means the... Conservation Service or the person delegated authority to act for the Chief. Commenced conversion wetland means...

  20. 42 CFR 422.100 - General requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... services. (g) Benefits affecting screening mammography, influenza vaccine, and pneumoccal vaccine. (1... influenza vaccine. (2) MA organizations may not impose cost-sharing for influenza vaccine and pneumococcal...

  1. 42 CFR 422.100 - General requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... services. (g) Benefits affecting screening mammography, influenza vaccine, and pneumoccal vaccine. (1... influenza vaccine. (2) MA organizations may not impose cost-sharing for influenza vaccine and pneumococcal...

  2. 42 CFR 422.100 - General requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... services. (g) Benefits affecting screening mammography, influenza vaccine, and pneumoccal vaccine. (1... influenza vaccine. (2) MA organizations may not impose cost-sharing for influenza vaccine and pneumococcal...

  3. 42 CFR 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR... cost sharing under Medicaid, defined at § 447.78, track beneficiaries' incurred premiums and cost...

  4. 42 CFR 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR... cost sharing under Medicaid, defined at § 447.78, track beneficiaries' incurred premiums and cost...

  5. 34 CFR 675.45 - Allowable costs, Federal share, and institutional share.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-help payments or credits provided under the work-learning-service program within the limits of part F of title IV of the HEA. (2) Promote the work-learning-service experience as a tool of postsecondary education, financial self-help, and community service-learning opportunities. (3) Carry out activities in...

  6. 34 CFR 675.45 - Allowable costs, Federal share, and institutional share.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-help payments or credits provided under the work-learning-service program within the limits of part F of title IV of the HEA. (2) Promote the work-learning-service experience as a tool of postsecondary education, financial self-help, and community service-learning opportunities. (3) Carry out activities in...

  7. 34 CFR 675.45 - Allowable costs, Federal share, and institutional share.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-help payments or credits provided under the work-learning-service program within the limits of part F of title IV of the HEA. (2) Promote the work-learning-service experience as a tool of postsecondary education, financial self-help, and community service-learning opportunities. (3) Carry out activities in...

  8. 34 CFR 675.45 - Allowable costs, Federal share, and institutional share.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-help payments or credits provided under the work-learning-service program within the limits of part F of title IV of the HEA. (2) Promote the work-learning-service experience as a tool of postsecondary education, financial self-help, and community service-learning opportunities. (3) Carry out activities in...

  9. A Secure and Efficient Audit Mechanism for Dynamic Shared Data in Cloud Storage

    PubMed Central

    2014-01-01

    With popularization of cloud services, multiple users easily share and update their data through cloud storage. For data integrity and consistency in the cloud storage, the audit mechanisms were proposed. However, existing approaches have some security vulnerabilities and require a lot of computational overheads. This paper proposes a secure and efficient audit mechanism for dynamic shared data in cloud storage. The proposed scheme prevents a malicious cloud service provider from deceiving an auditor. Moreover, it devises a new index table management method and reduces the auditing cost by employing less complex operations. We prove the resistance against some attacks and show less computation cost and shorter time for auditing when compared with conventional approaches. The results present that the proposed scheme is secure and efficient for cloud storage services managing dynamic shared data. PMID:24959630

  10. A secure and efficient audit mechanism for dynamic shared data in cloud storage.

    PubMed

    Kwon, Ohmin; Koo, Dongyoung; Shin, Yongjoo; Yoon, Hyunsoo

    2014-01-01

    With popularization of cloud services, multiple users easily share and update their data through cloud storage. For data integrity and consistency in the cloud storage, the audit mechanisms were proposed. However, existing approaches have some security vulnerabilities and require a lot of computational overheads. This paper proposes a secure and efficient audit mechanism for dynamic shared data in cloud storage. The proposed scheme prevents a malicious cloud service provider from deceiving an auditor. Moreover, it devises a new index table management method and reduces the auditing cost by employing less complex operations. We prove the resistance against some attacks and show less computation cost and shorter time for auditing when compared with conventional approaches. The results present that the proposed scheme is secure and efficient for cloud storage services managing dynamic shared data.

  11. Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.

    PubMed

    Klinger, Christopher A; Howell, Doris; Marshall, Denise; Zakus, David; Brazil, Kevin; Deber, Raisa B

    2013-02-01

    Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.

  12. Health care costs and financing in world perspective.

    PubMed Central

    Roemer, M. I.

    1991-01-01

    Expenditures for health services, as a percentage of national wealth (gross national product, or GNP), have been rising throughout the world. Data to quantify this trend are available for many industrialized countries. The share of health spending derived from governmental sources has also been increasing. Mandatory or social insurance has developed to support health services in 70 nations. While widely used for paying doctors on a fee basis or by capitation, in Latin America doctors are organized in polyclinics and paid by salaries. General revenues are used to support Ministry of Health programs. Among health expenditures, the largest share goes to hospitalization. Cost sharing by patients is widely used to control rising costs. World trends have promoted equity in health care delivery. PMID:1814057

  13. 22 CFR 226.23 - Cost sharing or matching.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.23 Cost sharing or... volunteer services shall be consistent with those paid for similar work in the recipient's organizations. In...

  14. 48 CFR 35.003 - Policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... only when the principal purpose is the acquisition of supplies or services for the direct benefit or... purpose of the transaction is to stimulate or support research and development for another public purpose. (b) Cost sharing. Cost sharing policies (which are not otherwise required by law) under Government...

  15. 7 CFR 636.12 - Termination of cost-share agreements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Termination of cost-share agreements. 636.12 Section 636.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  16. 7 CFR 636.12 - Termination of cost-share agreements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Termination of cost-share agreements. 636.12 Section 636.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  17. 7 CFR 636.12 - Termination of cost-share agreements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Termination of cost-share agreements. 636.12 Section 636.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  18. 7 CFR 636.12 - Termination of cost-share agreements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Termination of cost-share agreements. 636.12 Section 636.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  19. 7 CFR 636.12 - Termination of cost-share agreements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Termination of cost-share agreements. 636.12 Section 636.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVES PROGRAM § 636...

  20. Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

    PubMed

    Keohane, Laura M; Rahman, Momotazur; Thomas, Kali S; Trivedi, Amal N

    2018-03-12

    To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012. Select MA plans. Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846). Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2-163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8-24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=-6.5-20.8, p=.30). Disenrollment patterns did not change after the cap took effect. When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  1. 7 CFR 631.12 - Cost-share payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... resource management systems or a practice or an identifiable unit according to specifications will be made... 7 Agriculture 6 2010-01-01 2010-01-01 false Cost-share payments. 631.12 Section 631.12 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF...

  2. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 1701(6). (e) Unless the cost of care is charged at rates agreed upon in a sharing agreement as described in § 17.102(e), the cost of hospital care and medical services provided under this section to an... individuals who receive hospital care or medical services under this section are responsible for the cost of...

  3. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 1701(6). (e) Unless the cost of care is charged at rates agreed upon in a sharing agreement as described in § 17.102(e), the cost of hospital care and medical services provided under this section to an... individuals who receive hospital care or medical services under this section are responsible for the cost of...

  4. 38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 1701(6). (e) Unless the cost of care is charged at rates agreed upon in a sharing agreement as described in § 17.102(e), the cost of hospital care and medical services provided under this section to an... individuals who receive hospital care or medical services under this section are responsible for the cost of...

  5. 36 CFR 230.41 - Eligibility requirements for cost-share assistance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE... of a responsible official, determines that significant public benefits would accrue from approval of...

  6. 7 CFR 636.11 - Transfer of interest in a cost-share agreement.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Transfer of interest in a cost-share agreement. 636.11 Section 636.11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  7. 7 CFR 636.11 - Transfer of interest in a cost-share agreement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Transfer of interest in a cost-share agreement. 636.11 Section 636.11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVES PROGRAM § 636...

  8. 7 CFR 636.11 - Transfer of interest in a cost-share agreement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Transfer of interest in a cost-share agreement. 636.11 Section 636.11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  9. 7 CFR 636.11 - Transfer of interest in a cost-share agreement.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Transfer of interest in a cost-share agreement. 636.11 Section 636.11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  10. 7 CFR 636.11 - Transfer of interest in a cost-share agreement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Transfer of interest in a cost-share agreement. 636.11 Section 636.11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVE PROGRAM § 636...

  11. 36 CFR 230.41 - Eligibility requirements for cost-share assistance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

  12. 36 CFR 230.41 - Eligibility requirements for cost-share assistance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

  13. 36 CFR 230.41 - Eligibility requirements for cost-share assistance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

  14. 36 CFR 230.41 - Eligibility requirements for cost-share assistance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... management plans such as Tree Farm management plans, Forest Stewardship management plans, or similar plans... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Eligibility requirements for cost-share assistance. 230.41 Section 230.41 Parks, Forests, and Public Property FOREST SERVICE...

  15. 42 CFR 447.50 - Cost sharing: Basis and purpose.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Cost Sharing § 447... the following four criteria: (A) Is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by...

  16. 45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

  17. 45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

  18. 40 CFR 35.929-1 - Approval of the user charge system.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the grantee's costs of waste water treatment services; (B) The grantee's budgeting and accounting... operation and maintenance; (C) The ad valorem tax system collected tax funds for the costs of waste water..., which required the subscriber to pay its share of the cost of waste water treatment services. (4) A user...

  19. 40 CFR 35.929-1 - Approval of the user charge system.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the grantee's costs of waste water treatment services; (B) The grantee's budgeting and accounting... operation and maintenance; (C) The ad valorem tax system collected tax funds for the costs of waste water..., which required the subscriber to pay its share of the cost of waste water treatment services. (4) A user...

  20. 40 CFR 35.929-1 - Approval of the user charge system.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the grantee's costs of waste water treatment services; (B) The grantee's budgeting and accounting... operation and maintenance; (C) The ad valorem tax system collected tax funds for the costs of waste water..., which required the subscriber to pay its share of the cost of waste water treatment services. (4) A user...

  1. 40 CFR 35.929-1 - Approval of the user charge system.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the grantee's costs of waste water treatment services; (B) The grantee's budgeting and accounting... operation and maintenance; (C) The ad valorem tax system collected tax funds for the costs of waste water..., which required the subscriber to pay its share of the cost of waste water treatment services. (4) A user...

  2. 40 CFR 35.929-1 - Approval of the user charge system.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... the grantee's costs of waste water treatment services; (B) The grantee's budgeting and accounting... operation and maintenance; (C) The ad valorem tax system collected tax funds for the costs of waste water..., which required the subscriber to pay its share of the cost of waste water treatment services. (4) A user...

  3. Out-Of-Pocket Prescription Costs Under A Typical Silver Plan Are Twice As High As They Are In The Average Employer Plan.

    PubMed

    Thorpe, Kenneth E; Allen, Lindsay; Joski, Peter

    2015-10-01

    The health insurance Marketplaces created under the Affordable Care Act have attracted nearly ten million enrollees, including many people who were previously insured by an employer-sponsored plan. The most popular Marketplace plan--the silver plan--has significantly higher cost sharing than does a typical employer-sponsored plan, which may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions. We estimated the impact of higher cost sharing on drug and medical spending among patients with chronic conditions. Using national data, we compared cost sharing and prescription and medical spending for patients covered by employer-sponsored plans to the spending for those in a typical silver plan in the Marketplaces. Our results show that out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan, resulting in fewer prescriptions filled and refilled and in higher spending on other medical services. Maintaining the use of cost-effective prescription medications might require lower cost sharing for patients with chronic conditions than is currently found in the Marketplaces. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Research Shared Services: A Case Study in Implementation

    ERIC Educational Resources Information Center

    Squilla, Brian; Lee, Jenna; Steil, Andrew

    2017-01-01

    The private sector has been moving toward the idea of consolidating administrative functions within organizations since the 1980s. While this sector has traditionally implemented shared services with cost reduction in mind, traditionally through economies of scale, many universities across the country have begun to explore the concept of managing…

  5. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  6. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  7. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  8. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  9. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  10. NRCS-EQIP Tree Fruit IPM Program

    USDA-ARS?s Scientific Manuscript database

    In 2008, the WVU Extension Service partnered with the Natural Resources Conservation Service (NRCS) to develop and implement a cost-share IPM program for the commercial tree fruit growers in West Virginia. Fifty percent of implementation costs were paid by NRCS through the Environmental Quality Ince...

  11. 48 CFR 2016.307-70 - Contract provisions and clauses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., Level of Effort, in solicitations for negotiated procurements containing labor costs other than maintenance services to be awarded on a cost reimbursement, cost sharing, cost-plus-award fee, cost-plus-fixed... COMMISSION CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Cost Reimbursement Contracts 2016.307-70...

  12. The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea.

    PubMed

    Lee, Hyo Jung; Jang, Sung-In; Park, Eun-Cheol

    2017-02-20

    The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization. The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed. After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p < 0.0001); however, the number increased at hospitals and clinics (β = 0.0580, p < 0.0001). Eventually, the number of outpatient visits to hospitals and clinics began to decrease after policy initiation (β = -0.0018, p < 0.0001). Outpatient medical costs decreased for both medical care organizations (general or tertiary hospitals: β = -2913.4, P < 0.0001; hospitals or clinics: β = -591.35, p < 0.0001), and this decreasing trend continued with time. It is not clear that decreased utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations.

  13. In Search of Cost-Effective Schools.

    ERIC Educational Resources Information Center

    Raywid, Mary Anne; Shaheen, Thomas A.

    1994-01-01

    Examines major cost-effectiveness proposals, describing developments that highlight concerns over making schools cost effective. The article discusses ways to blend the concerns of educational quality, equity, and costs (district consolidations, shared service and facilities arrangements, new accountability strategies, new information systems,…

  14. 77 FR 3605 - Section 482; Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-25

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9568] RIN 1545-BI47 Section 482; Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement; Correction... 22, 2011 (76 FR 80082), Relating to section 482 and methods to determine taxable income in connection...

  15. 78 FR 18234 - Section 482: Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 Section 482: Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement CFR Correction 0 In Title 26 of the...) * * * (1) * * * See Sec. 1.482-8 for examples of the application of the best method rule...

  16. 77 FR 8144 - Section 482; Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9568] RIN 1545-BI47 Section 482; Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement; Correction... Federal Register on Wednesday, January 25, 2012 (77 FR 3606) relating to section 482 and methods to...

  17. Cost-Sharing of Agricultural Technology Transfer in Nigeria: Perceptions of Farmers and Extension Professionals

    ERIC Educational Resources Information Center

    Ozor, N.; Agwu, A. E.; Chukwuone, N. A.; Madukwe, M. C.; Garforth, C. J.

    2007-01-01

    Cost-sharing, which involves government-farmer partnership in the funding of agricultural extension service, is one of the reforms aimed at achieving sustainable funding for extension systems. This study examined the perceptions of farmers and extension professionals on this reform agenda in Nigeria. The study was carried out in six geopolitical…

  18. Impact of drug cost sharing on service use and adverse clinical outcomes in elderly receiving antidepressants.

    PubMed

    Wang, Philip S; Patrick, Amanda R; Dormuth, Colin; Maclure, Malcolm; Avorn, Jerry; Canning, Claire F; Schneeweiss, Sebastian

    2010-03-01

    Depression imposes enormous burdens on the elderly. Despite this, rates of initiation of and adherence to recommended pharmacotherapy are frequently low in this population. Although initiatives such as the Medicare Modernization Act (MMA) have improved seniors' access to antidepressants, there are concerns that the patient cost-sharing incorporated in the MMA may have unintended consequences if it reduces essential drug use. Age-related pharmacokinetic and pharmacodynamic changes could make seniors particularly vulnerable to antidepressant regimens used inappropriately to save costs, increasing their risks of morbidity, hospitalizations, and nursing home placements. Two sequential large-scale "natural experiments'' in British Columbia provide a unique opportunity to evaluate the effect of cost sharing on outcomes and mental health service use among seniors. In January 2002 the province introduced a CAD 25 copay (CAD10 for low-income seniors). In May 2003 this copay policy was replaced by a second policy consisting of an income-based deductible, 25% coinsurance once the deductible was met, and full coverage once an out-of-pocket ceiling was met. The transition between the two policies is analogous to what many U.S. seniors experience when they transition from private insurance requiring copays to Medicare Part D requiring deductibles and coinsurance. To evaluate whether declines in antidepressant initiation after the introduction of two drug cost-sharing policies in British Columbia were associated with increased use of physician services, hospitalizations, and nursing home admissions among all British Columbia residents aged 65+. Records of physician service use, inpatient hospitalizations, and residential care admissions were obtained from administrative databases. Population-level patterns over time were plotted, and effects of implementing the cost-sharing policies examined in segmented linear regression models. Neither policy affected the rates of visits to physicians or psychiatrists for depression, hospitalizations with a depression diagnosis, or long-term care admissions. The cost-sharing policies studied may have contained non-essential antidepressant use without substantially increasing mental health service utilization. However, it is possible that the policies had effects that we were unable to detect, such as increasing rates of visits to social workers or psychologists or forcing patients to reduce other spending. Further, the sequential implementation of the policy changes, makes it difficult to estimate the effect of a direct change from full coverage to a coinsurance/income-based deductible policy. It may be possible to design policies to contain non-essential antidepressant use without substantially increasing other service utilization or adverse events. However, because undertreatment remains a serious problem among depressed elderly, well-designed prescription drug policies should be coupled with interventions to address under-treatment.

  19. Impact of Drug Cost Sharing on Service Use and Adverse Clinical Outcomes In Elderly Receiving Antidepressants

    PubMed Central

    Wang, Philip S.; Patrick, Amanda R.; Dormuth, Colin; Maclure, Malcolm; Avorn, Jerry; Canning, Claire F.; Schneeweiss, Sebastian

    2010-01-01

    Background Depression imposes enormous burdens on the elderly. Despite this, rates of initiation of and adherence to recommended pharmacotherapy are frequently low in this population. Although initiatives such as the Medicare Modernization Act (MMA) in have improved seniors' access to antidepressants, there are concerns that the patient cost-sharing incorporated in the MMA may have unintended consequences if it reduces essential drug use. Age-related pharmacokinetic and pharmacodynamic changes could make seniors particularly vulnerable to antidepressant regimens used inappropriately to save costs, increasing their risks of morbidity, hospitalizations, and nursing home placements. Two sequential large-scale “natural experiments” in British Columbia provide a unique opportunity to evaluate the effect of cost sharing on outcomes and mental health service use among seniors. In January 2002 the province introduced a $25 Canadian copay ($10 for low-income seniors). In May 2003 this copay policy was replaced by a second policy consisting of an income-based deductible, 25% coinsurance once the deductible was met, and full coverage once an out-of-pocket ceiling was met. The transition between the two policies is analogous to what many U.S. seniors experience when they transition from private insurance requiring copays to Medicare Part D requiring deductibles and coinsurance. Aims To evaluate whether declines in antidepressant initiation after the introduction of two drug cost-sharing policies in British Columbia were associated with increased use of physician services, hospitalizations, and nursing home admissions among all British Columbia residents aged 65+. Methods Records of physician service use, inpatient hospitalizations, and residential care admissions were obtained from administrative databases. Population-level patterns over time were plotted, and effects of implementing the cost-sharing policies examined in segmented linear regression models. Results Neither policy affected the rates of visits to physicians or psychiatrists for depression, hospitalizations with a depression diagnosis, or long-term care admissions. Discussion The cost-sharing policies studied may have contained non-essential antidepressant use without substantially increasing mental health service utilization. However, it is possible that the policies had effects that we were unable to detect, such as increasing rates of visits to social workers or psychologists or forcing patients to reduce other spending. Further, the sequential implementation of the policy changes, makes it difficult to estimate the effect of a direct change from full coverage to a coinsurance/income-based deductible policy. Implications for Health Policies It may be possible to design policies to contain non-essential antidepressant use without substantially increasing other service utilization or adverse events. However, because undertreatment remains a serious problem among depressed elderly, well-designed prescription drug policies should be coupled with interventions to address under-treatment. PMID:20571181

  20. 34 CFR 675.33 - Allowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... costs. An institution's share of allowable costs may be in cash or in the form of services. The... 34 Education 3 2010-07-01 2010-07-01 false Allowable costs. 675.33 Section 675.33 Education... costs. (a)(1) Allowable and unallowable costs. Except as provided in paragraph (a)(2) of this section...

  1. Cost containment in laundry and linen service.

    PubMed

    Ellis, B

    1978-03-16

    One major problem looms among all others in the area of laundry and linen service, whether a hospital has an in-house operation, is part of a shared or central laundry, or uses a commercial service. That is the costly problem of controling linen consumption and replacement. A recent seminar offers some insight into reasons for the problem and some possible solutions.

  2. Defense Health Care: Additional Analysis of Costs and Benefits of Potential Governance Structures Is Needed

    DTIC Science & Technology

    2012-09-01

    options, (2) a business case analysis and strategy for implementing its shared services concept, and (3) more complete analyses of the options’ strengths...and weaknesses. DoD concurred with developing a business case analysis for its shared services concept. DoD did not concur with the other two

  3. Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in Burkina Faso.

    PubMed

    Richard, F; Ouédraogo, C; Compaoré, J; Dubourg, D; De Brouwere, V

    2007-08-01

    To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the cost-sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).

  4. 48 CFR 42.707 - Cost-sharing rates and limitations on indirect cost rates.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... final indirect cost rate ceiling in a contract. Examples of such circumstances are when the proposed... ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Indirect Cost Rates 42... authorized, may call for the contractor to participate in the costs of the contract by accepting indirect...

  5. 76 FR 80081 - Section 482: Methods To Determine Taxable Income in Connection With a Cost Sharing Arrangement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-22

    ... Service 26 CFR Parts 1, 301, and 602 Section 482: Methods To Determine Taxable Income in Connection With a... 26 CFR Parts 1, 301, and 602 [TD 9568] RIN 1545-BI47 Section 482: Methods To Determine Taxable Income... regulations regarding methods to determine taxable income in connection with a cost sharing arrangement under...

  6. Medicare Advantage Members' Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services.

    PubMed

    Keohane, Laura M; Grebla, Regina C; Mor, Vincent; Trivedi, Amal N

    2015-06-01

    Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans' expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Medicare Advantage Members’ Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services

    PubMed Central

    Keohane, Laura M.; Grebla, Regina C.; Mor, Vincent; Trivedi, Amal N.

    2015-01-01

    Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans’ expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing. PMID:26056208

  8. Effect of cost-sharing reductions on preventive service use among Medicare fee-for-service beneficiaries.

    PubMed

    Goodwin, Suzanne M; Anderson, Gerard F

    2012-01-01

    Section 4104 of the Patient Protection and Affordable Care Act (ACA) waives previous cost-sharing requirements for many Medicare-covered preventive services. In 1997, Congress passed similar legislation waiving the deductible only for mammograms and Pap smears. The purpose of this study is to examine the effect of the deductible waiver on mammogram and Pap smear utilization rates. Using 1995-2003 Medicare claims from a sample of female, elderly Medicare fee-for-service beneficiaries, two pre/post analyses were conducted comparing mammogram and Pap smear utilization rates before and after implementation of the deductible waiver. Receipt of screening mammograms and Pap smears served as the outcome measures, and two time measures, representing two post-test observation periods, were used to examine the short- and long-term impacts on utilization. There was a 20 percent short-term and a 25 percent longer term increase in the probability of having had a mammogram in the four years following the 1997 deductible waiver. Beneficiaries were no more likely to receive a Pap smear following the deductible waiver. Elimination of cost sharing may be an effective strategy for increasing preventive service use, but the impact could depend on the characteristics of the procedure, its cost, and the disease and populations it targets. These historical findings suggest that, with implementation of Section 4104, the greatest increases in utilization will be seen for preventive services that screen for diseases with high incidence or prevalence rates that increase with age, that are expensive, and that are performed on a frequent basis.

  9. Complying with physician gain-sharing restrictions.

    PubMed

    O'Hare, P K

    1998-05-01

    Many IDSs are considering implementing gain-sharing programs as a way to motivate their physicians to provide high-quality, cost-effective services. Before embarking on such programs, however, IDSs need to understand the legal requirements associated with such programs to ensure that the gain-sharing arrangement is in compliance with Federal law.

  10. Design Activity in the Software Cost Reduction Project.

    DTIC Science & Technology

    1986-08-18

    PM Physical Model S G System Generation SS Shared Services SU System Utilities . NOV M N 1600SEP A 0 JUL TOTAL 14000 MAAR cc 100 FEB :IESGN 0o 10000...iy---- .... ;’ TESTING Jan 78 Jan 79 Jan 80 Jan 81 Jan 82 Jan 83 Jan 84 Jan 85 M3ITH Fig. 7 - Shared services activities A F 0 U E C 1600 G B T...DISCUSSING 200M Jan 78 Jan 79 Jan 80 Jan 81 Jan 82 Jan 83 Jan 84 Jan 85 Fig 13 - Shared services design activities 5.~ S% 12 ......,ooU7 . . NRL REPORT 8974 A

  11. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... quality than similar items in the bridge prior to alteration. Examples include improved signal and fender... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge owner...

  12. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... quality than similar items in the bridge prior to alteration. Examples include improved signal and fender... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge owner...

  13. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... quality than similar items in the bridge prior to alteration. Examples include improved signal and fender... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge owner...

  14. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... quality than similar items in the bridge prior to alteration. Examples include improved signal and fender... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge owner...

  15. Viewing the Impact of Shared Services through the Four Frames of Bolman and Deal

    ERIC Educational Resources Information Center

    Schumacher, Kyle A.

    2011-01-01

    On March 31, 2011, Governor Quinn of Illinois called for schools to consolidate in order to become more financially and administratively efficient. This call for massive school reform is not new. Although consolidation, or reducing the number of school districts to save administrative costs, seemed radical to some, the idea of sharing services to…

  16. 48 CFR 1816.303-70 - Cost-sharing contracts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... has no commercial, production, education, or service activities that would benefit from the results of... not-for-profit organizations. (1) Costs to perform research stemming from an unsolicited proposal by...

  17. 48 CFR 1816.303-70 - Cost-sharing contracts.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... has no commercial, production, education, or service activities that would benefit from the results of... not-for-profit organizations. (1) Costs to perform research stemming from an unsolicited proposal by...

  18. 48 CFR 1816.303-70 - Cost-sharing contracts.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... has no commercial, production, education, or service activities that would benefit from the results of... not-for-profit organizations. (1) Costs to perform research stemming from an unsolicited proposal by...

  19. 48 CFR 1816.303-70 - Cost-sharing contracts.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... has no commercial, production, education, or service activities that would benefit from the results of... not-for-profit organizations. (1) Costs to perform research stemming from an unsolicited proposal by...

  20. Impact of medical subsidy disqualification on children's healthcare utilization: A difference-in-differences analysis from Japan.

    PubMed

    Miyawaki, Atsushi; Noguchi, Haruko; Kobayashi, Yasuki

    2017-10-01

    Financial support for children's medical expenses has been introduced in many countries. Limited work has been done on price elasticity in children's healthcare demand, especially in countries other than the United States. Moreover, it remains unclear how the effects of a change in the cost sharing rate on healthcare demand would differ by medical condition. We investigated the impact of an increase in the cost sharing rate on medical service utilization among school children as a whole and for each of nine common conditions, applying a difference-in-differences approach. The study period ranged from April 1, 2012, to March 30, 2014. Participants were elementary school children in an urban area who were eligible for National Health Insurance (a community-based public insurance) during the study period and who were enrolled in the 2nd, 3rd, or 4th grade in April 2013. We collected observations from 2896 persons and 69,504 (2896 × 24 months) person-months. When elementary school children were promoted to the 4th grade, they became disqualified for a municipal medical subsidy. The control group was the children promoted to the 2nd or the 3rd grade, who remained eligible for the subsidy. All data were obtained from health insurance claims. We identified the nine most common medical conditions among the subject children, and stratified the analyses by the condition diagnosed. We found that an increase in the cost sharing rate reduced outpatient service utilization as a whole. Also, we observed an increase in inpatient service utilization, not because of worsened health conditions, but rather due to substitution of inpatient service for outpatient service. The reductions in outpatient service were heterogeneous across medical conditions; declines were sharper for mild or chronic conditions. These findings may help to characterize how a change in cost sharing rate affects health outcomes in children. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. How Low-Income Subsidy Recipients Respond to Medicare Part D Cost Sharing.

    PubMed

    Stuart, Bruce; Hendrick, Franklin B; Xu, Jing; Dougherty, J Samantha

    2017-06-01

    To determine the magnitude and mechanisms of response to Medicare Part D cost sharing by low-income subsidy (LIS) recipients using oral hypoglycemic agents (OHAs) and statins. Medicare data for a 5 percent random sample of beneficiaries with diabetes enrolled in fee-for-service Part D drug plans in 2008. We evaluated the impact of differences between generic and brand cost sharing rates among cohorts of LIS and non-LIS recipients to determine if wider price spreads increased the generic dispensing rate (GDR) and reduced total drug use and cost. We found little association between cost sharing and aggregate OHA and statin use. In adjusted analyses, non-LIS beneficiaries who paid 46 percent of total OHA costs had 2.5 percent fewer OHA days supply than full benefit dual eligibles who paid just 5 percent of their therapy costs. For statins, the difference in days supply between those facing the lowest and highest cost sharing was 4.6 percent. Higher cost sharing was associated with filling fewer but larger prescriptions for both generics and brands. Higher generic and brand copays had little association with OHA and statin use among LIS recipients. This implies that modest changes in required cost sharing for these medicines would have very little substantive impact on generic dispensing or utilization patterns among LIS recipients and thus would have little effect on total program spending. At the same time, any increases in out-of-pocket costs would be expected to shift costs and place greater financial burden on low-income beneficiaries, particularly those in poor health. © Health Research and Educational Trust.

  2. Clinical Decision Making and Mental Health Service Use Among Persons With Severe Mental Illness Across Europe.

    PubMed

    Cosh, Suzanne; Zenter, Nadja; Ay, Esra-Sultan; Loos, Sabine; Slade, Mike; De Rosa, Corrado; Luciano, Mario; Berecz, Roland; Glaub, Theodora; Munk-Jørgensen, Povl; Krogsgaard Bording, Malene; Rössler, Wulf; Kawohl, Wolfram; Puschner, Bernd

    2017-09-01

    The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness. Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models. A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005). A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.

  3. Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan.

    PubMed

    Yamauchi, Yasuhiro

    2015-07-12

    Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care.

  4. From Outsourcing to Alliances: Strategies for Sharing Leadership and Exploiting Resources at Metropolitan Universities.

    ERIC Educational Resources Information Center

    Ender, Kenneth L.; Mooney, Kathleen A.

    1994-01-01

    University partnerships with private industry to effect service delivery in facilities management, food services, bookstore management, parking management, arena management, housing operations, business services, safety operations, communication services, and purchasing improves the quality of these services, reduces costs, does not affect core…

  5. State Funding for Students with Disabilities. ECS 50-State Review

    ERIC Educational Resources Information Center

    Millard, Maria; Aragon, Stephanie

    2015-01-01

    About 13 percent of all public school students receive special educational services and state spending for these students is rising. In Michigan, for example, spending rose 60 percent from 2000 to 2010. While service costs have been increasing, the share of the costs covered by federal funding has been decreasing. Six years ago, the Individuals…

  6. The impact of patient cost-sharing on low-income populations: evidence from Massachusetts.

    PubMed

    Chandra, Amitabh; Gruber, Jonathan; McKnight, Robin

    2014-01-01

    Greater patient cost-sharing could help reduce the fiscal pressures associated with insurance expansion by reducing the scope for moral hazard. But it is possible that low-income recipients are unable to cut back on utilization wisely and that, as a result, higher cost-sharing will lead to worse health and higher downstream costs through increased use of inpatient and outpatient care. We use exogenous variation in the copayments faced by low-income enrollees in the Massachusetts Commonwealth Care program to study these effects. We estimate separate price elasticities of demand by type of service. Overall, we find price elasticities of about -0.16 for this low-income population - similar to elasticities calculated for higher-income populations in other settings. These elasticities are somewhat smaller for the chronically sick, especially for those with asthma, diabetes, and high cholesterol. These lower elasticities are attributable to lower responsiveness to prices across all categories of service, and to some statistically insignificant increases in inpatient care. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Physician responsibility for the cost of unnecessary medical services.

    PubMed

    Eisenberg, J M; Rosoff, A J

    1978-07-13

    Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

  8. Cardiology needs good planning for the future.

    PubMed

    Goodroe, J H; Hicks, K J

    1990-08-01

    In today's health care environment, hospitals have to develop strategies to maintain their market share, especially in cardiac services. The authors share generic strategies in cost leadership, product differentiation and technological leadership that can be adapted and implemented in cardiac centers.

  9. 47 CFR 24.239 - Cost-sharing requirements for broadband PCS.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...) are required to relocate the existing Fixed Microwave Services (FMS) licensees in these bands if... by other PCS entities or a voluntarily relocating microwave incumbent, must contribute to such...

  10. 47 CFR 24.239 - Cost-sharing requirements for broadband PCS.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...) are required to relocate the existing Fixed Microwave Services (FMS) licensees in these bands if... by other PCS entities or a voluntarily relocating microwave incumbent, must contribute to such...

  11. 47 CFR 24.239 - Cost-sharing requirements for broadband PCS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...) are required to relocate the existing Fixed Microwave Services (FMS) licensees in these bands if... by other PCS entities or a voluntarily relocating microwave incumbent, must contribute to such...

  12. 47 CFR 24.239 - Cost-sharing requirements for broadband PCS.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the...) are required to relocate the existing Fixed Microwave Services (FMS) licensees in these bands if... by other PCS entities or a voluntarily relocating microwave incumbent, must contribute to such...

  13. What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

    PubMed

    Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

    2016-02-01

    U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician-administered pharmaceuticals was slightly higher in HRP, their use did not alter this spending pattern. Overall, expenditures in the HRP population are more than 10-fold higher compared with the full population. Managed care pharmacy can benefit from understanding what contributes to these higher costs, and managed care directors should consider an appropriately balanced assessment of the share of total spend by service and therapeutic category in HRP when devising drug usage and related cost-management strategies.

  14. Circuit Riding: A Method for Providing Reference Services.

    ERIC Educational Resources Information Center

    Plunket, Linda; And Others

    1983-01-01

    Discussion of the design and implementation of the Circuit Rider Librarian Program, a shared services project for delivering reference services to eight hospitals in Maine, includes a cost analysis of services and description of user evaluation survey. Five references, composite results of the survey, and postgrant options proposal are appended.…

  15. The evolution of leader-follower reciprocity: the theory of service-for-prestige.

    PubMed

    Price, Michael E; Van Vugt, Mark

    2014-01-01

    We describe the service-for-prestige theory of leadership, which proposes that voluntary leader-follower relations evolved in humans via a process of reciprocal exchange that generated adaptive benefits for both leaders and followers. We propose that although leader-follower relations first emerged in the human lineage to solve problems related to information sharing and social coordination, they ultimately evolved into exchange relationships whereby followers could compensate leaders for services which would otherwise have been prohibitively costly for leaders to provide. In this exchange, leaders incur costs to provide followers with public goods, and in return, followers incur costs to provide leaders with prestige (and associated fitness benefits). Because whole groups of followers tend to gain from leader-provided public goods, and because prestige is costly for followers to produce, the provisioning of prestige to leaders requires solutions to the "free rider" problem of disrespectful followers (who benefit from leader services without sharing the costs of producing prestige). Thus service-for-prestige makes the unique prediction that disrespectful followers of beneficial leaders will be targeted by other followers for punitive sentiment and/or social exclusion. Leader-follower relations should be more reciprocal and mutually beneficial when leaders and followers have more equal social bargaining power. However, as leaders gain more relative power, and their high status becomes less dependent on their willingness to pay the costs of benefitting followers, service-for-prestige predicts that leader-follower relations will become based more on leaders' ability to dominate and exploit rather than benefit followers. We review evidential support for a set of predictions made by service-for-prestige, and discuss how service-for-prestige relates to social neuroscience research on leadership.

  16. The evolution of leader–follower reciprocity: the theory of service-for-prestige

    PubMed Central

    Price, Michael E.; Van Vugt, Mark

    2014-01-01

    We describe the service-for-prestige theory of leadership, which proposes that voluntary leader–follower relations evolved in humans via a process of reciprocal exchange that generated adaptive benefits for both leaders and followers. We propose that although leader–follower relations first emerged in the human lineage to solve problems related to information sharing and social coordination, they ultimately evolved into exchange relationships whereby followers could compensate leaders for services which would otherwise have been prohibitively costly for leaders to provide. In this exchange, leaders incur costs to provide followers with public goods, and in return, followers incur costs to provide leaders with prestige (and associated fitness benefits). Because whole groups of followers tend to gain from leader-provided public goods, and because prestige is costly for followers to produce, the provisioning of prestige to leaders requires solutions to the “free rider” problem of disrespectful followers (who benefit from leader services without sharing the costs of producing prestige). Thus service-for-prestige makes the unique prediction that disrespectful followers of beneficial leaders will be targeted by other followers for punitive sentiment and/or social exclusion. Leader–follower relations should be more reciprocal and mutually beneficial when leaders and followers have more equal social bargaining power. However, as leaders gain more relative power, and their high status becomes less dependent on their willingness to pay the costs of benefitting followers, service-for-prestige predicts that leader–follower relations will become based more on leaders’ ability to dominate and exploit rather than benefit followers. We review evidential support for a set of predictions made by service-for-prestige, and discuss how service-for-prestige relates to social neuroscience research on leadership. PMID:24926244

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

    Feibel, C.E.

    This study uses multiple data collection and research methods including in depth interviews, 271 surveys of shared taxi and minibus operators, participant observation, secondary sources, and the literature on public transport from low, medium, and high-income countries. Extensive use is also made of a survey administered in Istanbul in 1976 to 1935 paratransit operators. Primary findings are that private buses are more efficient than public buses on a cost per passenger-km basis, and that private minibuses are as efficient as public buses. In terms of energy efficiency, minibuses are almost as efficient as public and private buses using actual-occupancy levels.more » Large shared taxis are twice as cost and energy efficient as cars, and small shared taxis 50% more efficient. In terms of investment cost per seat, large shared taxis have the lowest cost followed by smaller shared taxis, minibuses, and buses. Considering actual occupancy levels, minibuses are only slightly less effective in terms of congestion than buses, and large and small shared taxis are twice as effective as cars. It is also shown that minibuses and shared taxis have better service quality than buses because of higher frequencies and speeds, and because they provide a much higher probability of getting a seat than buses. Analysis of regulation and policy suggests that there are many unintended cost of public-transport regulations.« less

  18. Medicaid Eligibility

    MedlinePlus

    ... recover for other Medicaid benefits, except for Medicare cost-sharing benefits paid on behalf of Medicare Savings Program beneficiaries. Third Party Liability: Third Party Liability (TPL) refers to third ... or all of the cost of medical services provided to a Medicaid beneficiary. ...

  19. Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan

    PubMed Central

    Yamauchi, Yasuhiro

    2016-01-01

    Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care. PMID:26493427

  20. 75 FR 57898 - National Urban and Community Forestry Advisory Council

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-23

    ... DEPARTMENT OF AGRICULTURE Forest Service National Urban and Community Forestry Advisory Council AGENCY: Forest Service, USDA. ACTION: Notice; Announcement for the 2011 U.S. Forest Service Urban and Community Forestry Challenge Cost Share Grant Opportunity. SUMMARY: The National Urban and Community Foresty...

  1. Lost in Cloud

    NASA Technical Reports Server (NTRS)

    Maluf, David A.; Shetye, Sandeep D.; Chilukuri, Sri; Sturken, Ian

    2012-01-01

    Cloud computing can reduce cost significantly because businesses can share computing resources. In recent years Small and Medium Businesses (SMB) have used Cloud effectively for cost saving and for sharing IT expenses. With the success of SMBs, many perceive that the larger enterprises ought to move into Cloud environment as well. Government agency s stove-piped environments are being considered as candidates for potential use of Cloud either as an enterprise entity or pockets of small communities. Cloud Computing is the delivery of computing as a service rather than as a product, whereby shared resources, software, and information are provided to computers and other devices as a utility over a network. Underneath the offered services, there exists a modern infrastructure cost of which is often spread across its services or its investors. As NASA is considered as an Enterprise class organization, like other enterprises, a shift has been occurring in perceiving its IT services as candidates for Cloud services. This paper discusses market trends in cloud computing from an enterprise angle and then addresses the topic of Cloud Computing for NASA in two possible forms. First, in the form of a public Cloud to support it as an enterprise, as well as to share it with the commercial and public at large. Second, as a private Cloud wherein the infrastructure is operated solely for NASA, whether managed internally or by a third-party and hosted internally or externally. The paper addresses the strengths and weaknesses of both paradigms of public and private Clouds, in both internally and externally operated settings. The content of the paper is from a NASA perspective but is applicable to any large enterprise with thousands of employees and contractors.

  2. Lunar COTS: An Economical and Sustainable Approach to Reaching Mars

    NASA Technical Reports Server (NTRS)

    Zuniga, Allison F.; Rasky, Daniel; Pittman, Robert B.; Zapata, Edgar; Lepsch, Roger

    2015-01-01

    The NASA COTS (Commercial Orbital Transportation Services) Program was a very successful program that developed and demonstrated cost-effective development and acquisition of commercial cargo transportation services to the International Space Station (ISS). The COTS acquisition strategy utilized a newer model than normally accepted in traditional procurement practices. This new model used Space Act Agreements where NASA entered into partnerships with industry to jointly share cost, development and operational risks to demonstrate new capabilities for mutual benefit. This model proved to be very beneficial to both NASA and its industry partners as NASA saved significantly in development and operational costs while industry partners successfully expanded their market share of the global launch transportation business. The authors, who contributed to the development of the COTS model, would like to extend this model to a lunar commercial services program that will push development of technologies and capabilities that will serve a Mars architecture and lead to an economical and sustainable pathway to transporting humans to Mars. Over the past few decades, several architectures for the Moon and Mars have been proposed and studied but ultimately halted or not even started due to the projected costs significantly exceeding NASA's budgets. Therefore a new strategy is needed that will fit within NASA's projected budgets and takes advantage of the US commercial industry along with its creative and entrepreneurial attributes. The authors propose a new COTS-like program to enter into partnerships with industry to demonstrate cost-effective, cis-lunar commercial services, such as lunar transportation, lunar ISRU operations, and cis-lunar propellant depots that can enable an economical and sustainable Mars architecture. Similar to the original COTS program, the goals of the proposed program, being notionally referred to as Lunar Commercial Orbital Transfer Services (LCOTS) program will be to: 1) reduce development and operational costs by sharing costs with industry; 2) create new markets in cis-lunar space to further reduce operational costs; and 3) enable NASA to develop an affordable and economical exploration Mars architecture. The paper will describe a plan for a proposed LCOTS program, its potential impact to an eventual Mars architecture and its many benefits to NASA, commercial space industry and the US economy.

  3. Expect the unexpected: a role for behavioral economics in understanding the impact of cost-sharing on emergency department utilization.

    PubMed

    Tzeel, Albert; Brown, Jack

    2010-07-01

    AS EMPLOYERS AND PAYERS ADDRESS INCREASING HEALTHCARE COSTS, THEY RESORT TO THE TENETS OF CLASSICAL ECONOMICS: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (-58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of "gains" or "losses" relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design.

  4. Fragile Relationships: Japan, High Technology, and U.S. Vital Interests

    DTIC Science & Technology

    1990-04-04

    costs ; better manufacturing techniques; higher quality products; excellent marketing plans; and, direct and indirect government support. 5 Akio...short-term and have not looked to the future, as have the Japanese. The stockholders’ demand for large, quick profits often cost market shares and...grip the country as we use increasing amounts of our wealth to service the national debt. Japan will be our creditor. U.S. market shares, both

  5. 7 CFR 3015.52 - Qualifications and exceptions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... applied towards other Federal cost-sharing requirements. Recipient costs or the value of third party in... or cost-type contractors. These records shall show how the value placed on third party in-kind... paragraph (f) of this section. Volunteer services, to the extent possible, shall be supported by the same...

  6. 7 CFR 3015.52 - Qualifications and exceptions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... applied towards other Federal cost-sharing requirements. Recipient costs or the value of third party in... or cost-type contractors. These records shall show how the value placed on third party in-kind... paragraph (f) of this section. Volunteer services, to the extent possible, shall be supported by the same...

  7. 7 CFR 3015.52 - Qualifications and exceptions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... applied towards other Federal cost-sharing requirements. Recipient costs or the value of third party in... or cost-type contractors. These records shall show how the value placed on third party in-kind... paragraph (f) of this section. Volunteer services, to the extent possible, shall be supported by the same...

  8. 7 CFR 3015.52 - Qualifications and exceptions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... applied towards other Federal cost-sharing requirements. Recipient costs or the value of third party in... or cost-type contractors. These records shall show how the value placed on third party in-kind... paragraph (f) of this section. Volunteer services, to the extent possible, shall be supported by the same...

  9. 75 FR 38748 - Medicaid Program; Premiums and Cost Sharing; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-06

    ... more than 150 percent of the Federal poverty level (FPL) does not apply to non-emergency services... more than 150 percent of the Federal poverty level (FPL) does not apply to non-emergency services...

  10. 45 CFR 98.42 - Sliding fee scales.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.42 Sliding fee scales... provides for cost sharing by families that receive CCDF child care services. (b) A sliding fee scale(s...

  11. 45 CFR 98.42 - Sliding fee scales.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.42 Sliding fee scales... provides for cost sharing by families that receive CCDF child care services. (b) A sliding fee scale(s...

  12. 45 CFR 98.42 - Sliding fee scales.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.42 Sliding fee scales... provides for cost sharing by families that receive CCDF child care services. (b) A sliding fee scale(s...

  13. 45 CFR 98.42 - Sliding fee scales.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.42 Sliding fee scales... provides for cost sharing by families that receive CCDF child care services. (b) A sliding fee scale(s...

  14. Student Centered Financial Services: Innovations That Succeed

    ERIC Educational Resources Information Center

    Sinsabaugh, Nancy, Ed.

    2007-01-01

    This collection of best practices shares how 18 higher education institutions across the country have successfully evaluated and redesigned their student financial services programs to improve services to students and their parents and find cost savings for the institution. This volume illustrates how other institutions have successfully tackled…

  15. The effectiveness and cost-effectiveness of shared care: protocol for a realist review.

    PubMed

    Hardwick, Rebecca; Pearson, Mark; Byng, Richard; Anderson, Rob

    2013-02-12

    Shared care (an enhanced information exchange over and above routine outpatient letters) is commonly used to improve care coordination and communication between a specialist and primary care services for people with long-term conditions. Evidence of the effectiveness and cost-effectiveness of shared care is mixed. Informed decision-making for targeting shared care requires a greater understanding of how it works, for whom it works, in what contexts and why. This protocol outlines how realist review methods can be used to synthesise evidence on shared care for long-term conditions.A further aim of the review is to explore economic evaluations of shared care. Economic evaluations are difficult to synthesise due to problems in accounting for contextual differences that impact on resource use and opportunity costs. Realist review methods have been suggested as a way to overcome some of these issues, so this review will also assess whether realist review methods are amenable to synthesising economic evidence. Database and web searching will be carried out in order to find relevant evidence to develop and test programme theories about how shared care works. The review will have two phases. Phase 1 will concentrate on the contextual conditions and mechanisms that influence how shared care works, in order to develop programme theories, which partially explain how it works. Phase 2 will focus on testing these programme theories. A Project Reference Group made up of health service professionals and people with actual experience of long-term conditions will be used to ground the study in real-life experience. Review findings will be disseminated through local and sub-national networks for integrated care and long-term conditions. This realist review will explore why and for whom shared care works, in order to support decision-makers working to improve the effectiveness of care for people outside hospital. The development of realist review methods to take into account cost and cost-effectiveness evidence is particularly innovative and challenging, and if successful will offer a new approach to synthesising economic evidence. This systematic review protocol is registered on the PROSPERO database (registration number: CRD42012002842).

  16. Impact of medicare part D plan features on use of generic drugs.

    PubMed

    Tang, Yan; Gellad, Walid F; Men, Aiju; Donohue, Julie M

    2014-06-01

    Little is known about how Medicare Part D plan features influence choice of generic versus brand drugs. To examine the association between Part D plan features and generic medication use. Data from a 2009 random sample of 1.6 million fee-for-service, Part D enrollees aged 65 years and above, who were not dually eligible or receiving low-income subsidies, were used to examine the association between plan features (generic cost-sharing, difference in brand and generic copay, prior authorization, step therapy) and choice of generic antidepressants, antidiabetics, and statins. Logistic regression models accounting for plan-level clustering were adjusted for sociodemographic and health status. Generic cost-sharing ranged from $0 to $9 for antidepressants and statins, and from $0 to $8 for antidiabetics (across 5th-95th percentiles). Brand-generic cost-sharing differences were smallest for statins (5th-95th percentiles: $16-$37) and largest for antidepressants ($16-$64) across plans. Beneficiaries with higher generic cost-sharing had lower generic use [adjusted odds ratio (OR)=0.97, 95% confidence interval (CI), 0.95-0.98 for antidepressants; OR=0.97, 95% CI, 0.96-0.98 for antidiabetics; OR=0.94, 95% CI, 0.92-0.95 for statins]. Larger brand-generic cost-sharing differences and prior authorization were significantly associated with greater generic use in all categories. Plans could increase generic use by 5-12 percentage points by reducing generic cost-sharing from the 75th ($7) to 25th percentiles ($4-$5), increasing brand-generic cost-sharing differences from the 25th ($25-$26) to 75th ($32-$33) percentiles, and using prior authorization and step therapy. Cost-sharing features and utilization management tools were significantly associated with generic use in 3 commonly used medication categories.

  17. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the... incumbent. (2) To obtain reimbursement, a voluntarily relocating microwave incumbent must submit... PCS relocator or the voluntarily relocating microwave incumbent, must submit documentation itemizing...

  18. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the... incumbent. (2) To obtain reimbursement, a voluntarily relocating microwave incumbent must submit... PCS relocator or the voluntarily relocating microwave incumbent, must submit documentation itemizing...

  19. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the... incumbent. (2) To obtain reimbursement, a voluntarily relocating microwave incumbent must submit... PCS relocator or the voluntarily relocating microwave incumbent, must submit documentation itemizing...

  20. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES PERSONAL COMMUNICATIONS SERVICES Broadband PCS Policies Governing Microwave Relocation from the... incumbent. (2) To obtain reimbursement, a voluntarily relocating microwave incumbent must submit... PCS relocator or the voluntarily relocating microwave incumbent, must submit documentation itemizing...

  1. Cutting Costs and Improving Outcomes for Janitorial Services

    ERIC Educational Resources Information Center

    Campbell, Jeffery L.

    2011-01-01

    Recent research reveals that janitorial services account for nearly 30 percent of facility budgets, which translates into billions of dollars annually. With janitorial services consuming such a large share of budgets, other industry findings are alarming. Most cleaning systems: 1) have no quantifiable standards; 2) are based solely on appearance;…

  2. 42 CFR 447.66 - General alternative premium protections.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

  3. 42 CFR 447.66 - General alternative premium protections.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

  4. 42 CFR 447.66 - General alternative premium protections.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

  5. 42 CFR 447.66 - General alternative premium protections.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

  6. Keeping Up with the Laws--There's Safety in Numbers.

    ERIC Educational Resources Information Center

    Rinere, Carol

    1990-01-01

    Describes a network formed by 96 school districts and 7 Boards of Cooperative Education Services to comply with New York State's 1980 chemical safety law. This shared services approach succeeds because of its cost effectiveness, convenience, and confidential liaison services. Major issues include recycling, sick building syndrome, disaster…

  7. ESAs in the Shadows: Meeting Rural Challenges in an Urban State.

    ERIC Educational Resources Information Center

    Bouchard, Rene L.

    2003-01-01

    Boards of Cooperative Educational Services (BOCES) provide cost-effective shared services to New York's rural districts. Services in career and technical education and staff development offered by the Steuben-Allegany BOCES are described. Future plans include increased cooperation with colleges in providing adult education, evolution of the…

  8. 36 CFR 212.9 - Principles for sharing use of roads.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...; or (5) A combination of the aforementioned methods. (f) Road maintenance and resurfacing. Cooperators will share the road maintenance and resurfacing costs under suitable agreements to perform, arrange for... roads. 212.9 Section 212.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

  9. Social inequalities and pharmaceutical cost sharing in Italian regions.

    PubMed

    Terraneo, Marco; Sarti, Simone; Tognetti Bordogna, Mara

    2014-01-01

    In recent years, Italian citizens have increasingly been asked to share pharmaceutical costs, but at the same time, households' medicines expenditure has decreased. Cost-sharing policies have to be assessed not just in terms of limitation of moral hazard and revenue to the state, but also for equal opportunities for citizen users accessing health services. The aim of this article is to analyze how Italian co-payment policies ("ticket") on medicines may affect pharmaceutical expenditure of households, considering territorial and social groups variation. We reviewed the per capita private spending on medicines of Italian regions, separating pharmaceutical outlay and "ticket." Across the period 2001-2010 we found that the overall per capita private spending on medicines remained substantially stable, although medicine expenditure decreases while the "ticket" increases. When cost sharing rises, out-of-pocket spending on medicines by poorer families seems to remain unchanged; however, poorer families seem to reduce their pharmaceutical expenditure. Our analysis suggests that applying co-payment in Italy is partly successful, in terms of greater revenue to the health system, but in the last few years, cost-sharing increases would seem to have rebounded negatively on more vulnerable families, due to the economic crisis.

  10. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

    PubMed Central

    van der Wees, Philip J.; Wammes, Joost J.G.; Westert, Gert P.; Jeurissen, Patrick P.T.

    2016-01-01

    Background: Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered) and depth of coverage (the proportion of costs of the covered benefits that is covered publicly) are corresponding variables in determining the benefits package. We hypothesized that a more comprehensive health benefit package may increase user cost-sharing charges. Methods: We conducted a desktop research study to assess the interrelationship between the scope of covered health benefits and the height of statutory spending in a sample of 8 European countries: Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted a targeted literature search to identify characteristics of the healthcare systems in our sample of countries. We analyzed similarities and differences based on the dimensions of publicly financed healthcare as published by the European Observatory on Health Care Systems. Results: We found that the scope of services is comparable and comprehensive across our sample, with only marginal differences. Cost-sharing arrangements show the most variation. In general, we found no direct interrelationship in this sample between the ranges of services covered in the health benefits package and the height of public spending on healthcare. With regard to specific services (dental care, physical therapy), we found indications of an association between coverage of services and cost-sharing arrangements. Strong variations in the volume and price of healthcare services between the 8 countries were found for services with large practice variations. Conclusion: Although reducing the scope of the benefit package as well as increasing user charges may contribute to the financial sustainability of healthcare, variations in the volume and price of care seem to have a much larger impact on financial sustainability. Policy-makers should focus on a variety of measures within an integrated approach. There is no silver bullet for addressing the sustainability of healthcare. PMID:26673645

  11. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries.

    PubMed

    van der Wees, Philip J; Wammes, Joost J G; Westert, Gert P; Jeurissen, Patrick P T

    2015-09-12

    Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered) and depth of coverage (the proportion of costs of the covered benefits that is covered publicly) are corresponding variables in determining the benefits package. We hypothesized that a more comprehensive health benefit package may increase user cost-sharing charges. We conducted a desktop research study to assess the interrelationship between the scope of covered health benefits and the height of statutory spending in a sample of 8 European countries: Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted a targeted literature search to identify characteristics of the healthcare systems in our sample of countries. We analyzed similarities and differences based on the dimensions of publicly financed healthcare as published by the European Observatory on Health Care Systems. We found that the scope of services is comparable and comprehensive across our sample, with only marginal differences. Cost-sharing arrangements show the most variation. In general, we found no direct interrelationship in this sample between the ranges of services covered in the health benefits package and the height of public spending on healthcare. With regard to specific services (dental care, physical therapy), we found indications of an association between coverage of services and cost-sharing arrangements. Strong variations in the volume and price of healthcare services between the 8 countries were found for services with large practice variations. Although reducing the scope of the benefit package as well as increasing user charges may contribute to the financial sustainability of healthcare, variations in the volume and price of care seem to have a much larger impact on financial sustainability. Policy-makers should focus on a variety of measures within an integrated approach. There is no silver bullet for addressing the sustainability of healthcare. © 2016 by Kerman University of Medical Sciences.

  12. Formal Professional Relationships Between General Practitioners and Specialists in Shared Care: Possible Associations with Patient Health and Pharmacy Costs.

    PubMed

    Lublóy, Ágnes; Keresztúri, Judit Lilla; Benedek, Gábor

    2016-04-01

    Shared care in chronic disease management aims at improving service delivery and patient outcomes, and reducing healthcare costs. The introduction of shared-care models is coupled with mixed evidence in relation to both patient health status and cost of care. Professional interactions among health providers are critical to a successful and efficient shared-care model. This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) in shared care affects either the health status of patients or their pharmacy costs. In strong GP-SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. This article measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. To test the hypotheses and compare the characteristics of the strongest GP-SP connections with those of the weakest, this article concentrates on diabetes-a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest frequency of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health status. Overall drug expenditure may be reduced by lowering patient care fragmentation through channelling a GP's patients to a small number of SPs.

  13. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  14. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  15. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The State determines and documents that good cause as specified at... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing...

  16. Exploring the cost and value of private versus shared bedrooms in nursing homes.

    PubMed

    Calkins, Margaret; Cassella, Christine

    2007-04-01

    There is debate about the relative merits and costs of private versus shared bedrooms in nursing homes, particularly in light of the current efforts at creating both cost-efficient and person-centered care facilities. The purpose of this project was to explore the extent to which there is evidence-based information that supports the merits of three different bedroom configurations: traditional shared, enhanced shared, and private. We developed a framework of four broad domains that were related to the different bedroom configurations: psychosocial, clinical, operational, and construction or building factors. Within each dimension, we identified individual factors through the literature, interviews, and focus groups, with the goal of determining the breadth, depth, and quality of evidence supporting the benefits of one configuration over another. The vast majority of factors identified in this study, regardless of whether there was solid empirical data, information from the focus groups, or other anecdotal evidence, indicated better outcomes associated with private rooms over shared rooms in nursing homes. Cost estimates suggest that construction cost (plus debt service) differences range from roughly $20,506 per bed for a traditional shared room to $36,515 for a private one, and that such differences are recouped in less than 2 years if beds are occupied, and in less than 3 months if a shared bed remains unoccupied at average private-pay room costs. Despite limited empirical evidence in some areas, this project provides the foundation for an evidence-based life-cycle costing perspective regarding the relative merits of different bedroom configurations.

  17. 36 CFR 212.9 - Principles for sharing use of roads.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... roads. 212.9 Section 212.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE... of roads. The use of roads under arrangements for sharing costs or performance shall be in accordance with the following: (a) Road improvement. Use of a road for commercial hauling, except occasional or...

  18. 36 CFR 212.9 - Principles for sharing use of roads.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... roads. 212.9 Section 212.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE... of roads. The use of roads under arrangements for sharing costs or performance shall be in accordance with the following: (a) Road improvement. Use of a road for commercial hauling, except occasional or...

  19. 36 CFR 212.9 - Principles for sharing use of roads.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... roads. 212.9 Section 212.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE... of roads. The use of roads under arrangements for sharing costs or performance shall be in accordance with the following: (a) Road improvement. Use of a road for commercial hauling, except occasional or...

  20. 36 CFR 212.9 - Principles for sharing use of roads.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... minor amounts, will be conditioned upon improvement or supplemental construction of the road to safety... roads. 212.9 Section 212.9 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE... of roads. The use of roads under arrangements for sharing costs or performance shall be in accordance...

  1. Regional cost and experience, not size or hospital inclusion, helps predict ACO success.

    PubMed

    Schulz, John; DeCamp, Matthew; Berkowitz, Scott A

    2017-06-01

    The Medicare Shared Savings Program (MSSP) continues to expand and now includes 434 accountable care organizations (ACOs) serving more than 7 million beneficiaries. During 2014, 86 of these ACOs earned over $300 million in shared savings payments by promoting higher-quality patient care at a lower cost.Whether organizational characteristics, regional cost of care, or experience in the MSSP are associated with the ability to achieve shared savings remains uncertain.Using financial results from 2013 and 2014, we examined all 339 MSSP ACOs with a 2012, 2013, or 2014 start-date. We used a cross-sectional analysis to examine all ACOs and used a multivariate logistic model to predict probability of achieving shared savings.Experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs: ACOs in high cost regions were more likely to earn savings. In the multivariate model, the number of ACO beneficiaries, inclusion of a hospital or involvement of an academic medical center, was not associated with likelihood of earning shared savings, after accounting for regional baseline cost variation.These results suggest ACOs are learning and improving from their experience. Additionally, the results highlight regional differences in ACO success and the strong association with variation in regional per capita costs, which can inform CMS policy to help promote ACO success nationwide.

  2. 7 CFR 625.10 - Cost-share payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... the cost with landowners of restoring land enrolled in HFRP as provided in the HFRP restoration plan. The HFRP restoration plan may include periodic manipulation to maximize wildlife habitat and preserve...

  3. Increased Patient Cost-Sharing, Weak US Economy, and Poor Health Habits: Implications for Employers and Insurers.

    PubMed

    Haren, Melinda C; McConnell, Kirk; Shinn, Arthur F

    2009-04-01

    Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal. The present article aims to assess the implications of those results in the context of the growing tendency to increase patient cost-sharing, a weak US economy, and poor health habits. Increasing cost-sharing is a blunt instrument: although it may reduce utilization of frivolous services, it may also result in individuals forgoing medically necessary care. Increases in deductibles will lead to an overall decrease in optimal care-seeking behavior as families juggle healthcare costs with a weak economy and stagnating wages.

  4. Increased Patient Cost-Sharing, Weak US Economy, and Poor Health Habits: Implications for Employers and Insurers

    PubMed Central

    Haren, Melinda C.; McConnell, Kirk; Shinn, Arthur F.

    2009-01-01

    Many healthcare stakeholders, including insurers and employers, agree that growth in healthcare costs is inevitable. But the current trend toward further cost-shifting to employees and other health plan members is unsustainable. In 2008, the Zitter Group conducted a large national study on the relationship between insurers and employers, to understand how these 2 healthcare stakeholders interact in the creation of health benefit design. The survey results were previously summarized and discussed in the February/March 2009 issue of this journal. The present article aims to assess the implications of those results in the context of the growing tendency to increase patient cost-sharing, a weak US economy, and poor health habits. Increasing cost-sharing is a blunt instrument: although it may reduce utilization of frivolous services, it may also result in individuals forgoing medically necessary care. Increases in deductibles will lead to an overall decrease in optimal care-seeking behavior as families juggle healthcare costs with a weak economy and stagnating wages. PMID:25126283

  5. [Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

    PubMed

    Bergholz, W

    2008-11-01

    In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

  6. 42 CFR 447.54 - Maximum allowable and nominal charges.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., any co-payments it imposes under a fee-for-service delivery system do not exceed the amounts shown in... Deductible, Coinsurance, Co-Payment Or Similar Cost-Sharing Charge § 447.54 Maximum allowable and nominal... paragraph (a)(3)(i) of this section for comparable services under a fee-for-service delivery system. When...

  7. 42 CFR 447.54 - Maximum allowable and nominal charges.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., any co-payments it imposes under a fee-for-service delivery system do not exceed the amounts shown in... Deductible, Coinsurance, Co-Payment Or Similar Cost-Sharing Charge § 447.54 Maximum allowable and nominal... paragraph (a)(3)(i) of this section for comparable services under a fee-for-service delivery system. When...

  8. [Changing the internal cost allocation (ICA) on DRG shares : Example of computed tomography in a university radiology setting].

    PubMed

    Wirth, K; Zielinski, P; Trinter, T; Stahl, R; Mück, F; Reiser, M; Wirth, S

    2016-08-01

    In hospitals, the radiological services provided to non-privately insured in-house patients are mostly distributed to requesting disciplines through internal cost allocation (ICA). In many institutions, computed tomography (CT) is the modality with the largest amount of allocation credits. The aim of this work is to compare the ICA to respective DRG (Diagnosis Related Groups) shares for diagnostic CT services in a university hospital setting. The data from four CT scanners in a large university hospital were processed for the 2012 fiscal year. For each of the 50 DRG groups with the most case-mix points, all diagnostic CT services were documented including their respective amount of GOÄ allocation credits and invoiced ICA value. As the German Institute for Reimbursement of Hospitals (InEK) database groups the radiation disciplines (radiology, nuclear medicine and radiation therapy) together and also lacks any modality differentiation, the determination of the diagnostic CT component was based on the existing institutional distribution of ICA allocations. Within the included 24,854 cases, 63,062,060 GOÄ-based performance credits were counted. The ICA relieved these diagnostic CT services by € 819,029 (single credit value of 1.30 Eurocent), whereas accounting by using DRG shares would have resulted in € 1,127,591 (single credit value of 1.79 Eurocent). The GOÄ single credit value is 5.62 Eurocent. The diagnostic CT service was basically rendered as relatively inexpensive. In addition to a better financial result, changing the current ICA to DRG shares might also mean a chance for real revenues. However, the attractiveness considerably depends on how the DRG shares are distributed to the different radiation disciplines of one institution.

  9. 47 CFR 27.1186 - Payment issues.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Payment issues. 27.1186 Section 27.1186 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and 2180-2200 MHz bands Cost-Sharing...

  10. 47 CFR 27.1170 - Payment issues.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 2 2013-10-01 2013-10-01 false Payment issues. 27.1170 Section 27.1170 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2000-2020 MHz, and 2180-2200 MHz bands Cost-Sharing...

  11. 30 CFR 220.013 - Unallowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Unallowable costs. 220.013 Section 220.013 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL SHELF OIL AND GAS LEASES...

  12. Expect the Unexpected: A Role for Behavioral Economics in Understanding the Impact of Cost-Sharing on Emergency Department Utilization

    PubMed Central

    Tzeel, Albert; Brown, Jack

    2010-01-01

    Background As employers and payers address increasing healthcare costs, they resort to the tenets of classical economics: if one increases the price for a service (defined as an individual's cost-sharing), then that individual's demand for services should decrease. This, however, may not necessarily be true, and raises the question of whether increased cost-sharing for emergency department services will lead to decreased utilization of those services as would be expected in classical economics. Objective To assess the effect of emergency department cost-sharing on patient utilization of emergency department services. Method In 2002, we retrospectively reviewed 2001 claims and identified 797 members who have had at least 2 nonemergent visits to the emergency department. This cohort was comprised of members with high emergency department utilization patterns who also had potentially differing emergency department copayment changes from one health insurance plan year to the next. Participants had to be covered by Humana for a minimum of 12 consecutive months. Of the original cohort, 415 remained covered by Humana after the end of the first year, 322 remained covered after the second year, and 194 after the end of the third year. After completions of three 12-month blocks of time with appropriate claims run out, we assessed changes in the cohort's emergency department encounters from the previous year to the current year relative to emergency department copayment changes, using matched pairs t-test. Results Surprisingly, in the first 12 months, reductions in emergency department copayments resulted in decreases in patient utilization (−58.3% change, P <.007), and increases in emergency department copayment resulted in an increased utilization (1096.0% change, P <.001). This unexpected trend continued in the second and third periods. Overall, in our cohort, increases in emergency department copayments were significantly associated with increased emergency department encounters by different individuals in each of the 3 study periods. In contrast, in the 2 groups with no increases in emergency department copayments, utilization of these services decreased or remained flat. Conclusion When assessing the need for emergency department services, many factors besides cost play a role in choosing to obtain emergency department care, including individual assessments of the probability of a given illness and the financial or temporal implications for the care sought in terms of “gains” or “losses” relative to a reference point. Behavioral economics can therefore play a role in understanding why healthcare consumers behave as they do. The implications of behavioral economics need to be factored in when considering a healthcare benefit design. PMID:25126317

  13. When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions.

    PubMed

    Anis, Aslam H; Guh, Daphne P; Lacaille, Diane; Marra, Carlo A; Rashidi, Amir A; Li, Xin; Esdaile, John M

    2005-11-22

    Previous research has shown that patient cost-sharing leads to a reduction in overall health resource utilization. However, in Canada, where health care is provided free of charge except for prescription drugs, the converse may be true. We investigated the effect of prescription drug cost-sharing on overall health care utilization among elderly patients with rheumatoid arthritis. Elderly patients (> or = 65 years) were selected from a population-based cohort with rheumatoid arthritis. Those who had paid the maximum amount of dispensing fees (200 dollars) for the calendar year (from 1997 to 2000) were included in the analysis for that year. We defined the period during which the annual maximum co-payment had not been reached as the "cost-sharing period" and the one beyond which the annual maximum co-payment had been reached as the "free period." We compared health services utilization patterns between these periods during the 4 study years, including the number of hospital admissions, the number of physician visits, the number of prescriptions filled and the number of prescriptions per physician visit. Overall, 2968 elderly patients reached the annual maximum cost-sharing amount at least once during the study periods. Across the 4 years, there were 0.38 more physician visits per month (p < 0.001), 0.50 fewer prescriptions filled per month (p = 0.001) and 0.52 fewer prescriptions filled per physician visit (p < 0.001) during the cost-sharing period than during the free period. Among patients who were admitted to the hospital at least once, there were 0.013 more admissions per month during the cost-sharing period than during the free period (p = 0.03). In a predominantly publicly funded health care system, the implementation of cost-containment policies such as prescription drug cost-sharing may have the unintended effect of increasing overall health utilization among elderly patients with rheumatoid arthritis.

  14. 42 CFR 447.90 - FFP: Conditions related to pending investigations of credible allegations of fraud against the...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... required by § 455.23 of this chapter unless— (1) The item or service is furnished as an emergency item or service, but not including items or services furnished in an emergency room of a hospital; or (2) The... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Medicaid Premiums and Cost Sharing...

  15. Impact of pharmacy benefit design on prescription drug utilization: a fixed effects analysis of plan sponsor data.

    PubMed

    Roebuck, M Christopher; Liberman, Joshua N

    2009-06-01

    To study the impact of various elements of pharmacy benefit design on both the absolute and relative utilization of generics, brands, retail pharmacy, and mail service. Panel data on 1,074 plan sponsors covering 21.6 million individuals over 12 calendar quarters (2005-2007). A retrospective analysis of pharmacy claims. To control for potential endogeneity, linear fixed effects models were estimated for each of six dependent variables: the generic utilization rate, the brand utilization rate, the generic dispensing rate (GDR), the retail pharmacy utilization rate, the mail service utilization rate, and the mail distribution rate. Most member cost-share variables were nonlinearly associated with changes in prescription drug utilization. Marginal effects were generally greater in magnitude for brand out-of-pocket costs than for generic out-of-pocket costs. Time dummies, as well as other pharmacy benefit design elements, also yielded significant results. Prior estimates of the effect of member cost sharing on prescription drug utilization may be biased if complex benefit designs, mail service fulfillment, and unmeasured factors such as pharmaceutical pipelines are not accounted for. Commonly cited relative utilization metrics, such as GDR, may be misleading if not examined alongside absolute prescription drug utilization.

  16. OCLC for the hospital library: the justification plan for hospital administration.

    PubMed

    Allen, C W; Branson, J R

    1982-07-01

    This paper delineates the necessary steps to provide hospital administrators with the information needed to evaluate an automated system, OCLC, for addition to the medical library. Based on experience at the Norton-Children's Hospitals, included are: (1) cost analyses of present technical processing systems and cost comparisons with OCLC; (2) delineation of start-up costs for installing OCLC; (3) budgetary requirements for 1981; (4) the impact of automation on library systems, personnel, and services; (5) potential as a shared service; and (6) preparation of the proposal for administrative review.

  17. OCLC for the hospital library: the justification plan for hospital administration.

    PubMed Central

    Allen, C W; Branson, J R

    1982-01-01

    This paper delineates the necessary steps to provide hospital administrators with the information needed to evaluate an automated system, OCLC, for addition to the medical library. Based on experience at the Norton-Children's Hospitals, included are: (1) cost analyses of present technical processing systems and cost comparisons with OCLC; (2) delineation of start-up costs for installing OCLC; (3) budgetary requirements for 1981; (4) the impact of automation on library systems, personnel, and services; (5) potential as a shared service; and (6) preparation of the proposal for administrative review. PMID:7116018

  18. Price-Shopping in Consumer-Directed Health Plans

    PubMed Central

    Sood, Neeraj; Wagner, Zachary; Huckfeldt, Peter; Haviland, Amelia

    2013-01-01

    We use health insurance claims data from 63 large employers to estimate the extent of price shopping for nine common outpatient services in consumer-directed health plans (CDHPs) compared to traditional health plans. The main measures of price-shopping include: (1) the total price paid on the claim, (2) the share of claims from low and high cost providers and (3) the savings from price shopping relative to choosing prices randomly. All analyses control for individual and zip code level demographics and plan characteristics. We also estimate differences in price shopping within CDHPs depending on expected health care costs and whether the service was bought before or after reaching the deductible. For 8 out of 9 services analyzed, prices paid by CDHP and traditional plan enrollees did not differ significantly; CDHP enrollees paid 2.3% less for office visits. Similarly, office visits was the only service where CDHP enrollment resulted in a significantly larger share of claims from low cost providers and greater savings from price shopping relative to traditional plans. There was also no evidence that, within CDHP plans, consumers with lower expected medical expenses exhibited more price-shopping or that consumers exhibited more price-shopping before reaching the deductible. PMID:25342936

  19. Accountable Care Organizations: roles and opportunities for hospitals.

    PubMed

    Schoenbaum, Stephen C

    2011-08-01

    Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers.

  20. The Integrated Bibliographic Information System: Resource Sharing Tailored for Local Needs.

    ERIC Educational Resources Information Center

    Cotter, Gladys A.; Hartt, Richard W.

    The Defense Technical Information Center (DTIC), which is charged with providing information services to the scientific and technical community of the Department of Defense (DoD), actively seeks ways to promote resource sharing as a means for speeding access to information while reducing the costs of information processing throughout the defense…

  1. 42 CFR 423.773 - Requirements for eligibility.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for eligibility. 423.773 Section 423.773 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies...

  2. 10 CFR 600.313 - Cost sharing or matching.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...'s accounting records at the time of donation; or (ii) The current fair market value. If there is...) Valuing volunteer services. Volunteer services furnished by professional and technical personnel... charges. When use charges are applied, values must be determined in accordance with the usual accounting...

  3. 76 FR 4859 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-27

    ... severely damaged by natural disasters. The authorities to collect information for this collection are found... sharing with agricultural producers the cost of rehabilitating farmland damaged by natural disaster, and... cooperation with the Natural Resources Conservation Service, the Forest Service, and other agencies and...

  4. The Chicago-Iowa City passenger rail service : project summary.

    DOT National Transportation Integrated Search

    2011-01-12

    An Iowa investment of $20.6 million will match a federal investment of $86.8 million for the capital costs of the Iowa segment of the Chicago to Iowa City service. Iowas share of the expected gap between revenues and operating and maintenance expe...

  5. Health care demand elasticities by type of service.

    PubMed

    Ellis, Randall P; Martins, Bruno; Zhu, Wenjia

    2017-09-01

    We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0.44), specialists visits (-0.32), MRIs (-0.29) and mental health/substance abuse (-0.26), and lower elasticities for prevention visits (-0.02) and emergency rooms (-0.04). Demand response is lower for children, in larger firms, among hourly waged employees, and for sicker people. Overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. 7 CFR 1709.112 - Ineligible grant purposes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... target community's proportionate share of a larger energy project. (c) Grant funds may not be used to... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES RUS High Energy Cost Grant Program § 1709.112..., structures or real property not directly associated with providing energy services in the target community...

  7. 7 CFR 1709.112 - Ineligible grant purposes.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... target community's proportionate share of a larger energy project. (c) Grant funds may not be used to... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES RUS High Energy Cost Grant Program § 1709.112..., structures or real property not directly associated with providing energy services in the target community...

  8. 7 CFR 1709.112 - Ineligible grant purposes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... target community's proportionate share of a larger energy project. (c) Grant funds may not be used to... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES RUS High Energy Cost Grant Program § 1709.112..., structures or real property not directly associated with providing energy services in the target community...

  9. 7 CFR 1709.112 - Ineligible grant purposes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... target community's proportionate share of a larger energy project. (c) Grant funds may not be used to... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES RUS High Energy Cost Grant Program § 1709.112..., structures or real property not directly associated with providing energy services in the target community...

  10. 7 CFR 1709.112 - Ineligible grant purposes.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... target community's proportionate share of a larger energy project. (c) Grant funds may not be used to... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES RUS High Energy Cost Grant Program § 1709.112..., structures or real property not directly associated with providing energy services in the target community...

  11. The effects of patient cost sharing on inpatient utilization, cost, and outcome.

    PubMed

    Xu, Yuan; Li, Ning; Lu, Mingshan; Dixon, Elijah; Myers, Robert P; Jelley, Rachel J; Quan, Hude

    2017-01-01

    Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

  12. IT Research Services: Powerful Tools to Track a Fast Moving Industry

    NASA Technical Reports Server (NTRS)

    Hunter, Paul

    2010-01-01

    Research services change and evolve over time, sometimes suddenly, in their focus, topics, formats, service model, etc. You have to check in often. Some offer products that you can customize to your environment, others not so much. You will find a variation in customer management practices (e.g., when and how they share information) ...can sometimes be annoying. Assess your needs carefully. Each research service has a very different service model. Explore ways to share or lower the cost. Someone out there may share the expense when that is an option. Make sure you read the small print. It can work for you as well as against you. When in doubt, ask your Vendor's POC. Set up Research Service "gurus or SME's." Not to violate the copyright agreement of course, just have someone who knows what's there. After you subscribe, reassess.Get the most out of your investment. Some early enthusiasts will fade, and there will be others who don't know it's there and can use it.

  13. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings.

    PubMed

    Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

    2015-12-01

    HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care. © The Author(s) 2015.

  14. Quantifying the benefits of vehicle pooling with shareability networks

    PubMed Central

    Santi, Paolo; Resta, Giovanni; Szell, Michael; Sobolevsky, Stanislav; Strogatz, Steven H.; Ratti, Carlo

    2014-01-01

    Taxi services are a vital part of urban transportation, and a considerable contributor to traffic congestion and air pollution causing substantial adverse effects on human health. Sharing taxi trips is a possible way of reducing the negative impact of taxi services on cities, but this comes at the expense of passenger discomfort quantifiable in terms of a longer travel time. Due to computational challenges, taxi sharing has traditionally been approached on small scales, such as within airport perimeters, or with dynamical ad hoc heuristics. However, a mathematical framework for the systematic understanding of the tradeoff between collective benefits of sharing and individual passenger discomfort is lacking. Here we introduce the notion of shareability network, which allows us to model the collective benefits of sharing as a function of passenger inconvenience, and to efficiently compute optimal sharing strategies on massive datasets. We apply this framework to a dataset of millions of taxi trips taken in New York City, showing that with increasing but still relatively low passenger discomfort, cumulative trip length can be cut by 40% or more. This benefit comes with reductions in service cost, emissions, and with split fares, hinting toward a wide passenger acceptance of such a shared service. Simulation of a realistic online system demonstrates the feasibility of a shareable taxi service in New York City. Shareability as a function of trip density saturates fast, suggesting effectiveness of the taxi sharing system also in cities with much sparser taxi fleets or when willingness to share is low. PMID:25197046

  15. Quantifying the benefits of vehicle pooling with shareability networks.

    PubMed

    Santi, Paolo; Resta, Giovanni; Szell, Michael; Sobolevsky, Stanislav; Strogatz, Steven H; Ratti, Carlo

    2014-09-16

    Taxi services are a vital part of urban transportation, and a considerable contributor to traffic congestion and air pollution causing substantial adverse effects on human health. Sharing taxi trips is a possible way of reducing the negative impact of taxi services on cities, but this comes at the expense of passenger discomfort quantifiable in terms of a longer travel time. Due to computational challenges, taxi sharing has traditionally been approached on small scales, such as within airport perimeters, or with dynamical ad hoc heuristics. However, a mathematical framework for the systematic understanding of the tradeoff between collective benefits of sharing and individual passenger discomfort is lacking. Here we introduce the notion of shareability network, which allows us to model the collective benefits of sharing as a function of passenger inconvenience, and to efficiently compute optimal sharing strategies on massive datasets. We apply this framework to a dataset of millions of taxi trips taken in New York City, showing that with increasing but still relatively low passenger discomfort, cumulative trip length can be cut by 40% or more. This benefit comes with reductions in service cost, emissions, and with split fares, hinting toward a wide passenger acceptance of such a shared service. Simulation of a realistic online system demonstrates the feasibility of a shareable taxi service in New York City. Shareability as a function of trip density saturates fast, suggesting effectiveness of the taxi sharing system also in cities with much sparser taxi fleets or when willingness to share is low.

  16. Maintenance service contract model for heavy equipment in mining industry using principal agent theory

    NASA Astrophysics Data System (ADS)

    Pakpahan, Eka K. A.; Iskandar, Bermawi P.

    2015-12-01

    Mining industry is characterized by a high operational revenue, and hence high availability of heavy equipment used in mining industry is a critical factor to ensure the revenue target. To maintain high avaliability of the heavy equipment, the equipment's owner hires an agent to perform maintenance action. Contract is then used to control the relationship between the two parties involved. The traditional contracts such as fixed price, cost plus or penalty based contract studied is unable to push agent's performance to exceed target, and this in turn would lead to a sub-optimal result (revenue). This research deals with designing maintenance contract compensation schemes. The scheme should induce agent to select the highest possible maintenance effort level, thereby pushing agent's performance and achieve maximum utility for both parties involved. Principal agent theory is used as a modeling approach due to its ability to simultaneously modeled owner and agent decision making process. Compensation schemes considered in this research includes fixed price, cost sharing and revenue sharing. The optimal decision is obtained using a numerical method. The results show that if both parties are risk neutral, then there are infinite combination of fixed price, cost sharing and revenue sharing produced the same optimal solution. The combination of fixed price and cost sharing contract results in the optimal solution when the agent is risk averse, while the optimal combination of fixed price and revenue sharing contract is obtained when agent is risk averse. When both parties are risk averse, the optimal compensation scheme is a combination of fixed price, cost sharing and revenue sharing.

  17. 7 CFR 3015.53 - Valuation of donated services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Valuation of donated services. 3015.53 Section 3015.53 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Cost-Sharing or Matching § 3015...

  18. 42 CFR 423.771 - 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. 423.771 Section 423.771 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies for Low...

  19. 26 CFR 1.936-4 - Intangible property income in the absence of an election out.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 1, 1983, to use the cost-plus method of pricing without reflecting a return from intangibles, but... and its affiliates do not make an election under either the cost sharing or 50/50 profit split option... disposition of any product or from the rendering of a service which is in excess of the reasonable costs it...

  20. A Cost Sharing Plan: Solutions for the Child Care Crisis.

    ERIC Educational Resources Information Center

    Delaware Valley Child Care Council, Philadelphia, PA.

    This booklet discusses the current child care crisis and suggests a solution to the crisis. The gap between the cost of child care and parents' ability to pay is restricting the expansion and availability of child care services and undercutting the quality of child care. The average cost of full-day child care in the Delaware Valley, Pennsylvania,…

  1. 42 CFR 423.780 - Premium subsidy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies for Low... 42 Public Health 3 2010-10-01 2010-10-01 false Premium subsidy. 423.780 Section 423.780 Public...-service plans or 1876 cost plans) in a PDP region in the reference month. (ii) Premium amounts. The...

  2. 30 CFR 220.014 - Allocation of joint costs and credits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Allocation of joint costs and credits. 220.014 Section 220.014 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL SHELF OIL AND...

  3. Mammography Use Among Medicare Beneficiaries After Elimination of Cost Sharing.

    PubMed

    Sabatino, Susan A; Thompson, Trevor D; Guy, Gery P; de Moor, Janet S; Tangka, Florence K

    2016-04-01

    We examined mammography use before and after Medicare eliminated cost sharing for screening mammography in January 2011. Using National Health Interview Survey data, we examined changes in mammography use between 2010 and 2013 among Medicare beneficiaries aged 65-74 years. Logistic regression and predictive margins were used to examine changes in use after adjusting for covariates. In 2013, 74.7% of women reported a mammogram within 2 years, a 3.5 percentage point increase (95% confidence interval, -0.3, 7.2) compared with 2010. Increases occurred among women aged 65-69 years, unmarried women, and women with usual sources of care and 2-5 physician visits in the prior year. After adjustment, mammography use increased in 2013 versus 2010 (74.8% vs. 71.3%, P=0.039). Interactions between year and income, insurance, race, or ethnicity were not significant. There was a modest increase in mammography use from 2010 to 2013 among Medicare beneficiaries aged 65-74 years, possibly consistent with an effect of eliminating Medicare cost sharing during this time. Findings suggest that eliminating cost sharing might increase use of recommended screening services.

  4. Technical and economic aspects of the Intelsat system

    NASA Astrophysics Data System (ADS)

    Jefferis, A. K.

    1992-03-01

    The paper gives some background on the Intelsat system and explains the financial principles of the organization, which operates as a cost sharing cooperative. The members contribute both capital and operating costs in accordance with their use. The determination of the measure of 'use' in such a complex system requires a careful analysis of the factors which cause the cost. Most of these are technical, based on the use of satellite power, bandwidth and similar factors. Others reflect service related features such as priority, long-term commitment and market elasticity. This last element is only taken into account after ensuring that every service fully contributes the marginal cost of providing it.

  5. Investments and costs of oral health care for Family Health Care

    PubMed Central

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team’s operational cost. PMID:27463254

  6. Demand Response Advanced Controls Framework and Assessment of Enabling Technology Costs

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

    Potter, Jennifer; Cappers, Peter

    The Demand Response Advanced Controls Framework and Assessment of Enabling Technology Costs research describe a variety of DR opportunities and the various bulk power system services they can provide. The bulk power system services are mapped to a generalized taxonomy of DR “service types”, which allows us to discuss DR opportunities and bulk power system services in fewer yet broader categories that share similar technological requirements which mainly drive DR enablement costs. The research presents a framework for the costs to automate DR and provides descriptions of the various elements that drive enablement costs. The report introduces the various DRmore » enabling technologies and end-uses, identifies the various services that each can provide to the grid and provides the cost assessment for each enabling technology. In addition to a report, this research includes a Demand Response Advanced Controls Database and User Manual. They are intended to provide users with the data that underlies this research and instructions for how to use that database more effectively and efficiently.« less

  7. Minimum savings requirements in shared savings provider payment.

    PubMed

    Pope, Gregory C; Kautter, John

    2012-11-01

    Payer (insurer) sharing of savings is a way of motivating providers of medical services to reduce cost growth. A Medicare shared savings program is established for accountable care organizations in the 2010 Patient Protection and Affordable Care Act. However, savings created by providers cannot be distinguished from the normal (random) variation in medical claims costs, setting up a classic principal-agent problem. To lessen the likelihood of paying undeserved bonuses, payers may pay bonuses only if observed savings exceed minimum levels. We study the trade-off between two types of errors in setting minimum savings requirements: paying bonuses when providers do not create savings and not paying bonuses when providers create savings. Copyright © 2011 John Wiley & Sons, Ltd.

  8. Economies of scale in federally-funded state-organized public health programs: results from the National Breast and Cervical Cancer Early Detection Programs

    PubMed Central

    Trogdon, Justin G.; Subramanian, Sujha; Crouse, Wesley

    2018-01-01

    This study investigates the existence of economies of scale in the provision of breast and cervical cancer screening and diagnostic services by state National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees. A translog cost function is estimated as a system with input factor share equations. The estimated cost function is then used to determine output levels for which average costs are decreasing (i.e., economies of scale exist). Data were collected from all state NBCCEDP programs and District of Columbia for program years 2006–2007, 2008–2009 and 2009–2010 (N =147). Costs included all programmatic and in-kind contributions from federal and non-federal sources, allocated to breast and cervical cancer screening activities. Output was measured by women served, women screened and cancers detected, separately by breast and cervical services for each measure. Inputs included labor, rent and utilities, clinical services, and quasi-fixed factors (e.g., percent of women eligible for screening by the NBCCEDP). 144 out of 147 program-years demonstrated significant economies of scale for women served and women screened; 136 out of 145 program-years displayed significant economies of scale for cancers detected. The cost data were self-reported by the NBCCEDP State programs. Quasi-fixed inputs were allowed to affect costs but not economies of scale or the share equations. The main analysis accounted for clustering of observations within State programs, but it did not make full use of the panel data. The average cost of providing breast and cervical cancer screening services decreases as the number of women screened and served increases. PMID:24326873

  9. 42 CFR 447.51 - Requirements and options.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Requirements and options. 447.51 Section 447.51 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., Premium Or Similar Cost Sharing Charge § 447.51 Requirements and options. (a) The plan must provide that...

  10. Cloud Computing. Technology Briefing. Number 1

    ERIC Educational Resources Information Center

    Alberta Education, 2013

    2013-01-01

    Cloud computing is Internet-based computing in which shared resources, software and information are delivered as a service that computers or mobile devices can access on demand. Cloud computing is already used extensively in education. Free or low-cost cloud-based services are used daily by learners and educators to support learning, social…

  11. 78 FR 3477 - International Mail Contracts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-16

    ... they share similar cost and market characteristics. Id. at 5. It notes that the pricing formula and...-filed Postal Service request concerning an additional Global Plus 2C contract. This document invites... announcing that it is entering into an additional Global Plus 2C contract (Agreement).\\1\\ The Postal Service...

  12. 45 CFR 154.301 - CMS's determinations of Effective Rate Review Programs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) The examination must take into consideration the following factors to the extent applicable to the filing under review: (i) The impact of medical trend changes by major service categories; (ii) The impact of utilization changes by major service categories; (iii) The impact of cost-sharing changes by major...

  13. 45 CFR 154.301 - CMS's determinations of Effective Rate Review Programs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) The examination must take into consideration the following factors to the extent applicable to the filing under review: (i) The impact of medical trend changes by major service categories; (ii) The impact of utilization changes by major service categories; (iii) The impact of cost-sharing changes by major...

  14. A Librarian's Guide to Speaking the Business Language.

    ERIC Educational Resources Information Center

    Zach, Lisl

    2002-01-01

    Discusses budgeting in corporate libraries as a basic tool of financial management. Highlights include focusing on goals; developing a list or matrix of services; resources needed for each service; shared costs; types of budgets, including operating budget, capital budget, and cash budget; and approaches to budgeting, including incremental…

  15. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System

    PubMed Central

    Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

    2015-01-01

    Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. PMID:25882486

  16. Health benefits of reduced patient cost sharing in Japan.

    PubMed

    Nishi, Akihiro; McWilliams, J Michael; Noguchi, Haruko; Hashimoto, Hideki; Tamiya, Nanako; Kawachi, Ichiro

    2012-06-01

    To assess the effect on out-of-pocket medical spending and physical and mental health of Japan's reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age. Study data came from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design. For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of-pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P = 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P = 0.084). Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults.

  17. Starting a Fee-Based Systematic Review Service.

    PubMed

    Knehans, Amy; Dell, Esther; Robinson, Cynthia

    2016-01-01

    The George T. Harrell Health Sciences Library at Penn State College of Medicine began a fee-based systematic review service, a model for cost recovery, in October 2013. This article describes the library's experience in establishing, introducing, and promoting the new service, which follows the Institute of Medicine's recommended standards for performing systematic reviews. The goal is to share this information with librarians who are contemplating starting such a service.

  18. Framework for Financial Ratio Analysis of Audited Federal Financial Reports

    DTIC Science & Technology

    1999-12-01

    franchising operations, allowing them to lower costs and share administrative support services with other agencies. [Ref. 60:sec. 402-403] The GMRA also...96 Federal Financial Reporting Statement of Net Cost Report Format 97 Federal Financial Reporting Statement of Changes in Net Position Report Format...analysis for sales, profitability, efficiency, marketing, investment, debt and capital analysis. Monitor growth Monitor costs Measure profitability and

  19. High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

    PubMed

    Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

    2016-03-01

    Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

  20. 42 CFR 422.100 - General requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in the service area of the MA plan; (2) At a uniform premium, with uniform benefits and level of cost... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... 42 Public Health 3 2010-10-01 2010-10-01 false General requirements. 422.100 Section 422.100...

  1. Vendor's Perspective on the Issues of Information Access in Relation to Rising Costs.

    ERIC Educational Resources Information Center

    Schrift, Leonard

    1990-01-01

    Discusses the rising costs of library materials from a vendor's perspective. Effects of corporate takeovers of publishers are examined, resource sharing among libraries is discussed, the role of the library as a supplier of information resources and services is considered, and libraries' need for product development and marketing strategies is…

  2. Global payment for health services as a solution in the financial crisis in Europe.

    PubMed

    Schrijvers, Guus

    2012-10-01

    In these financial difficult years many European governments used global ceilings to control costs of health services. Two scenarios are thinkable. The first is that all individual providers get a budget for their own costs: general practitioners, specialists, hospitals, nursing homes and mental health institutes. The second scenario is to work with global budgets for health care providers servicing a total population. Scientists and policy makers in Europe, North America and Asia need time to design new payment systems based on the idea of global budgeting, bundled payment and shared savings.

  3. Health Card: a new reform plan.

    PubMed

    Seidman, L S

    1995-01-01

    Health Card is a new reform plan. Every household, regardless of employment of health status, would receive a government-issued health credit card to use at the doctor's office or hospital like MasterCard. Later, it would be billed a percentage of the provider's charge--a percentage scaled to its last income tax return; its annual burden would never exceed a designated percentage of its income. Health Card would simply and directly achieve universal coverage and equitable patient cost-sharing. Like MasterCard, government would pay bills, not regulate providers. Each household would choose its medical provider (fee-for-service or HMO), bearing a percentage of the charge. Provider competition for cost-sharing consumers would help contain health care costs.

  4. 7 CFR 634.23 - Water quality plan.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... quality improvement. These measures are not eligible for cost sharing under this program. The installation... Conservation Service will certify as to the technical adequacy of the water-quality plan. (g) The soil...

  5. Can value-based insurance impose societal costs?

    PubMed

    Koenig, Lane; Dall, Timothy M; Ruiz, David; Saavoss, Josh; Tongue, John

    2014-09-01

    Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA). Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes. We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study. We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA. We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Controlling supply expenses through capitated supply contracting.

    PubMed

    Kowalski, J C

    1997-07-01

    Some providers dealing with the financial challenges of managed care are attempting to control supply expenses through capitated supply contracting and similar risk/reward sharing arrangements. Under such arrangements, a supplier sells products and services to a provider for a fixed, prospective price in exchange for the provider's exclusive business. If expenses exceed the prospectively established amount, the supplier and provider share the loss. Conversely, if expenses are less than the fixed amount, they share the savings. For a capitated supply arrangement to be successful, providers must be able to identify and track supply expense drivers, such as clinical pathways, technology utilization, and product selection and utilization. Sophisticated information systems are needed to capture data, such as total and per-transaction product usage/volume; unit price per item; average and cost per item; average and total cost per transaction; and total cost per outcome. Providers also will need to establish mutually cooperative relationships with the suppliers with whom they contract.

  7. 76 FR 46677 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-03

    ... Care Act) relating to coverage of preventive services without any participant cost sharing. The IRS is issuing the temporary regulations at the same time that the Employee Benefits Security Administration of... the Public Health Service Act. The temporary regulations provide guidance to employers, group health...

  8. The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada.

    PubMed

    Chai, Huamin; Guerriere, Denise N; Zagorski, Brandon; Coyte, Peter C

    2014-01-01

    With increasing emphasis on the provision of home-based palliative care in Canada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home-based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care-giving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component - $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. © 2013 John Wiley & Sons Ltd.

  9. Tracking and data relay satellite system: NASA's new spacecraft data acquisition system

    NASA Astrophysics Data System (ADS)

    Schneider, W. C.; Garman, A. A.

    The growth in NASA's ground network complexity and cost triggered a search for an alternative. Through a lease service contract, Western Union will provide to NASA 10 years of space communications services with a Tracking and Data Relay Satellite System (TDRSS). A constellation of four operating satellites in geostationary orbit and a single ground terminal will provide complete tracking, telemetry and command service for all of NASA's Earth orbital satellites below an altitude of 12,000 km. The system is shared: two satellites will be dedicated to NASA service; a third will provide backup as a shared spare; the fourth satellite will be dedicated to Western Union's Advanced Westar commercial service. Western Union will operate the ground terminal and provide operational satellite control. NASA's Network Control Center will provide the focal point for scheduling user services and controlling the interface between TDRSS and the rest of the NASA communications network, project control centers and data processing facilities. TDRSS single access user spacecraft data systems should be designed for efficient time shared data relay support. Reimbursement policy and rate structure for non-NASA users are currently being developed.

  10. Fixed Access Network Sharing

    NASA Astrophysics Data System (ADS)

    Cornaglia, Bruno; Young, Gavin; Marchetta, Antonio

    2015-12-01

    Fixed broadband network deployments are moving inexorably to the use of Next Generation Access (NGA) technologies and architectures. These NGA deployments involve building fiber infrastructure increasingly closer to the customer in order to increase the proportion of fiber on the customer's access connection (Fibre-To-The-Home/Building/Door/Cabinet… i.e. FTTx). This increases the speed of services that can be sold and will be increasingly required to meet the demands of new generations of video services as we evolve from HDTV to "Ultra-HD TV" with 4k and 8k lines of video resolution. However, building fiber access networks is a costly endeavor. It requires significant capital in order to cover any significant geographic coverage. Hence many companies are forming partnerships and joint-ventures in order to share the NGA network construction costs. One form of such a partnership involves two companies agreeing to each build to cover a certain geographic area and then "cross-selling" NGA products to each other in order to access customers within their partner's footprint (NGA coverage area). This is tantamount to a bi-lateral wholesale partnership. The concept of Fixed Access Network Sharing (FANS) is to address the possibility of sharing infrastructure with a high degree of flexibility for all network operators involved. By providing greater configuration control over the NGA network infrastructure, the service provider has a greater ability to define the network and hence to define their product capabilities at the active layer. This gives the service provider partners greater product development autonomy plus the ability to differentiate from each other at the active network layer.

  11. A Novel Market-Oriented Dynamic Collaborative Cloud Service Platform

    NASA Astrophysics Data System (ADS)

    Hassan, Mohammad Mehedi; Huh, Eui-Nam

    In today's world the emerging Cloud computing (Weiss, 2007) offer a new computing model where resources such as computing power, storage, online applications and networking infrastructures can be shared as "services" over the internet. Cloud providers (CPs) are incentivized by the profits to be made by charging consumers for accessing these services. Consumers, such as enterprises, are attracted by the opportunity for reducing or eliminating costs associated with "in-house" provision of these services.

  12. Leveraging National Healthcare Reform to Improve Army National Guard Readiness

    DTIC Science & Technology

    2010-03-01

    Specifically, monitoring Soldier use of TRICARE Reserve Select (TRS) to meet the health insurance mandate and changing the TRS benefit by developing...TRS benefit by developing incentives for healthy behaviors and eliminating cost sharing for preventive services, will help control health care costs...amount of heath care gained relative to the amount spent) can improve readiness while controlling cost growth. 50 In 2008, health care expenditures

  13. Routine real-time cost-effectiveness monitoring of a web-based depression intervention: a risk-sharing proposal.

    PubMed

    Naveršnik, Klemen; Mrhar, Aleš

    2014-02-27

    A new health care technology must be cost-effective in order to be adopted. If evidence regarding cost-effectiveness is uncertain, then the decision maker faces two choices: (1) adopt the technology and run the risk that it is less effective in actual practice, or (2) reject the technology and risk that potential health is forgone. A new depression eHealth service was found to be cost-effective in a previously published study. The results, however, were unreliable because it was based on a pilot clinical trial. A conservative decision maker would normally require stronger evidence for the intervention to be implemented. Our objective was to evaluate how to facilitate service implementation by shifting the burden of risk due to uncertainty to the service provider and ensure that the intervention remains cost-effective during routine use. We propose a risk-sharing scheme, where the service cost depends on the actual effectiveness of the service in real-life setting. Routine efficacy data can be used as the input to the cost-effectiveness model, which employs a mapping function to translate a depression specific score into quality-adjusted life-years. The latter is the denominator in the cost-effectiveness ratio calculation, required by the health care decision maker. The output of the model is a "value graph", showing intervention value as a function of its observed (future) efficacy, using the €30,000 per quality-adjusted life-year (QALY) threshold. We found that the eHealth service should improve the patient's outcome by at least 11.9 points on the Beck Depression Inventory scale in order for the cost-effectiveness ratio to remain below the €30,000/QALY threshold. The value of a single point improvement was found to be between €200 and €700, depending on depression severity at treatment start. Value of the eHealth service, based on the current efficacy estimates, is €1900, which is significantly above its estimated cost (€200). The eHealth depression service is particularly suited to routine monitoring, since data can be gathered through the Internet within the service communication channels. This enables real-time cost-effectiveness evaluation and allows a value-based price to be established. We propose a novel pricing scheme where the price is set to a point in the interval between cost and value, which provides an economic surplus to both the payer and the provider. Such a business model will assure that a portion of the surplus is retained by the payer and not completely appropriated by the private provider. If the eHealth service were to turn out less effective than originally anticipated, then the price would be lowered in order to achieve the cost-effectiveness threshold and this risk of financial loss would be borne by the provider.

  14. Straddling care and education: Developing interprofessional collaboration through a hotspotting service learning project.

    PubMed

    Jones, Anne C; Li, Trudy; Zomorodi, Meg; Broadhurst, Rob; Weil, Amy B

    2018-06-01

    Interprofessional (IP) team work has been shown to decrease burnout and improve care and decrease costs. However, institutional barriers have challenged adoption in practice and education. Faculty and students are turning to IP service-learning projects to help students gain experience and provide needed services. This paper highlights a "hotspotting" program where students from different health professions work collaboratively to improve high utilizing patients' health. Benefits, challenges and preliminary results including cost savings and student efficacy are shared. Institutions should surmount barriers that make hotspotting service-learning challenging as IP team-based experiences prepare students for the workplace and can help mitigate burnout. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Optimising boiler performance.

    PubMed

    Mayoh, Paul

    2009-01-01

    Soaring fuel costs continue to put the squeeze on already tight health service budgets. Yet it is estimated that combining established good practice with improved technologies could save between 10% and 30% of fuel costs for boilers. Paul Mayoh, UK technical manager at Spirax Sarco, examines some of the practical measures that healthcare organisations can take to gain their share of these potential savings.

  16. MARC and the Library Service Center: Automation at Bargain Rates.

    ERIC Educational Resources Information Center

    Pearson, Karl M.

    Despite recent research and development in the field of library automation, libraries have been unable to reap the benefits promised by technology due to the high cost of building and maintaining their own computer-based systems. Time-sharing and disc mass storage devices will bring automation costs, if spread over a number of users, within the…

  17. Consumer cost sharing and use of biopharmaceuticals for rheumatoid arthritis.

    PubMed

    Robinson, James C

    2013-06-01

    To evaluate the effect of consumer cost sharing on use of physician-administered and patient self-administered specialty drugs for rheumatoid arthritis. Multivariate statistical analysis of probability and use of physician-administered specialty drugs, patient self-injected specialty drugs, non-biologic disease-modifying anti-rheumatic drugs, and symptom relief drugs. Analyses were conducted for patients enrolling in preferred provider organization (PPO) plans and health maintenance organization (HMO) plans with different cost-sharing requirements, adjusted for patient demographics, health status, and geographical location. Professional, facility, and pharmaceutical claims for beneficiaries of CalPERS, the public employee insurance purchasing alliance in California, for 2008-2009. Consumer cost-sharing requirements were obtained for each type of drug and service for each type of insurance plan. PPO insurance enrollees face substantially higher cost sharing for physician-administered specialty drugs, compared with HMO enrollees in CalPERS. PPO patients with rheumatoid arthritis are only half as likely as HMO enrollees to choose a physician-administered specialty drug (4.2% vs 9.3%) (P ≤.05), and use 25% less of the drugs if they use any ($10,356 vs $13,678) (P ≤.05). They are 30% more likely to use a self-administered specialty drug than are HMO enrollees (29.3% vs 22.1%) (P ≤.05), and use 35% more of the drugs if any ($16,015 vs $12,378) (P ≤.05). Consumer cost sharing reduces the use of physician-administered specialty drugs for rheumatoid arthritis. The higher use of patient self-administered specialty drugs suggests that the disincentives for use of physician-administered drugs were offset by an increased incentive to use self-administered drugs.

  18. Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods.

    PubMed

    Pace, Lydia E; Dusetzina, Stacie B; Keating, Nancy L

    2016-09-01

    The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA's mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA's contraceptive mandate. A retrospective cohort study using Truven Health MarketScan claims data from January 2010 to December 2013. Women aged 18-45 years with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010-2013 (N=3,794,793). Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time after the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. The proportion of claims with $0 cost-sharing for intrauterine devices and implants, respectively, rose from 36.6% and 9.3% in 2010 to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<0.001). LARC uptake increased over time with no significant change in level of LARC use after ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously reported (β coefficient for trend, -0.004; P<0.001). The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.

  19. State trends in the cost of employer health insurance coverage, 2003-2013.

    PubMed

    Schoen, Cathy; Radley, David; Collins, Sara R

    2015-01-01

    From 2010 to 2013--the years following the implementation of the Affordable Care Act--there has been a marked slowdown in premium growth in 31 states and the District of Columbia. Yet, the costs employees and their families pay out-of-pocket for deductibles and their share of premiums continued to rise, consuming a greater share of incomes across the country. In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. Workers are paying more but getting less protective benefits. Costs are particularly high, compared with median income, in Southern and South Central states, where incomes are below the national average. Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families, and employers will likely require action to address rising costs of medical care services.

  20. Financial barriers to care among low-income children with asthma: health care reform implications.

    PubMed

    Fung, Vicki; Graetz, Ilana; Galbraith, Alison; Hamity, Courtnee; Huang, Jie; Vollmer, William M; Hsu, John; Wu, Ann Chen

    2014-07-01

    The Patient Protection and Affordable Care Act (ACA) includes subsidies that reduce patient cost sharing for low-income families. Limited information on the effects of cost sharing among children is available to guide these efforts. To examine the associations between cost sharing, income, and care seeking and financial stress among children with asthma. A telephone survey in 2012 about experiences during the prior year within an integrated health care delivery system. Respondents included 769 parents of children aged 4 to 11 years with asthma. Of these, 25.9% of children received public subsidies; 21.7% were commercially insured with household incomes at or below 250% of the federal poverty level (FPL) and 18.2% had higher cost-sharing levels for all services (e.g., ≥$75 for emergency department visits). We classified children with asthma based on (1) current receipt of a subsidy (i.e., Medicaid or Children's Health Insurance Program) or potential eligibility for ACA low-income cost sharing or premium subsidies in 2014 (i.e., income ≤250%, 251%-400%, or >400% of the FPL) and (2) cost-sharing levels for prescription drugs, office visits, and emergency department visits. We examined the frequency of changes in care seeking and financial stress due to asthma care costs across these groups using logistic regression, adjusted for patient/family characteristics. Switching to cheaper asthma drugs, using less medication than prescribed, delaying/avoiding any office or emergency department visits, and financial stress (eg, cutting back on necessities) because of the costs of asthma care. After adjustment, parents at or below 250% of the FPL with lower vs higher cost-sharing levels were less likely to delay or avoid taking their children to a physician's office visit (3.8% vs. 31.6%; odds ratio, 0.07 [95% CI, 0.01-0.39]) and the emergency department (1.2% vs. 19.4%; 0.05 [0.01-0.25]) because of cost; higher-income parents and those whose children were receiving public subsidies (eg, Medicaid) were also less likely to forego their children's care than parents at or below 250% of the FPL with higher cost-sharing levels. Overall, 15.6% of parents borrowed money or cut back on necessities to pay for their children's asthma care. Cost-related barriers to care among children with asthma were concentrated among low-income families with higher cost-sharing levels. The ACA's low-income subsidies could reduce these barriers for many families, but millions of dependents for whom employer-sponsored family coverage is unaffordable could remain at risk for cost-related problems because of ACA subsidy eligibility rules.

  1. Improving clinicians' access to cost data.

    PubMed

    Kenagy, John; Shah, Ben

    2014-08-01

    Bringing clinical and financial data together is critical to effectively running and operating service lines. Helping clinicians use cost data to make decisions requires a shared vision and a partnership between finance leaders and physicians. Hosting a "jam session" of technical, financial, and clinical experts can accelerate an organization's business intelligence strategy. Labor and supply costs represent the most actionable cost data for clinicians. Clinician buy-in hinges on education and support. It is important to focus on easy wins at the beginning of the project.

  2. 42 CFR 447.56 - Limitations on premiums and cost sharing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Indian who is eligible to receive or has received an item or service furnished by an Indian health care... currently receiving or have ever received an item or service furnished by an Indian health care provider or..., the agency may not reduce the payment it makes to a provider, including an Indian health care provider...

  3. The demand for ambulatory mental health services from specialty providers.

    PubMed Central

    Horgan, C M

    1986-01-01

    A two-part model is used to examine the demand for ambulatory mental health services in the specialty sector. In the first equation, the probability of having a mental health visit is estimated. In the second part of the model, variations in levels of use expressed in terms of visits and expenditures are examined in turn, with each of these equations conditional on positive utilization of mental health services. In the second part of the model, users are additionally grouped into those with and without out-of-pocket payment for services. This specification accounts for special characteristics regarding the utilization of ambulatory mental health services: (1) a large part of the population does not use these services; (2) of those who use services, the distribution of use is highly skewed; and (3) a large number of users have zero out-of-pocket expenditures. Cost-sharing does indeed matter in the demand for ambulatory mental health services from specialty providers; however, the decision to use mental health services is affected by the level of cost-sharing to a lesser degree than is the decision regarding the level of use of services. The results also show that price is only one of several important factors in determining the demand for services. The lack of significance of family income and of being female is notable. Evidence is presented for the existence of bandwagon effects. The importance of Medicaid in the probability of use equations is noted. PMID:3721874

  4. Patient cost-sharing and insurance arrangements are associated with hospital readmissions after abdominal surgery: Implications for access and quality health care.

    PubMed

    Youn, Bora; Soley-Bori, Marina; Soria-Saucedo, Rene; Ryan, Colleen M; Schneider, Jeffrey C; Haynes, Alex B; Cabral, Howard J; Kazis, Lewis E

    2016-03-01

    Readmission rates after operative procedures are used increasingly as a measure of hospital care quality. Patient access to care may influence readmission rates. The objective of this study was to determine the relationship between patient cost-sharing, insurance arrangements, and the risk of postoperative readmissions. Using the MarketScan Research Database (n = 121,002), we examined privately insured, nonelderly patients who underwent abdominal surgery in 2010. The main outcome measures were risk-adjusted unplanned readmissions within 7 days and 30 days of discharge. Odds of readmissions were compared with multivariable logistic regression models. In adjusted models, $1,284 increase in patient out-of-pocket payments during index admission (a difference of one standard deviation) was associated with 19% decrease in the odds of 7-day readmission (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.78-0.85) and 17% decrease in the odds of 30-day readmission (OR 0.83, 95% CI 0.81-0.86). Patients in the noncapitated point-of-service plans (OR 1.19, 95% CI 1.07-1.33), preferred provider organization plans (OR 1.11, 95% CI 1.03-1.19), and high-deductible plans (OR 1.12, 95% CI 1.00-1.26) were more likely to be readmitted within 30 days compared with patients in the capitated health maintenance organization and point-of-service plans. Among privately insured, nonelderly patients, increased patient cost-sharing was associated with lower odds of 7-day and 30-day readmission after abdominal surgery. Insurance arrangements also were significantly associated with postoperative readmissions. Patient cost sharing and insurance arrangements need consideration in the provision of equitable access for quality care. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

    PubMed

    Bratt, John H; Torpey, Kwasi; Kabaso, Mushota; Gondwe, Yebo

    2011-01-01

    To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia. Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT. Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening. © 2010 Blackwell Publishing Ltd.

  6. Achieving strategic cost advantages by focusing on back-office efficiency.

    PubMed

    McDowell, Jim

    2010-06-01

    A study of more than 270 hospitals over a four-year period highlighted a number of investments that can reduce hospitals' costs and improve efficiency, including the following: E-procurement systems. Electronic exchange of invoices and payments (and electronic receipt of payments). Human resources IT systems that reduce the need for manual entry of data. Shared services deployment.

  7. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.

    PubMed

    Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

    2015-04-16

    To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals' outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. USA VA Health Care System. 5.2 million VA patients. Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. The 5% highest cost patients (n=261,699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01). Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions. 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.

  8. Impact of Affordable Care Act coverage expansion on women's reproductive preventive services in the United States.

    PubMed

    Arora, Prachi; Desai, Karishma

    2016-08-01

    The Affordable Care Act (ACA) expansion mandated the private health plans to cover women's preventive services starting August 2012. With limited and contradictory evidence, this study intends to assess the impact of ACA on the utilization rates and the cost burden of women's reproductive preventive service. A pre-post analysis was conducted using a nationally representative sample of females (aged 15-44years, n=4397) participating in the 2011-2013 National Survey of Family Growth. The utilization rates and cost burdens were compared for six services using bivariate and multivariable logistic regression models. After the ACA expansion, there wasn't a significant increase in the utilization rates of birth control/prescription (33.7% vs. 30.7%), birth control counseling (17.7% vs. 16.9%), sterilization counseling (3.3% vs. 3.5%), STI counsel/test/treat (15% vs. 14.6%) and HIV screening (24.1% vs. 23.1%). Respondents paying through insurance increased after ACA, but out-of-pocket spending (cost-sharing) didn't decrease for respondents. Type of insurance was an important predictor of utilization rates with publicly insured having significantly higher Odds Ratio (OR) or likelihood of receiving birth control counseling (OR:1.71), sterilization counseling (OR:2.67), STI counsel/test/treat (OR:1.54) and HIV screening (OR:1.69) compared to privately insured. The early-on impact of ACA expansion on utilization rates of women's reproductive preventive services didn't appear to be significant. Private health plans, however, might have expanded their coverage but burden of cost sharing still existed. Future research should evaluate the long term impact of ACA expansion on women's health and the economic gains. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Effect of Reaganomics on the U.S. health-care system.

    PubMed

    Enright, S M

    1982-07-01

    Health care under President Ronald Reagan is discussed as it relates to consumers, third-party carriers, hospitals, and hospital pharmacists. The Reagan Administration's goals are to: (1) promote cost containment and quality control through competition, and (2) shift the major elements of program control to the state and local governments and the competitive private sector. Described are the regulatory and legislative initiatives of the Administration, such as the Omnibus Reconciliation Budget Act, Block Grant Programs, Medicare and Medicaid cuts, and procompetition legislation. Under increased competition in the health insurance system, the locus of responsibility for costs will shift from employers and unions to employees. Incentives for greater cost sharing will force hospitals to restrain costs. Multihospital systems are likely to proliferate. Proposed ancillary service caps will increase competition for resources among hospital departments. Pharmacy departments must implement strategic long-range planning to withstand the pressures for reductions in staff and services. Clinical pharmacy services will become increasingly difficult to implement without full documentation. As a result of all these changes, consumer demand for health-care services may decrease, and the way such services are delivered will probably shift.

  10. The cost structure of routine infant immunization services: a systematic analysis of six countries

    PubMed Central

    Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

    2017-01-01

    Abstract Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. PMID:28575193

  11. The cost structure of routine infant immunization services: a systematic analysis of six countries.

    PubMed

    Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

    2017-10-01

    Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77-93% of national routine infant immunization costs. Labour and vaccine costs comprised 14-69% and 13-69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48-78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  12. Video Relay Service for Signing Deaf - Lessons Learnt from a Pilot Study

    NASA Astrophysics Data System (ADS)

    Ponsard, Christophe; Sutera, Joelle; Henin, Michael

    The generalization of high speed Internet, efficient compression techniques and low cost hardware have resulted in low cost video communication since the year 2000. For the Deaf community, this enables native communication in sign language and a better communication with hearing people over the phone. This implies that Video Relay Service can take over the old Text Relay Service which is less natural and requires mastering written language. A number of such services have developed throughout the world. The objectives of this paper are to present the experience gained in the Walloon Region of Belgium, to share a number of lessons learnt, and to provide recommendations at the technical, user adoption and political levels. A survey of video relay services around the world is presented together with the feedback from users both before and after using the pilot service.

  13. To Meet the Needs of the Nations: Staffing the U.S. Civil Service and the Public Service of Canada

    DTIC Science & Technology

    1992-01-01

    63 Appendix H. A Summary Comparison of the Rights and Benefits Granted to Surplus Employees by the Public Service of... benefit from a closer examination of the way in which the Public Service Commission of Canada gathers and uses relevant information from the individual...business class air travel N Shared cost (50-50) of premiums for provincial when the one-way flight is 850 or more air kilome- health insurance plans

  14. Healthcare payment incentives: a comparative analysis of reforms in Taiwan, South Korea and China.

    PubMed

    Eggleston, Karen; Hsieh, Chee-Ruey

    2004-01-01

    Payment incentives to both consumers and providers have significant consequences for the equity and efficiency of a healthcare system, and have recently come to the fore in health policy reforms. This review first discusses the economic rationale for the apparent international convergence toward payment systems with mixed demand- and supply-side cost sharing. The recent payment reforms undertaken in Taiwan, South Korea and China are then summarised. Available evidence clearly indicates that payment incentives matter, and, in particular, that supply-side cost sharing can improve efficiency without undermining equity. Further study and monitoring of health service quality and risk selection is warranted.

  15. Chlamydia screening for sexually active young women under the Affordable Care Act: new opportunities and lingering barriers.

    PubMed

    Loosier, Penny S; Malcarney, Mary-Beth; Slive, Lauren; Cramer, Ryan C; Burgess, Brittany; Hoover, Karen W; Romaguera, Raul

    2014-09-01

    The Affordable Care Act of 2010 (ACA) contains a provision requiring private insurers issuing or renewing plans on or after September 23, 2010, to provide, without cost sharing, preventive services recommended by US Preventive Services Task Force (grades A and B), among other recommending bodies. As a grade A recommendation, chlamydia screening for sexually active young women 24 years and younger and older women at risk for chlamydia falls under this requirement. This article examines the potential effect on chlamydia screening among this population across private and public health plans and identifies lingering barriers not addressed by this legislation. Examination of the impact on women with private insurance touches upon the distinction between coverage under grandfathered plans, where the requirement does not apply, and nongrandfathered plans, where the requirement does apply. Acquisition of private health insurance through health insurance Marketplaces is also discussed. For public health plans, coverage of preventive services without cost sharing differs for individuals enrolled in standard Medicaid, covered under the Medicaid expansion included in the ACA, or those enrolled under the Children's Health Insurance Program or who fall under Early, Periodic, Screening, Diagnosis and Treatment criteria. The discussion of lingering barriers not addressed by the ACA includes the uninsured, physician reimbursement, cost sharing, confidentiality, low rates of appropriate sexual history taking by providers, and disclosures of sensitive information. In addition, the role of safety net programs that provide health care to individuals regardless of ability to pay is examined in light of the expectation that they also remain a payer of last resort.

  16. NASA policy on pricing shuttle launch services

    NASA Technical Reports Server (NTRS)

    Smith, J. M.

    1977-01-01

    The paper explains the rationale behind key elements of the pricing policy for STS, the major features of the non-government user policy, and some of the stimulating features of the policy which will open space to a wide range of new users. Attention is given to such major policy features as payment schedule, cost and standard services, the two phase pricing structure, optional services, shared flights, cancellation and postponement, and earnest money.

  17. Private Information Retrieval Techniques for Enabling Location Privacy in Location-Based Services

    NASA Astrophysics Data System (ADS)

    Khoshgozaran, Ali; Shahabi, Cyrus

    The ubiquity of smartphones and other location-aware hand-held devices has resulted in a dramatic increase in popularity of location-based services (LBS) tailored to user locations. The comfort of LBS comes with a privacy cost. Various distressing privacy violations caused by sharing sensitive location information with potentially malicious services have highlighted the importance of location privacy research aiming to protect user privacy while interacting with LBS.

  18. Utilities Cost Comparison Analysis between a Public Work Center and the Non-DoD Sector

    DTIC Science & Technology

    1992-12-01

    construction, consider innovative financing and 14 management arrangements (e.g. cost-sharing, public-private venture, leasing). Integrate...and services by financing all incurred costs. 27 Cash is put back into the working capital fund when customers pay cash from their O&M,N funds for the...firms, and other significantly sized business firms. The actual participants of the study may or may not be included in this listing. Disneyland was

  19. The impact of cost recovery and sharing system on water policy implementation and human right to water: a case of Ileje, Tanzania.

    PubMed

    Kibassa, Deusdedit

    2011-01-01

    In Tanzania, the National Water Policy (NAWAPO) of 2002 clearly stipulates that access to water supply and sanitation is a right for every Tanzanian and that cost recovery is the foundation of sustainable service delivery. To meet these demands, water authorities have introduced cost recovery and a water sharing system. The overall objective of this study was to assess the impact of cost recovery and the sharing system on water policy implementation and human rights to water in four villages in the Ileje district. The specific objectives were: (1) to assess the impact of cost recovery and the sharing system on the availability of water to the poor, (2) to assess user willingness to pay for the services provided, (3) to assess community understanding on the issue of water as a human right, (4) to analyse the implications of the results in relation to policies on human rights to water and the effectiveness of the implementation of the national water policy at the grassroots, and (5) to establish the guidelines for water pricing in rural areas. Questionnaires at water demand, water supply, ability and willingness to pay and revenue collection were the basis for data collection. While 36.7% of the population in the district had water supply coverage, more than 73,077 people of the total population of 115,996 still lacked access to clean and safe water and sanitation services in the Ileje district. The country's rural water supply coverage is 49%. Seventy-nine percent of the interviewees in all four villages said that water availability in litres per household per day had decreased mainly due to high water pricing which did not consider the income of villagers. On the other hand, more than 85% of the villagers were not satisfied with the amount they were paying because the services were still poor. On the issue of human rights to water, more than 92% of the villagers know about their right to water and want it exercised by the government. In all four villages, more than 78% of the interviewees are willing to payforwater provided that the tariffs are affordable. Water policy implementation continues slowly: regardless of the fact that more than five years have passed since policy inception, 60% of the villagers in Itumba still have no water services at all. The study shows that government fulfilment of human rights to water has a long way to go, especially in rural areas where people cannot afford to pay for water and some of the villages still depend on water from wells and seasonal rivers.

  20. Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa.

    PubMed

    Meehan, Sue-Ann; Beyers, Nulda; Burger, Ronelle

    2017-12-02

    In South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality. The study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality. The annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102). This study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

  1. Differences in health care spending across countries: statistical evidence.

    PubMed

    Pfaff, M

    1990-01-01

    The empirical evidence available for OECD countries suggests that economic factors play a major role and that demographic factors play a minor role in explaining differences in health care spending across countries. When countries are grouped on the basis of their health care systems, some significant cross-country differences result: countries with higher transfer rates (a larger share of collective financing) are not generally characterized by higher health care expenditures, and conversely, countries with a larger share of private financing (including higher coinsurance rates) do not have lower expenditures. Rather, the opposite holds true. Similar conclusions apply to the share of public versus private production of health goods. Furthermore, the results do not support the claims of those critics of universal public insurance systems who consider the expansion of the coverage to be a major source of expenditure growth. These findings cast serious doubt on the claim that cost containment can be achieved via market reforms that rely heavily on direct consumer payments and cost sharing as instruments of financing. A comparative analysis of the historic record of the United States, Canada, and the Federal Republic of Germany generally supports these conclusions; it also suggests that a greater degree of public penetration offers a better chance for control of health spending, particularly in periods of austerity. There is a strong presumption that health care systems relying on some overall control of spending generally are more cost-effective than those relying more on decentralized mechanisms of control. Services are more equitably distributed in relation to health and payment for health services is far more progressive in the former type of system.

  2. Impact of cost sharing on specialty drug utilization and outcomes: a review of the evidence and future directions.

    PubMed

    Doshi, Jalpa A; Li, Pengxiang; Ladage, Vrushabh P; Pettit, Amy R; Taylor, Erin A

    2016-03-01

    Specialty drugs often represent major medical advances for patients with few other effective options available, but high costs have attracted the attention of both payers and policy makers. We reviewed the evidence regarding the impact of cost sharing on utilization of specialty drugs indicated for rheumatoid arthritis (RA), multiple sclerosis (MS), and cancer, and on the use of nondrug medical services, health outcomes, and spending. Systematic review of Medline-indexed studies identified via an OVID search for articles published in English from 1995 to 2014, using combinations of terms for cost sharing and specialty drugs, and/or our 3 conditions of interest. We identified additional studies from reference lists. We identified 19 articles focusing on specialty drugs indicated for MS (n = 9), cancer (n = 8), and RA (n = 8). Studies examined prescription abandonment (n = 3), initiation or any utilization (n = 8), adherence (n = 9), persistence/discontinuation (n = 7), number of claims (n = 1), and drug spending (n = 1). Findings varied by disease, but generally indicated stronger effects for noninitiation or abandonment of a prescription at the pharmacy and somewhat smaller effects for refill behavior and drug spending once patients initiated therapy. Studies have not examined specialty tier cost sharing seen under Medicare Part D or health insurance exchanges, nor effects on medical utilization, spending, or health outcomes. Evidence to date generally indicates reductions in specialty drug utilization associated with higher cost sharing; effects have varied by type of disease and specialty drug use outcome. We draw upon our findings and the gaps in evidence to summarize future directions for research and policy.

  3. 26 CFR 1.420-1 - Significant reduction in retiree health coverage during the cost maintenance period.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Significant reduction in retiree health coverage during the cost maintenance period. 1.420-1 Section 1.420-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.420-1 Significant...

  4. Grandfathered, Grandmothered, And ACA-Compliant Health Plans Have Equivalent Premiums.

    PubMed

    Whitmore, Heidi; Gabel, Jon R; Satorius, Jennifer L; Green, Matthew

    2017-02-01

    Many small employers offer employees health plans that are not fully compliant with Affordable Care Act (ACA) provisions such as covering preventive services without cost sharing. These "grandfathered" and "grandmothered" plans accounted for about 65 percent of enrollment in the small-group market in 2014. Premium costs for these and ACA-compliant plans were equivalent. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network.

    PubMed

    Smith, Marie; Cannon-Breland, Michelle L; Spiggle, Susan

    2014-01-01

    Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient care and/or prevented adverse drug events, and the services were cost neutral (at a minimum). It was difficult for most consumers and physicians to envision pharmacists practicing in non-dispensing roles. The pharmacy profession must disseminate the existing body of evidence on pharmacists as care providers of medication management services and the related impact on clinical outcomes, patient safety, and cost savings to external audiences. Without such, new pharmacist practice models may have limited acceptance by consumers, primary care physicians, and payers. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Examining public knowledge and preferences for adult preventive services coverage.

    PubMed

    Williams, Jessica A R; Ortiz, Selena E

    2017-01-01

    To examine (1) what individuals know about the existing adult preventive service coverage provisions of the Affordable Care Act (ACA), and (2) which preventive services individuals think should be covered without cost sharing. An online panel from Survey Monkey was used to obtain a sample of 2,990 adults age 18 and older in March 2015, analyzed 2015-2017. A 17-item survey instrument was designed and used to evaluate respondents' knowledge of the adult preventive services provision of the ACA. Additionally, we asked whether various preventive services should be covered. The data include age, sex, race/ethnicity, and educational attainment as well as measures of political ideology, previous insurance status, the number of chronic conditions, and usual source of care. Respondents correctly answered 38.6% of the questions about existing coverage under the ACA, while on average respondents thought 12.1 of 15 preventive services should be covered (SD 3.5). Respondents were more knowledgeable about coverage for routine screenings, such as blood pressure (63.4% correct) than potentially stigmatizing screenings, such as for alcohol misuse (28.8% correct). Blood pressure screening received the highest support of coverage (89.8%) while coverage of gym memberships received the lowest support (59.4%). Individuals with conservative ideologies thought fewer services on average should be covered, but the difference was small-around one service less than those with liberal ideologies. Overwhelmingly, individuals think that most preventive services should be covered without cost sharing. Despite several years of coverage for preventive services, there is still confusion and lack of knowledge about which services are covered.

  7. Examining public knowledge and preferences for adult preventive services coverage

    PubMed Central

    Ortiz, Selena E.

    2017-01-01

    Introduction To examine (1) what individuals know about the existing adult preventive service coverage provisions of the Affordable Care Act (ACA), and (2) which preventive services individuals think should be covered without cost sharing. Methods An online panel from Survey Monkey was used to obtain a sample of 2,990 adults age 18 and older in March 2015, analyzed 2015–2017. A 17-item survey instrument was designed and used to evaluate respondents’ knowledge of the adult preventive services provision of the ACA. Additionally, we asked whether various preventive services should be covered. The data include age, sex, race/ethnicity, and educational attainment as well as measures of political ideology, previous insurance status, the number of chronic conditions, and usual source of care. Results Respondents correctly answered 38.6% of the questions about existing coverage under the ACA, while on average respondents thought 12.1 of 15 preventive services should be covered (SD 3.5). Respondents were more knowledgeable about coverage for routine screenings, such as blood pressure (63.4% correct) than potentially stigmatizing screenings, such as for alcohol misuse (28.8% correct). Blood pressure screening received the highest support of coverage (89.8%) while coverage of gym memberships received the lowest support (59.4%). Individuals with conservative ideologies thought fewer services on average should be covered, but the difference was small—around one service less than those with liberal ideologies. Conclusions Overwhelmingly, individuals think that most preventive services should be covered without cost sharing. Despite several years of coverage for preventive services, there is still confusion and lack of knowledge about which services are covered. PMID:29261757

  8. Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans.

    PubMed

    Trivedi, Amal N; Leyva, Bryan; Lee, Yoojin; Panagiotou, Orestis A; Dahabreh, Issa J

    2018-01-18

    The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, -7.3 to 8.1). The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.).

  9. Defense Health Care Reform: Actions Needed to Help Ensure Defense Health Agency Maintains Implementation Progress

    DTIC Science & Technology

    2015-09-01

    business case analyses, and performance measures for the DHA’s shared services. GAO compared this information with key management practices and DOD...headquarters personnel within the MHS in annual budget documents. • Approach to help achieve cost savings - The DHA has developed a business case...comprehensive business case analyses for 2 shared services— Public Health, and Medical Education and Training. Specifically, the DHA has proposed the

  10. 15 CFR 295.25 - Special rule for the valuation of transfers between separately-owned joint venture members.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... goods, including computer software, and services provided by the transferor related to the maintenance... non-Federal share of the total cost of the joint research and development program. (c) Definition. The...

  11. 15 CFR 295.25 - Special rule for the valuation of transfers between separately-owned joint venture members.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... goods, including computer software, and services provided by the transferor related to the maintenance... non-Federal share of the total cost of the joint research and development program. (c) Definition. The...

  12. 15 CFR 295.25 - Special rule for the valuation of transfers between separately-owned joint venture members.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... goods, including computer software, and services provided by the transferor related to the maintenance... non-Federal share of the total cost of the joint research and development program. (c) Definition. The...

  13. 15 CFR 295.25 - Special rule for the valuation of transfers between separately-owned joint venture members.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... goods, including computer software, and services provided by the transferor related to the maintenance... non-Federal share of the total cost of the joint research and development program. (c) Definition. The...

  14. 7 CFR 625.4 - Program requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... the HFRP, NRCS will purchase conservation easements from, or enter into 10-year cost-share agreements with, eligible landowners who voluntarily cooperate in the restoration and protection of forestlands...

  15. 75 FR 2515 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ...: This notice provides the updated regional per diem rates for low volume mental health providers; the... beneficiary per-diem cost-share amount for low-volume providers; and the updated per- [[Page 2516

  16. Financial performance in the social health maintenance organization, 1985-88

    PubMed Central

    Leutz, Walter; Malone, Joelyn; Kistner, Marlin; O'Bar, Tim; Ripley, Jeanne M.; Sandhaus, Martin

    1990-01-01

    Since early 1985, four social health maintenance organizations have delivered integrated health and long-term care services to Medicare beneficiaries under congressionally mandated waivers that included shared public-program risk for losses. Three of four sites had substantial losses in the first 3 years, primarily because of slow enrollment and resultant high marketing and administrative costs. After assuming full risk, two of the three showed surpluses in 1988. Service and management costs for expanded long-term care were similar across sites and were affordable within the framework of Medicare and Medicaid reimbursement and private premiums. PMID:10113466

  17. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

    PubMed Central

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-01-01

    Background: Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. Objectives: The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). Materials and Methods: We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Results: Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. Conclusion: As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs. PMID:26715979

  18. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

    PubMed

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-10-01

    Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.

  19. Implementing a comprehensive cost information system in rural health facilities: the case of Nouna health district, Burkina Faso.

    PubMed

    Flessa, Steffen; Kouyaté, Bocar

    2006-09-01

    To present first findings of a cost-of-illness (COI) information system implemented in Nouna health district, Burkina Faso. The entire project will include household and provider tangible COI, whereas this article concentrates on the development of a provider cost information system in rural first-line health facilities. Special forms and reports are prepared to routinely collect capital and recurrent costs of first-line facilities. Inventory lists are designed, and buildings and equipment are assessed by engineers. Total, fixed, variable and average costs are calculated for 15 rural health centres with five cost centres: general outpatient consultation, ambulatory nursing care, deliveries, immunization and other services (neonatal consultation, child care and family planning). In 2003, the average costs per service unit were 1.34 US$ for a general consultation, 0.51 US$ for ambulatory nursing care, 6.73 US$ per delivery, 3.64 US$ per vaccination and 1.11 US$ per service unit of other care. On average, a health centre consumes 29,900 US$ per year for a catchment population of 10,000 inhabitants. The major share of costs is fixed and does not depend on the workload of the health centre. Consequently, the costs of first-line facilities will hardly increase if the demand for health services rises. These findings can be used to improve the health financing in Nouna health district, Burkina Faso.

  20. 42 CFR 457.555 - Maximum allowable cost-sharing charges on targeted low-income children in families with income...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... requirements must be met: (1)(i) For Federal FY 2009, any co-payment or similar charge the State imposes under a fee-for-service delivery system may not exceed the amounts shown in the following table: State...) For Federal FY 2009, any co-payment that the State imposes for services provided by a managed care...

  1. 42 CFR 457.555 - Maximum allowable cost-sharing charges on targeted low-income children in families with income...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... requirements must be met: (1)(i) For Federal FY 2009, any co-payment or similar charge the State imposes under a fee-for-service delivery system may not exceed the amounts shown in the following table: State...) For Federal FY 2009, any co-payment that the State imposes for services provided by a managed care...

  2. A Dynamic Approach to Rebalancing Bike-Sharing Systems

    PubMed Central

    2018-01-01

    Bike-sharing services are flourishing in Smart Cities worldwide. They provide a low-cost and environment-friendly transportation alternative and help reduce traffic congestion. However, these new services are still under development, and several challenges need to be solved. A major problem is the management of rebalancing trucks in order to ensure that bikes and stalls in the docking stations are always available when needed, despite the fluctuations in the service demand. In this work, we propose a dynamic rebalancing strategy that exploits historical data to predict the network conditions and promptly act in case of necessity. We use Birth-Death Processes to model the stations’ occupancy and decide when to redistribute bikes, and graph theory to select the rebalancing path and the stations involved. We validate the proposed framework on the data provided by New York City’s bike-sharing system. The numerical simulations show that a dynamic strategy able to adapt to the fluctuating nature of the network outperforms rebalancing schemes based on a static schedule. PMID:29419771

  3. Benefit design innovations: implications for consumer-directed health care.

    PubMed

    Tu, Ha T; Ginsburg, Paul B

    2007-02-01

    Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rapidly rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a new study by the Center for Studying Health System Change (HSC). Innovative benefit designs include incentives to encourage healthy behaviors; incentives that vary by service type, patient condition or enrollee income; and incentives to use efficient providers. But most applications of these innovative designs are not widespread, suggesting that any significant cost impact is many years off. Moreover, regulations governing high-deductible, consumer-directed health plans eligible for health savings accounts (HSAs) preclude some promising benefit design innovations and dilute the incentives in others. A movement away from a one-size-fits-all HSA benefit structure toward a more flexible design might broaden the appeal of HSA plans and enable them to incorporate features that promote cost-effective care.

  4. [Methods and Applications to estimate the conversion factor of Resource-Based Relative Value Scale for nurse-midwife's delivery service in the national health insurance].

    PubMed

    Kim, Jinhyun; Jung, Yoomi

    2009-08-01

    This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

  5. Developing a PPO: challenges and benefits.

    PubMed

    Range, R P

    1984-12-01

    When deciding upon which kind of alternative delivery system to develop, Saint Vincent Charity Hospital and Health Center, Cleveland, selected the preferred provider organization (PPO) mode because of four basic advantages: (1) the health care consumer's freedom to choose providers; (2) effective cost containment; (3) coordination of services among allied providers; and (4) health promotion programs. More specifically, the Ohio Health Choice Plan (OHCP) benefits hospitals by assisting to maintain or increase market share, facilitating prompt claims payments, and improving financial mix. Physicians benefit not only because they receive prompt payment and are not a risk but also because the fee-for-service system is retained and their market shares can also be preserved or enhanced. Employers' advantages include savings through controlled utilization, positive employee relations, and improved management information. Employees' benefits include lower out-of-pocket costs and freedom of choice. As a full-service PPO, the organization provides benefits plans designed to meet each employer's needs as well as actuary services, claims screening and processing, benefits coordination, utilization control, management reporting, health promotion activities, and networking capabilities. Four major challenges do confront PPOs: 1. Start-up and operating costs can be significant; 2. The administrative skills required are different from those used in traditional health care systems; 3. The commitment in implementing and operating a PPO; and 4. All participating providers must genuinely accept the PPO. A PPO's success also can be measured in three ways: the development of a strong network; size of enrollment; and effectiveness in utilization control.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti

    PubMed Central

    Tilmans, Sebastien; Russel, Kory; Sklar, Rachel; Page, Leah; Kramer, Sasha

    2015-01-01

    Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible. This paper presents the results of a pilot household CBS service in Cap Haitien, Haiti. We quantify the excreta generated weekly in a dense urban slum,(1) the proportion safely removed via container-based public and household toilets, and the costs associated with these systems. The CBS service yielded an approximately 3.5-fold decrease in the unmanaged share of faeces produced, and nearly eliminated the reported use of open defecation and “flying toilets” among service recipients. The costs of this pilot small-scale service were higher than those of large-scale waterborne sewerage, but economies of scale have the potential to reduce CBS costs over time. The paper concludes with a discussion of planning and policy implications of incorporating CBS into the menu of sanitation options for rapidly growing cities. PMID:26097288

  7. Achieving regional fare integration in New Orleans: innovative cost sharing arrangements and technologies.

    DOT National Transportation Integrated Search

    2015-09-01

    Many regions across the country have more than one transit agency providing vital public transportation : services. While a transit agency may see their role limited by a jurisdictional boundary, transit riders : commutes know no such political bo...

  8. Guidelines for Outsourcing Remote Access.

    ERIC Educational Resources Information Center

    Hassler, Ardoth; Neuman, Michael

    1996-01-01

    Discusses the advantages and disadvantages of outsourcing remote access to campus computer networks and the Internet, focusing on improved service, cost-sharing, partnerships with vendors, supported protocols, bandwidth, scope of access, implementation, support, network security, and pricing. Includes a checklist for a request for proposals on…

  9. 7 CFR 636.9 - Cost-share agreements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... of one year after the completion of conservation practices identified in the WPO and a maximum of 10... and maintenance for each conservation practice and the Agency expectation that WHIP-funded...

  10. Chicago to Iowa City intercity passenger rail route : business plan.

    DOT National Transportation Integrated Search

    2011-03-21

    This business plan describes the methods by which the Iowa Department of Transportation (DOT will partner with Iowa counties and cities to fund Iowas share of the operating and maintenance cost for the Chicago-Iowa City passenger-rail service, an ...

  11. Immigration and health care reform: shared struggles.

    PubMed

    Gardner, Deborah B

    2007-01-01

    The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.

  12. Reference Pricing Changes The 'Choice Architecture' Of Health Care For Consumers.

    PubMed

    Robinson, James C; Brown, Timothy T; Whaley, Christopher

    2017-03-01

    Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are selected. The short-term impact of reference pricing has been to shift patient volumes from hospital-based to freestanding surgical, diagnostic, imaging, and laboratory facilities. This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. We conclude with a discussion of the incentives created for providers to redesign their clinical processes and for efficient providers to expand into price-sensitive markets. Over time, reference pricing may increase pressures for price competition and lead to further cost-reducing innovations in health care products and processes. Project HOPE—The People-to-People Health Foundation, Inc.

  13. Household food waste collection: Building service networks through neighborhood expansion.

    PubMed

    Armington, William R; Chen, Roger B

    2018-04-17

    In this paper we develop a residential food waste collection analysis and modeling framework that captures transportation costs faced by service providers in their initial stages of service provision. With this framework and model, we gain insights into network transportation costs and investigate possible service expansion scenarios faced by these organizations. We solve a vehicle routing problem (VRP) formulated for the residential neighborhood context using a heuristic approach developed. The scenarios considered follow a narrative where service providers start with an initial neighborhood or community and expands to incorporate other communities and their households. The results indicate that increasing household participation, decreases the travel time and cost per household, up to a critical threshold, beyond which we see marginal time and cost improvements. Additionally, the results indicate different outcomes in expansion scenarios depending on the household density of incorporated neighborhoods. As household participation and density increases, the travel time per household in the network decreases. However, at approximately 10-20 households per km 2 , the decrease in travel time per household is marginal, suggesting a lowerbound household density threshold. Finally, we show in food waste collection, networks share common scaling effects with respect to travel time and costs, regardless of the number of nodes and links. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Indirect medical education and disproportionate share adjustments to Medicare inpatient payment rates.

    PubMed

    Nguyen, Nguyen Xuan; Sheingold, Steven H

    2011-11-04

    The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare's prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations. These adjustments were originally established based on the statistical relationships between IME and DSH and hospital costs. Due to a variety of policy considerations, the legislated levels of these adjustments may have deviated over time from these "empirically justified levels," or simply, "empirical levels." In this paper, we estimate the empirical levels of IME and DSH using 2006 hospital data and 2009 Medicare final payment rules. Our analyses suggest that the empirical level for IME would be much smaller than under current law-about one-third to one-half. Our analyses also support the DSH adjustment prescribed by the Affordable Care Act of 2010 (ACA)--about one-quarter of the pre-ACA level. For IME, the estimates imply an increase in costs of 1.88% for each 10% increase in teaching intensity. For DSH, the estimates imply that costs would rise by 0.52% for each 10% increase in the low-income patient share for large urban hospitals. Public Domain.

  15. Partitioning Stakeholders for the Economic Valuation of Ecosystem Services: Examples of a Mangrove System

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

    Micheletti, Tatiane, E-mail: micheletti@forst.tu-dresden.de; Jost, François; Berger, Uta

    Although the importance of ecosystem services provided by natural forests, especially mangroves, is well known, the destruction of these environments is still ubiquitous and therefore protection measures are urgently needed. The present study compares the current approach of economic valuation of ecosystem services to a proposed one, using a study case of a mangrove system as an example. We suggest that a cost-benefit analysis for economically valuing environmental services should be performed with three additional modifications consisting of (i) a categorization of local stakeholders as demanders of particular ecosystem services, (ii) acknowledgement of the government as one of these demandermore » groups, and (iii) the inclusion of opportunity costs in the valuation. The application of this approach to the mangrove area in the east portion of Great Abaco Island, the Bahamas, reveals that not only the ecosystem services received differ between demander groups, but the monetary benefits and costs are also specific to each of these groups. We show that the economic valuation of the ecosystem should be differentiated for each category, instead of being calculated as a net ‘societal value’ as it is currently. Applying this categorization of demanders enables a better understanding of the cost and benefit structure of the protection of a natural area. The present paper aims to facilitate discussions regarding benefit and cost sharing related to the protection of natural areas.« less

  16. Housing Options for Older Adults: A Guide for Making Housing Decisions

    MedlinePlus

    ... from house sharing may have on eligibility for public benefits. ■ The effect of receiving Medicaid services on the ... facilities and whether the facility accepts individuals whose costs are paid by Medicaid. Benefits: Group housing options offer a wide range of ...

  17. 45 CFR 98.42 - Sliding fee scales.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... provides for cost sharing by families that receive CCDF child care services. (b) A sliding fee scale(s) shall be based on income and the size of the family and may be based on other factors as appropriate. (c... a family of the same size. ...

  18. An Ongoing Revolution: Resource Sharing and OCLC.

    ERIC Educational Resources Information Center

    Nevins, Kate

    1998-01-01

    Discusses early developments in the Online Computer Library Center (OCLC) interlibrary loan, including use of OCLC for verification and request transmittal, improved service to patrons, internal cost control, affect on work flow and borrowing patterns. Describes advances in OCLC, including internationalization, electronic information access,…

  19. 42 CFR 412.312 - Payment based on the Federal rate.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... disproportionate share adjustment factor + capital indirect medical education adjustment factor)×(for hospitals... to furnishing services to low income patients. (4) Indirect medical education adjustment. An... hospital to account for the indirect costs of medical education. (c) Additional payment for outlier cases...

  20. 7 CFR 636.9 - Cost-share agreements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... a minimum duration of one year after the completion of conservation activities identified in the... O&M agreement that describes the O&M for each conservation activity and the agency expectation that...

  1. 7 CFR 636.9 - Cost-share agreements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... a minimum duration of one year after the completion of conservation activities identified in the... O&M agreement that describes the O&M for each conservation activity and the agency expectation that...

  2. 7 CFR 636.9 - Cost-share agreements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... a minimum duration of one year after the completion of conservation activities identified in the... O&M agreement that describes the O&M for each conservation activity and the agency expectation that...

  3. 7 CFR 636.9 - Cost-share agreements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... a minimum duration of one year after the completion of conservation activities identified in the... O&M agreement that describes the O&M for each conservation activity and the agency expectation that...

  4. 7 CFR 623.12 - Payments to landowners by NRCS.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE... payments may be authorized for the replacement or restoration of practices for which cost share assistance has been previously allowed under the EWRP, but only if: (1) Replacement or restoration of the...

  5. Shared Services and Cooperatives; Schools Combine Resources to Improve Education.

    ERIC Educational Resources Information Center

    National School Public Relations Association, Washington, DC.

    Small school districts and other agencies are turning in increasing numbers to cooperative programs to provide better inservice teacher training; more vocational experiences for students; more qualified counselors and specialists; more audiovisual materials; low-cost teacher recruitment; increased science, foreign language, and mathematics…

  6. The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network.

    PubMed

    Fuentes-Alabi, Soad; Bhakta, Nickhill; Vasquez, Roberto Franklin; Gupta, Sumit; Horton, Susan E

    2018-01-15

    Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness. Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates. The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective. Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

  7. Assessing administrative costs of mental health and substance abuse services.

    PubMed

    Broyles, Robert W; Narine, Lutchmie; Robertson, Madeline J

    2004-05-01

    Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.

  8. Cost of schizophrenia in the Medicare program.

    PubMed

    Feldman, Rachel; Bailey, Robert A; Muller, James; Le, Jennifer; Dirani, Riad

    2014-06-01

    Medicare beneficiaries diagnosed with non-schizoaffective schizophrenia (MBS) in a 5% national Medicare fee-for-service sample from 2003-2007 were followed for 1-6 years. Medicare population and cost estimates also were made from 2001-2009. Service utilization and Medicare (and beneficiary share) payments for all services except prescription drugs were analyzed. Although adults with schizophrenia make up approximately 1% of the US adult population, they represent about 1.5% of Medicare beneficiaries. MBSs are disproportionately male and minority compared to national data describing the overall schizophrenia population. They also are younger than the general Medicare population (GMB): males are 9 years younger than females on average, and most enter Medicare long before age 65 through eligibility for social security disability, remaining in the program until death. The cost of care for MBSs in 2009 was, on average, 80% higher than for the average GMB per patient year (2010 dollars), and more than 50% of these costs are attributable to a combination of psychiatric and medical hospitalizations, concentrated in about 30% of MBSs with 1 or more hospitalizations per year. From 2004-2009, total estimated Medicare fee-for-service payments for MBSs increased from $9.4 billion to $11.5 billion, excluding Part D prescription drugs and payments for services to MBSs in Medicare for less than 1 year. Study results characterize utilization and costs for other services and suggest opportunities for further study to inform policy to improve access and continuity of care and decrease costs to the Medicare program associated with this population.

  9. U.S. Army Central did not Implement Controls to Effectively Manage the Shared Cost of Administrative Support Functions in Iraq

    DTIC Science & Technology

    2016-02-17

    diverse organization, working together as one professional team, recognized as leaders in our field. For more information about whistleblower protection...Administrative Support Services SOP Standard Operating Procedures SoS Subscription of Services Whistleblower Protection U.S. Department of Defense The... Whistleblower Protection Enhancement Act of 2012 requires the Inspector General to designate a Whistleblower Protection Ombudsman to educate agency

  10. Consumption and costs of antihypertensive drugs in Mexico: are diuretic agents a standing technological trajectory?

    PubMed

    Altagracia-Martínez, M; Kravzov-Jinich, J; Guadarrama-Atrizco, M D; Rubio-Poo, C; Wertheimer, A I

    2006-03-01

    Little is known about hypertension medication consumption and costs in Mexico. Hypertension control is a pharmacological challenge and a public health issue. (a) To compare drug sales, number of written prescriptions, and monthly treatment costs among 5 classes of antihypertensive drugs and (b) to analyze diuretic drug sales and prescriptions to determine whether these antihypertensive agents represent an established technological trajectory. A retrospective time series data study from 1999 to 2003. Data sources used were International Marketing Services of Mexico drug sales and the Mexico Prescription Audit databases. The 5 different classes of antihypertensive drugs were accommodated into 4 main technological trajectories according to their main biological mechanisms of action. Each technological trajectory was assessed using consumption and prescription data. Daily defined dose was used to calculate drug treatment costs. The market for cardiovascular agents is one of the largest, and in 2003 accounted for a value market share of 59 billion US dollar and a unit share of 40.7 million. Among cardiovascular agents, antihypertensive drugs made up a large percentage of market shares. Calcium channel blockers and angiotensin-converting enzyme inhibitors I had the biggest share value of the total cardiovascular market. Amlodipine had the highest share among calcium channel blockers, and enalapril and captopril had the largest share among angiotensin-converting enzyme inhibitors I. The top-selling diuretic drug was furosemide. The trend in number of prescriptions was parallel to that in sales. The diuretic spironolactone was the most expensive drug treatment (59 US dollar). Treatment with spironolactone might represent 47% of the income of a Mexican family if their household income was close to minimum wage (124 US dollar). The most effective and least expensive drugs-diuretics-had the smallest market share of all antihypertensive agents in Mexico. Nevertheless, diuretic agents are still in use and kept over time a steady market share both in value and in units.

  11. Health benefits in 2003: premiums reach thirteen-year high as employers adopt new forms of cost sharing.

    PubMed

    Gabel, Jon; Claxton, Gary; Holve, Erin; Pickreign, Jeremy; Whitmore, Heidi; Dhont, Kelley; Hawkins, Samantha; Rowland, Diane

    2003-01-01

    This paper reports changes in job-based health insurance from spring 2002 to spring 2003. The cost of health insurance rose 13.9 percent, the highest rate of increase since 1990. Employers required larger contributions from employees for the monthly cost of health insurance. Separate copayments and deductibles for hospital services have become commonplace, and provider networks have broadened. There was no change in the percentage of employers offering health plans to their workers. Employers indicate little confidence in any future strategies for controlling health care costs.

  12. Is shared care with annual hospital review better value for money than predominantly hospital‐based care in patients with established stable rheumatoid arthritis?

    PubMed Central

    Davies, Linda Mary; Fargher, Emily Anne; Tricker, Karen; Dawes, Peter; Scott, David L; Symmons, Deborah

    2007-01-01

    Objective To assess the cost effectiveness and cost effectiveness acceptability of symptom control delivered by shared care (SCSC) and aggressive treatment delivered in hospital (ATH) for established rheumatoid arthritis (RA). Methods Economic data were collected within the British Rheumatoid Outcome Study Group randomised controlled trial of SCSC and ATH. A broad perspective was used (UK National Health Service, social support services and patients). Cost per quality adjusted life year (QALY) gained, net benefit statistics and cost effectiveness acceptability curves were estimated. Costs and outcomes were discounted at 3.5%. Sensitivity analysis tested the robustness of the results to analytical assumptions. Results The mean (SD) cost per person was £4540 (4700) in the SCSC group and £4440 (4900) in the ATH group. The mean (SD) QALYs per person for 3 years were 1.67 (0.56) in the SCSC group and 1.60 (0.60) in the ATH group. If decision makers are prepared to pay ⩾£2000 to gain 1 QALY, SCSC is likely to be cost effective in 60–90% of cases. Conclusions The primary economic analysis and sensitivity analyses indicate that SCSC is likely to be more cost effective than ATH in 60–90% of cases. This result seems to be robust to assumptions required by the analysis. This study is one of a limited number of randomised controlled trials to collect detailed resource use and health status data and estimate the costs and QALYs of treatment for established RA. This trial is one of the largest RA studies to use the EuroQol. PMID:17124249

  13. A Cost-Effectiveness Analysis of Seminatural Wetlands and Activated Sludge Wastewater-Treatment Systems

    NASA Astrophysics Data System (ADS)

    Mannino, Ilda; Franco, Daniel; Piccioni, Enrico; Favero, Laura; Mattiuzzo, Erika; Zanetto, Gabriele

    2008-01-01

    A cost-effectiveness analysis was performed to evaluate the competitiveness of seminatural Free Water Surface (FWS) wetlands compared to traditional wastewater-treatment plants. Six scenarios of the service costs of three FWS wetlands and three different wastewater-treatment plants based on active sludge processes were compared. The six scenarios were all equally effective in their wastewater-treatment capacity. The service costs were estimated using real accounting data from an experimental wetland and by means of a market survey. Some assumptions had to be made to perform the analysis. A reference wastewater situation was established to solve the problem of the different levels of dilution that characterize the inflow water of the different systems; the land purchase cost was excluded from the analysis, considering the use of public land as shared social services, and an equal life span for both seminatural and traditional wastewater-treatment plants was set. The results suggest that seminatural systems are competitive with traditional biotechnological systems, with an average service cost improvement of 2.1-fold to 8-fold, according to the specific solution and discount rate. The main improvement factor was the lower maintenance cost of the seminatural systems, due to the self-regulating, low artificial energy inputs and the absence of waste to be disposed. In this work, only the waste-treatment capacity of wetlands was considered as a parameter for the economic competitiveness analysis. Other goods/services and environmental benefits provided by FWS wetlands were not considered.

  14. A cost-effectiveness analysis of seminatural wetlands and activated sludge wastewater-treatment systems.

    PubMed

    Mannino, Ilda; Franco, Daniel; Piccioni, Enrico; Favero, Laura; Mattiuzzo, Erika; Zanetto, Gabriele

    2008-01-01

    A cost-effectiveness analysis was performed to evaluate the competitiveness of seminatural Free Water Surface (FWS) wetlands compared to traditional wastewater-treatment plants. Six scenarios of the service costs of three FWS wetlands and three different wastewater-treatment plants based on active sludge processes were compared. The six scenarios were all equally effective in their wastewater-treatment capacity. The service costs were estimated using real accounting data from an experimental wetland and by means of a market survey. Some assumptions had to be made to perform the analysis. A reference wastewater situation was established to solve the problem of the different levels of dilution that characterize the inflow water of the different systems; the land purchase cost was excluded from the analysis, considering the use of public land as shared social services, and an equal life span for both seminatural and traditional wastewater-treatment plants was set. The results suggest that seminatural systems are competitive with traditional biotechnological systems, with an average service cost improvement of 2.1-fold to 8-fold, according to the specific solution and discount rate. The main improvement factor was the lower maintenance cost of the seminatural systems, due to the self-regulating, low artificial energy inputs and the absence of waste to be disposed. In this work, only the waste-treatment capacity of wetlands was considered as a parameter for the economic competitiveness analysis. Other goods/services and environmental benefits provided by FWS wetlands were not considered.

  15. Cost Analysis in a Multi-Mission Operations Environment

    NASA Technical Reports Server (NTRS)

    Felton, Larry; Newhouse, Marilyn; Bornas, Nick; Botts, Dennis; Ijames, Gayleen; Montgomery, Patty; Roth, Karl

    2014-01-01

    Spacecraft control centers have evolved from dedicated, single-mission or single mission-type support to multi-mission, service-oriented support for operating a variety of mission types. At the same time, available money for projects is shrinking and competition for new missions is increasing. These factors drive the need for an accurate and flexible model to support estimating service costs for new or extended missions; the cost model in turn drives the need for an accurate and efficient approach to service cost analysis. The National Aeronautics and Space Administration (NASA) Huntsville Operations Support Center (HOSC) at Marshall Space Flight Center (MSFC) provides operations services to a variety of customers around the world. HOSC customers range from launch vehicle test flights; to International Space Station (ISS) payloads; to small, short duration missions; and has included long duration flagship missions. The HOSC recently completed a detailed analysis of service costs as part of the development of a complete service cost model. The cost analysis process required the team to address a number of issues. One of the primary issues involves the difficulty of reverse engineering individual mission costs in a highly efficient multi-mission environment, along with a related issue of the value of detailed metrics or data to the cost model versus the cost of obtaining accurate data. Another concern is the difficulty of balancing costs between missions of different types and size and extrapolating costs to different mission types. The cost analysis also had to address issues relating to providing shared, cloud-like services in a government environment, and then assigning an uncertainty or risk factor to cost estimates that are based on current technology, but will be executed using future technology. Finally the cost analysis needed to consider how to validate the resulting cost models taking into account the non-homogeneous nature of the available cost data and the decreasing flight rate. This paper presents the issues encountered during the HOSC cost analysis process, and the associated lessons learned. These lessons can be used when planning for a new multi-mission operations center or in the transformation from a dedicated control center to multi-center operations, as an aid in defining processes that support future cost analysis and estimation. The lessons can also be used by mature service-oriented, multi-mission control centers to streamline or refine their cost analysis process.

  16. Current and future industrial energy service characterizations. Volume III. Energy data on 15 selected states' manufacturing subsector

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

    Krawiec, F.; Thomas, T.; Jackson, F.

    1980-11-01

    An examination is made of the current and future energy demands, and uses, and cost to characterize typical applications and resulting services in the US and industrial sectors of 15 selected states. Volume III presents tables containing data on selected states' manufacturing subsector energy consumption, functional uses, and cost in 1974 and 1976. Alabama, California, Illinois, Indiana, Louisiana, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, West Virginia, and Wisconsin were chosen as having the greatest potential for replacing conventional fuel with solar energy. Basic data on the quantities, cost, and types of fuel and electric energy purchasedmore » by industr for heat and power were obtained from the 1974 and 1976 Annual Survey of Manufacturers. The specific indutrial energy servic cracteristics developed for each selected state include. 1974 and 1976 manufacturing subsector fuels and electricity consumption by 2-, 3-, and 4-digit SIC and primary fuel (quantity and relative share); 1974 and 1976 manufacturing subsector fuel consumption by 2-, 3-, and 4-digit SIC and primary fuel (quantity and relative share); 1974 and 1976 manufacturing subsector average cost of purchsed fuels and electricity per million Btu by 2-, 3-, and 4-digit SIC and primary fuel (in 1976 dollars); 1974 and 1976 manufacturing subsector fuels and electric energy intensity by 2-, 3-, and 4-digit SIC and primary fuel (in 1976 dollars); manufacturing subsector average annual growth rates of (1) fuels and electricity consumption, (2) fuels and electric energy intensity, and (3) average cost of purchased fuels and electricity (1974 to 1976). Data are compiled on purchased fuels, distillate fuel oil, residual ful oil, coal, coal, and breeze, and natural gas. (MCW)« less

  17. The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies.

    PubMed

    Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J; Brenzel, Logan; Resch, Stephen C

    2017-10-06

    Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. We developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume. Across countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely-on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0-32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product. We identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.

  18. Medicare payment reform and provider entry and exit in the post-acute care market.

    PubMed

    Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

    2013-10-01

    To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

  19. Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

    PubMed Central

    Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

    2013-01-01

    Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

  20. Navy Littoral Combat Ship (LCS) Program: Background, Issues, and Options for Congress

    DTIC Science & Technology

    2011-01-20

    response, including the time for reviewing instructions, searching existing data sources , gathering and maintaining the data needed, and completing and...Congressional Research Service 3 Figure 1. Lockheed LCS Design (Top) and General Dynamics LCS Design (Bottom) Source : Source : U.S. Navy file photo...according to an agreed apportionment (i.e., a “share line”). Any cost growth above the ceiling cost would be borne entirely by the contractor. The Navy

  1. 7 CFR 625.15 - Violations and remedies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE... listed species and forest ecosystem functions and values or other rights of the United States under the..., NRCS may withhold any easement and cost-share payments owing to landowners at any time there is a...

  2. 7 CFR 636.13 - Violations and remedies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Violations and remedies. 636.13 Section 636.13 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE... remedies. (a) If NRCS determines that a participant is in violation of a cost-share agreement, NRCS will...

  3. 7 CFR 636.13 - Violations and remedies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Violations and remedies. 636.13 Section 636.13 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE... remedies. (a) If NRCS determines that a participant is in violation of a cost-share agreement, NRCS shall...

  4. CD-ROM + Fax = Shared Reference Resources.

    ERIC Educational Resources Information Center

    Fitzwater, Diana; Fradkin, Bernard

    1988-01-01

    Describes the Reference by GammaFax Project, which joined nine area libraries to provide cooperative reference access to optical disk databases. The configuration of disk players, microcomputers, and facsimile equipment used by the libraries is explained, and the improvements in cost effectiveness, provision of service, and librarian expertise are…

  5. 75 FR 67227 - Relocation Cost Sharing in the Broadcast Auxiliary Service

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-02

    ... relocating parties. In the process, the Commission balances the responsibilities for and benefits of... well as to balance the responsibilities for and benefits of relocating incumbent BAS operations among... adhere closely to these time-tested principles to balance the interest of incumbent licensees, new...

  6. 45 CFR 147.130 - Coverage of preventive health services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... visiting the provider, the individual is screened for cholesterol abnormalities, which has in effect a... the cholesterol screening test. (ii) Conclusion. In this Example 1, the plan may not impose any cost-sharing requirements with respect to the separately-billed laboratory work of the cholesterol screening...

  7. 45 CFR 147.130 - Coverage of preventive health services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... visiting the provider, the individual is screened for cholesterol abnormalities, which has in effect a... the cholesterol screening test. (ii) Conclusion. In this Example 1, the plan may not impose any cost-sharing requirements with respect to the separately-billed laboratory work of the cholesterol screening...

  8. Advanced information society (1)

    NASA Astrophysics Data System (ADS)

    Ohira, Gosei

    In considering the relationship of informationization and industrial structure, this paper analize some factors such as information revolution, informationization of industries and industrialization of information as background of informationization of Japanese society. Next, some information indicators such as, information coefficient of household which is a share of information related expenditure, information coefficient of industry which is a share of information related cost to total cost of production, and information transmission census developed by Ministry of Post and Telecommunication are introduced. Then new information indicator by Economic Planning Agency, that is, electronic info-communication indicator is showed. In this study, the information activities are defined to produce message or to supply services on process, stores or sale of message using electronic information equipment. International comparisons of information labor force are also presented.

  9. Employer-sponsored health insurance in New York: findings from the 2003 Commonwealth Fund/HRET survey.

    PubMed

    Edwards, Jennifer N; How, Sabrina; Whitmore, Heidi; Gabel, Jon R; Hawkins, Samantha; Pickreign, Jeremy D

    2004-05-01

    A 2003 Commonwealth Fund/Health Research and Educational Trust survey of 576 New York State firms found that, in order to manage rising health costs, employers are increasing the share of the insurance premium that employees pay, delaying the start of benefits, and increasing cost-sharing at the point of service. This has enabled employers to preserve health benefits, but has raised costs for workers and their families. On average, workers' contributions for family coverage rose 54 percent, from $1,392 per year in 2001 to $2,148 per year in 2003. During that time period, fewer workers selected family coverage. Employers are receptive to a wide range of approaches to make coverage more available and affordable for their employees, but they have limited familiarity with public programs that could cover their lower-wage workers, such as Healthy New York, Family Health Plus, or Child Health Plus.

  10. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities.

    PubMed

    Clancy, Gerard P

    2015-12-01

    Academic medical centers (AMCs) and universities are experiencing increasing pressure to enhance the value they offer at the same time that they are facing challenges related to outcomes, controlling costs, new competition, and government mandates. Yet, rarely do the leaders of these academic neighbors work cooperatively to enhance value. In this Perspective the author, a former university regional campus president with duties in an AMC as an academic physician, shares his insights into the shared challenges these academic neighbors face in improving the value of their services in complex environments. He describes the successes some AMCs have had in generating revenues from new clinical programs that reduce the overall cost of care for larger populations. He also describes how several universities have taken a comprehensive approach to reduce overhead and administrative costs. The author identifies six themes related to successful value improvement efforts and provides examples of successful strategies used by AMCs and their university neighbors to improve the overall value of their programs. He concludes by encouraging leaders of AMCs and universities to share information about their successes in value improvements with each other, to seek additional joint value enhancement efforts, and to market their value improvements to the public.

  11. Radiologic image communication and archive service: a secure, scalable, shared approach

    NASA Astrophysics Data System (ADS)

    Fellingham, Linda L.; Kohli, Jagdish C.

    1995-11-01

    The Radiologic Image Communication and Archive (RICA) service is designed to provide a shared archive for medical images to the widest possible audience of customers. Images are acquired from a number of different modalities, each available from many different vendors. Images are acquired digitally from those modalities which support direct digital output and by digitizing films for projection x-ray exams. The RICA Central Archive receives standard DICOM 3.0 messages and data streams from the medical imaging devices at customer institutions over the public telecommunication network. RICA represents a completely scalable resource. The user pays only for what he is using today with the full assurance that as the volume of image data that he wishes to send to the archive increases, the capacity will be there to accept it. To provide this seamless scalability imposes several requirements on the RICA architecture: (1) RICA must support the full array of transport services. (2) The Archive Interface must scale cost-effectively to support local networks that range from the very small (one x-ray digitizer in a medical clinic) to the very large and complex (a large hospital with several CTs, MRs, Nuclear medicine devices, ultrasound machines, CRs, and x-ray digitizers). (3) The Archive Server must scale cost-effectively to support rapidly increasing demands for service providing storage for and access to millions of patients and hundreds of millions of images. The architecture must support the incorporation of improved technology as it becomes available to maintain performance and remain cost-effective as demand rises.

  12. Specialty service contracting.

    PubMed

    Malcolm, C L; Fukui, M

    1993-01-01

    Package pricing of specific services and procedures can be an effective cost-containment and marketing tool for payers and providers. Payers can secure fixed prices at discounted rates, and hospitals and physicians can retain and gain market share in an increasingly competitive health care market. Successful implementation of a package pricing strategy, however, requires a careful assessment of both market and operational factors. This chapter outlines how to identify opportunities for package pricing and how to establish rates and procedures.

  13. Aligning with physicians to regionalize services.

    PubMed

    Fink, John

    2014-11-01

    When effectively designed and implemented, regionalization allows a health system to coordinate care, eliminate redundancies, reduce costs, optimize resource utilization, and improve outcomes. The preferred model to manage service lines regionally will depend on each facility's capabilities and the willingness of physicians to accept changes in clinical delivery. Health systems can overcome physicians' objections to regionalization by implementing a hospital-physician alignment structure that gives a measure of shared control in the management of the organization.

  14. 14 CFR 1260.54 - Cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... cash and non-cash contributions shall be governed by § 1260.123, Cost Sharing or Matching. The... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Cost sharing. 1260.54 Section 1260.54... Special Conditions § 1260.54 Cost sharing. Cost Sharing October 2000 (a) NASA and the Recipient will share...

  15. 47 CFR 27.1184 - Triggering a reimbursement obligation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES 1710-1755 MHz, 2110-2155 MHz, 2160-2180 MHz Bands Cost-Sharing... a fixed base station at commercial power and the incumbent BRS system would have been within the... the 2150-2160/62 MHz band exclusively to provide one-way transmissions to subscribers, the...

  16. Collaboration, Technology, and Outsourcing Initiatives in Higher Education: A Literature Review.

    ERIC Educational Resources Information Center

    Kaganoff, Tessa

    This report presents a sector-wide review of three types of cost-containment initiatives. The first, collaboration, allows for the sharing of resources, facilitates joint purchasing agreements, reduces duplication of services, and expands personal and professional contacts, but requires time to develop institutional relationships. The second,…

  17. Navigating the Challenges of the Cloud

    ERIC Educational Resources Information Center

    Ovadia, Steven

    2010-01-01

    Cloud computing is increasingly popular in education. Cloud computing is "the delivery of computer services from vast warehouses of shared machines that enables companies and individuals to cut costs by handing over the running of their email, customer databases or accounting software to someone else, and then accessing it over the internet."…

  18. 33 CFR 241.3 - References.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Information Services, 5285 Port Royal Road, Springfield, VA 22161. References (a), (b) and (c) may be reviewed... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false References. 241.3 Section 241.3... CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.3 References. References cited...

  19. Integrated Bibliographic Information System: Integrating Resources by Integrating Information Technologies.

    ERIC Educational Resources Information Center

    Cotter, Gladys A.; Hartt, Richard W.

    The Defense Technical Information Center (DTIC), an organization charged with providing information services to the Department of Defense (DoD) scientific and technical community, actively seeks ways to promote resource sharing as a means for speeding access to information while reducing the costs of information processing throughout the technical…

  20. 50 CFR 80.84 - How does the Service establish the non-Federal share of allowable costs?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON... for the Commonwealth of the Northern Mariana Islands and the territories of Guam, the U.S. Virgin Islands, and American Samoa, the Regional Director must first calculate a preliminary percentage of non...

  1. 50 CFR 80.84 - How does the Service establish the non-Federal share of allowable costs?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON... for the Commonwealth of the Northern Mariana Islands and the territories of Guam, the U.S. Virgin Islands, and American Samoa, the Regional Director must first calculate a preliminary percentage of non...

  2. 50 CFR 80.84 - How does the Service establish the non-Federal share of allowable costs?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON... for the Commonwealth of the Northern Mariana Islands and the territories of Guam, the U.S. Virgin Islands, and American Samoa, the Regional Director must first calculate a preliminary percentage of non...

  3. 50 CFR 80.84 - How does the Service establish the non-Federal share of allowable costs?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON... for the Commonwealth of the Northern Mariana Islands and the territories of Guam, the U.S. Virgin Islands, and American Samoa, the Regional Director must first calculate a preliminary percentage of non...

  4. Tips and Tools for Creating eNewsletters

    ERIC Educational Resources Information Center

    Walker, Tim

    2006-01-01

    An electronic newsletter, or "eNewsletter" for short, is a cost-effective informational publication typically distributed weekly or monthly using e-mail. If properly implemented, it can become an effective customer service tool, providing an opportunity to share information with children, parents, and families. It can also serve as a powerful…

  5. Making Knowledge Services Work in Higher Education

    ERIC Educational Resources Information Center

    Norris, Donald M.; Lefrere, Paul; Mason, Jon

    2006-01-01

    Over the past three years, knowledge-based practices in higher education have advanced, driving the development of low/no-cost, mass-market tools for knowledge sharing and reducing some barriers to change. New investors in higher education are developing strategies to exploit the knowledge-driven value propositions. Existing institutions, anxious…

  6. 78 FR 21633 - International Mail Product

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... of United States Postal Service Filing of a Functionally Equivalent International Business Reply...); Attachment 3--a copy of Governors' Decision No. 08-24; and Attachment 4--an application for non-public... equivalent to the baseline agreement filed in Docket No. CP2011-59 because it shares similar cost and market...

  7. 78 FR 21632 - International Mail Product

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... of United States Postal Service Filing of a Functionally Equivalent International Business Reply...' Decision No. 08-24; and Attachment 4--an application for non-public treatment of materials filed under seal... equivalent to the baseline agreement filed in Docket No. CP2011-59 because it shares similar cost and market...

  8. 26 CFR 54.9815-2713T - Coverage of preventive health services (temporary).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... visiting the provider, the individual is screened for cholesterol abnormalities, which has in effect a... the cholesterol screening test. (ii) Conclusion. In this Example 1, the plan may not impose any cost-sharing requirements with respect to the separately-billed laboratory work of the cholesterol screening...

  9. 26 CFR 54.9815-2713T - Coverage of preventive health services (temporary).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... visiting the provider, the individual is screened for cholesterol abnormalities, which has in effect a... the cholesterol screening test. (ii) Conclusion. In this Example 1, the plan may not impose any cost-sharing requirements with respect to the separately-billed laboratory work of the cholesterol screening...

  10. 20 CFR 416.1133 - What is a pro rata share of household operating expenses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

  11. 20 CFR 416.1133 - What is a pro rata share of household operating expenses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

  12. 20 CFR 416.1133 - What is a pro rata share of household operating expenses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

  13. 20 CFR 416.1133 - What is a pro rata share of household operating expenses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

  14. 34 CFR 461.41 - What are the cost-sharing requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION STATE-ADMINISTERED BASIC GRANT..., services, and activities of adult education, as defined in the Act, made by public or private entities that receive from the State Federal funds made available under the Act or State funds for adult education; and...

  15. 34 CFR 461.41 - What are the cost-sharing requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION STATE-ADMINISTERED BASIC GRANT..., services, and activities of adult education, as defined in the Act, made by public or private entities that receive from the State Federal funds made available under the Act or State funds for adult education; and...

  16. 34 CFR 461.41 - What are the cost-sharing requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION STATE-ADMINISTERED BASIC GRANT..., services, and activities of adult education, as defined in the Act, made by public or private entities that receive from the State Federal funds made available under the Act or State funds for adult education; and...

  17. 34 CFR 461.41 - What are the cost-sharing requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION STATE-ADMINISTERED BASIC GRANT..., services, and activities of adult education, as defined in the Act, made by public or private entities that receive from the State Federal funds made available under the Act or State funds for adult education; and...

  18. 34 CFR 461.41 - What are the cost-sharing requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... VOCATIONAL AND ADULT EDUCATION, DEPARTMENT OF EDUCATION ADULT EDUCATION STATE-ADMINISTERED BASIC GRANT..., services, and activities of adult education, as defined in the Act, made by public or private entities that receive from the State Federal funds made available under the Act or State funds for adult education; and...

  19. 36 CFR 230.6 - Project costs and cost share requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Project costs and cost share... Project costs and cost share requirements. (a) The CFP Federal contribution cannot exceed 50 percent of the total project costs. (b) Allowable project and cost share costs will include the purchase price...

  20. 36 CFR 230.6 - Project costs and cost share requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Project costs and cost share... Project costs and cost share requirements. (a) The CFP Federal contribution cannot exceed 50 percent of the total project costs. (b) Allowable project and cost share costs will include the purchase price...

  1. 36 CFR 230.6 - Project costs and cost share requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Project costs and cost share... Project costs and cost share requirements. (a) The CFP Federal contribution cannot exceed 50 percent of the total project costs. (b) Allowable project and cost share costs will include the purchase price...

  2. Cost Analysis In A Multi-Mission Operations Environment

    NASA Technical Reports Server (NTRS)

    Newhouse, M.; Felton, L.; Bornas, N.; Botts, D.; Roth, K.; Ijames, G.; Montgomery, P.

    2014-01-01

    Spacecraft control centers have evolved from dedicated, single-mission or single missiontype support to multi-mission, service-oriented support for operating a variety of mission types. At the same time, available money for projects is shrinking and competition for new missions is increasing. These factors drive the need for an accurate and flexible model to support estimating service costs for new or extended missions; the cost model in turn drives the need for an accurate and efficient approach to service cost analysis. The National Aeronautics and Space Administration (NASA) Huntsville Operations Support Center (HOSC) at Marshall Space Flight Center (MSFC) provides operations services to a variety of customers around the world. HOSC customers range from launch vehicle test flights; to International Space Station (ISS) payloads; to small, short duration missions; and has included long duration flagship missions. The HOSC recently completed a detailed analysis of service costs as part of the development of a complete service cost model. The cost analysis process required the team to address a number of issues. One of the primary issues involves the difficulty of reverse engineering individual mission costs in a highly efficient multimission environment, along with a related issue of the value of detailed metrics or data to the cost model versus the cost of obtaining accurate data. Another concern is the difficulty of balancing costs between missions of different types and size and extrapolating costs to different mission types. The cost analysis also had to address issues relating to providing shared, cloud-like services in a government environment, and then assigning an uncertainty or risk factor to cost estimates that are based on current technology, but will be executed using future technology. Finally the cost analysis needed to consider how to validate the resulting cost models taking into account the non-homogeneous nature of the available cost data and the decreasing flight rate. This paper presents the issues encountered during the HOSC cost analysis process, and the associated lessons learned. These lessons can be used when planning for a new multi-mission operations center or in the transformation from a dedicated control center to multi-center operations, as an aid in defining processes that support future cost analysis and estimation. The lessons can also be used by mature serviceoriented, multi-mission control centers to streamline or refine their cost analysis process.

  3. Between two beds: inappropriately delayed discharges from hospitals.

    PubMed

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

    2013-12-01

    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

  4. A state policy framework for integrating health and social services.

    PubMed

    McGinnis, Tricia; Crawford, Maia; Somers, Stephen A

    2014-07-01

    Recognizing that health is determined by a variety of interrelated factors, states are looking to connect health care, public health, and social services to help achieve improved population health, better care, and reduced cost of care. This issue brief describes three essential components for integrating health, including physical and behavioral health services and public health, and social services: (1) a coordinating mechanism, (2) quality measurement and data-sharing tools, and (3) aligned financing and payment. It also presents a five-step policy framework to help states move beyond isolated pilot efforts and establish the infrastructure necessary to support ongoing integration of health and social services, particularly for Medicaid beneficiaries.

  5. Value-based insurance design: embracing value over cost alone.

    PubMed

    Fendrick, A Mark; Chernew, Michael E; Levi, Gary W

    2009-12-01

    The US healthcare system is in crisis, with documented gaps in quality, safety, access, and affordability. Many believe the solution to unsustainable cost increases is increased patient cost-sharing. From an overall cost perspective, reduced consumption of certain essential services may yield short-term savings but lead to worse health and markedly higher costs down the road--in complications, hospitalizations, and increased utilization. Value-based insurance design (VBID) can help plug the inherent shortfalls in "across-the-board" patient cost-sharing. Instead of focusing on cost or quality alone, VBID focuses on value, aligning the financial and nonfinancial incentives of the various stakeholders and complementing other current initiatives to improve quality and subdue costs, such as high-deductible consumer-directed health plans, pay-for-performance programs, and disease management. Mounting evidence, both peer-reviewed and empirical, indicates not only that VBID can be implemented, but also leads to desired changes in behavior. For all its documented successes and recognized promise, VBID is in its infancy and is not a panacea for the current healthcare crisis. However, the available research and documented experiences indicate that as an overall approach, and in its fully evolved and widely adopted form, VBID will promote a healthier population and therefore support cost-containment efforts by producing better health at any price point.

  6. Measuring and Managing Army Supply Chain Risk: A Quantitative Approach by Item Number and Commercial Entity Code

    DTIC Science & Technology

    2015-01-01

    services to the end user across the modes of transport .” As such, the supply chain “may include vendors, manufacturing facilities, logistics providers...sharing them with a group, before ranking each. For more information, see Van De Ven and Delbecq, 1974. 12 “When working through the vulnerability...are cost-effective (Kiser and Cantrell, 2006), avoiding higher production and transportation costs. Figure 2.5 outlines two prevalent supply chain

  7. What CFOs should know before venturing into the cloud.

    PubMed

    Rajendran, Janakan

    2013-05-01

    There are three major trends in the use of cloud-based services for healthcare IT: Cloud computing involves the hosting of health IT applications in a service provider cloud. Cloud storage is a data storage service that can involve, for example, long-term storage and archival of information such as clinical data, medical images, and scanned documents. Data center colocation involves rental of secure space in the cloud from a vendor, an approach that allows a hospital to share power capacity and proven security protocols, reducing costs.

  8. Lowering the Barrier for Standards-Compliant and Discoverable Hydrological Data Publication

    NASA Astrophysics Data System (ADS)

    Kadlec, J.

    2013-12-01

    The growing need for sharing and integration of hydrological and climate data across multiple organizations has resulted in the development of distributed, services-based, standards-compliant hydrological data management and data hosting systems. The problem with these systems is complicated set-up and deployment. Many existing systems assume that the data publisher has remote-desktop access to a locally managed server and experience with computer network setup. For corporate websites, shared web hosting services with limited root access provide an inexpensive, dynamic web presence solution using the Linux, Apache, MySQL and PHP (LAMP) software stack. In this paper, we hypothesize that a webhosting service provides an optimal, low-cost solution for hydrological data hosting. We propose a software architecture of a standards-compliant, lightweight and easy-to-deploy hydrological data management system that can be deployed on the majority of existing shared internet webhosting services. The architecture and design is validated by developing Hydroserver Lite: a PHP and MySQL-based hydrological data hosting package that is fully standards-compliant and compatible with the Consortium of Universities for Advancement of Hydrologic Sciences (CUAHSI) hydrologic information system. It is already being used for management of field data collection by students of the McCall Outdoor Science School in Idaho. For testing, the Hydroserver Lite software has been installed on multiple different free and low-cost webhosting sites including Godaddy, Bluehost and 000webhost. The number of steps required to set-up the server is compared with the number of steps required to set-up other standards-compliant hydrologic data hosting systems including THREDDS, IstSOS and MapServer SOS.

  9. Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country.

    PubMed

    Mouseli, Ali; Barouni, Mohsen; Amiresmaili, Mohammadreza; Samiee, Siamak Mirab; Vali, Leila

    2017-04-01

    It is believed that laboratory tariffs in Iran don't reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector's tariffs in 2015. This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories.

  10. Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country

    PubMed Central

    Mouseli, Ali; Barouni, Mohsen; Amiresmaili, Mohammadreza; Samiee, Siamak Mirab; Vali, Leila

    2017-01-01

    Background It is believed that laboratory tariffs in Iran don’t reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. Objective This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. Methods This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. Results In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector’s tariffs in 2015. Conclusion This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories. PMID:28607638

  11. Coping with Prescription Drug Cost Sharing: Knowledge, Adherence, and Financial Burden

    PubMed Central

    Reed, Mary; Brand, Richard; Newhouse, Joseph P; Selby, Joe V; Hsu, John

    2008-01-01

    Objective Assess patient knowledge of and response to drug cost sharing. Study Setting Adult members of a large prepaid, integrated delivery system. Study Design/Data Collection Telephone interviews with 932 participants (72 percent response rate) who reported knowledge of the structures and amounts of their prescription drug cost sharing. Participants reported cost-related changes in their drug adherence, any financial burden, and other cost-coping behaviors. Actual cost sharing amounts came from administrative databases. Principal Findings Overall, 27 percent of patients knew all of their drug cost sharing structures and amounts. After adjustment for individual characteristics, additional patient cost sharing structures (tiers and caps), and higher copayment amounts were associated with reporting decreased adherence, financial burden, or other cost-coping behaviors. Conclusions Patient knowledge of their drug benefits is limited, especially for more complex cost sharing structures. Patients also report a range of responses to greater cost sharing, including decreasing adherence. PMID:18370979

  12. Scaling cost-sharing to wages: how employers can reduce health spending and provide greater economic security.

    PubMed

    Robertson, Christopher T

    2014-01-01

    In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums. Yet, there are legal obstacles to scaled cost-sharing. The group-based nature of employer health insurance, reinforced by federal law, makes it difficult for scaling to be achieved through individual choices. The Affordable Care Act's (ACA) "essential coverage" mandate also caps cost-sharing even for wealthy workers that need no such cap. Additionally, there is a tax distortion in favor of highly paid workers purchasing healthcare through insurance rather than out-of-pocket. These problems are all surmountable. In particular, the ACA has expanded the applicability of an unenforced employee-benefits rule that prohibits "discrimination" in favor of highly compensated workers. A novel analysis shows that this statute gives the Internal Revenue Service the authority to require scaling and to thereby eliminate the current inequities and inefficiencies caused by the tax distortion. The promise is smarter insurance for over 150 million Americans.

  13. 10 CFR 603.530 - Acceptable cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Evaluation Cost Sharing § 603.530 Acceptable cost sharing. The contracting officer may accept any cash or in... 10 Energy 4 2010-01-01 2010-01-01 false Acceptable cost sharing. 603.530 Section 603.530 Energy..., they represent meaningful cost sharing that demonstrates the recipient's commitment to the success of...

  14. Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea.

    PubMed

    Bae, Jong-Myon

    2017-07-01

    In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

  15. Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea

    PubMed Central

    2017-01-01

    In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids. PMID:28768400

  16. Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

    PubMed

    Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

    2013-01-01

    To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.

  17. Incentive Mechanism for P2P Content Sharing over Heterogenous Access Networks

    NASA Astrophysics Data System (ADS)

    Sato, Kenichiro; Hashimoto, Ryo; Yoshino, Makoto; Shinkuma, Ryoichi; Takahashi, Tatsuro

    In peer-to-peer (P2P) content sharing, users can share their content by contributing their own resources to one another. However, since there is no incentive for contributing contents or resources to others, users may attempt to obtain content without any contribution. To motivate users to contribute their resources to the service, incentive-rewarding mechanisms have been proposed. On the other hand, emerging wireless technologies, such as IEEE 802.11 wireless local area networks, beyond third generation (B3G) cellular networks and mobile WiMAX, provide high-speed Internet access for wireless users. Using these high-speed wireless access, wireless users can use P2P services and share their content with other wireless users and with fixed users. However, this diversification of access networks makes it difficult to appropriately assign rewards to each user according to their contributions. This is because the cost necessary for contribution is different in different access networks. In this paper, we propose a novel incentive-rewarding mechanism called EMOTIVER that can assign rewards to users appropriately. The proposed mechanism uses an external evaluator and interactive learning agents. We also investigate a way of appropriately controlling rewards based on the system service's quality and managing policy.

  18. Making Spatial Statistics Service Accessible On Cloud Platform

    NASA Astrophysics Data System (ADS)

    Mu, X.; Wu, J.; Li, T.; Zhong, Y.; Gao, X.

    2014-04-01

    Web service can bring together applications running on diverse platforms, users can access and share various data, information and models more effectively and conveniently from certain web service platform. Cloud computing emerges as a paradigm of Internet computing in which dynamical, scalable and often virtualized resources are provided as services. With the rampant growth of massive data and restriction of net, traditional web services platforms have some prominent problems existing in development such as calculation efficiency, maintenance cost and data security. In this paper, we offer a spatial statistics service based on Microsoft cloud. An experiment was carried out to evaluate the availability and efficiency of this service. The results show that this spatial statistics service is accessible for the public conveniently with high processing efficiency.

  19. Cryptonite: A Secure and Performant Data Repository on Public Clouds

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

    Kumbhare, Alok; Simmhan, Yogesh; Prasanna, Viktor

    2012-06-29

    Cloud storage has become immensely popular for maintaining synchronized copies of files and for sharing documents with collaborators. However, there is heightened concern about the security and privacy of Cloud-hosted data due to the shared infrastructure model and an implicit trust in the service providers. Emerging needs of secure data storage and sharing for domains like Smart Power Grids, which deal with sensitive consumer data, require the persistence and availability of Cloud storage but with client-controlled security and encryption, low key management overhead, and minimal performance costs. Cryptonite is a secure Cloud storage repository that addresses these requirements using amore » StrongBox model for shared key management.We describe the Cryptonite service and desktop client, discuss performance optimizations, and provide an empirical analysis of the improvements. Our experiments shows that Cryptonite clients achieve a 40% improvement in file upload bandwidth over plaintext storage using the Azure Storage Client API despite the added security benefits, while our file download performance is 5 times faster than the baseline for files greater than 100MB.« less

  20. Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy.

    PubMed

    Kolehmainen, Niina; MacLennan, Graeme; Ternent, Laura; Duncan, Edward A S; Duncan, Eilidh M; Ryan, Stephen B; McKee, Lorna; Francis, Jill J

    2012-08-16

    Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services. Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations. Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands. Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.

  1. 78 FR 5781 - Cost-Sharing Rates for Pharmacy Benefits Program of the TRICARE Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-28

    ... DEPARTMENT OF DEFENSE Office of the Secretary Cost-Sharing Rates for Pharmacy Benefits Program of... to cost-sharing rates to the TRICARE Pharmacy Benefits Program. SUMMARY: This notice is to advise interested parties of cost-sharing rate change for the Pharmacy Benefits Program. DATES: The cost-sharing...

  2. Basing care reforms on evidence: The Kenya health sector costing model

    PubMed Central

    2011-01-01

    Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies. PMID:21619567

  3. Basing care reforms on evidence: the Kenya health sector costing model.

    PubMed

    Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

    2011-05-27

    The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.

  4. Financial Impact of Direct-Acting Oral Anticoagulants in Medicaid: Budgetary Assessment Based on Number Needed to Treat.

    PubMed

    Fairman, Kathleen A; Davis, Lindsay E; Kruse, Courtney R; Sclar, David A

    2017-04-01

    Faced with rising healthcare costs, state Medicaid programs need short-term, easily calculated budgetary estimates for new drugs, accounting for medical cost offsets due to clinical advantages. To estimate the budgetary impact of direct-acting oral anticoagulants (DOACs) compared with warfarin, an older, lower-cost vitamin K antagonist, on 12-month Medicaid expenditures for nonvalvular atrial fibrillation (NVAF) using number needed to treat (NNT). Medicaid utilization files, 2009 through second quarter 2015, were used to estimate OAC cost accounting for generic/brand statutory minimum (13/23%) and assumed maximum (13/50%) manufacturer rebates. NNTs were calculated from clinical trial reports to estimate avoided medical events for a hypothetical population of 500,000 enrollees (approximate NVAF prevalence × Medicaid enrollment) under two DOAC market share scenarios: 2015 actual and 50% increase. Medical service costs were based on published sources. Costs were inflation-adjusted (2015 US$). From 2009-2015, OAC reimbursement per claim increased by 173 and 279% under maximum and minimum rebate scenarios, respectively, while DOAC market share increased from 0 to 21%. Compared with a warfarin-only counterfactual, counts of ischemic strokes, intracranial hemorrhages, and systemic embolisms declined by 36, 280, and 111, respectively; counts of gastrointestinal hemorrhages increased by 794. Avoided events and reduced monitoring, respectively, offset 3-5% and 15-24% of increased drug cost. Net of offsets, DOAC-related cost increases were US$258-US$464 per patient per year (PPPY) in 2015 and US$309-US$579 PPPY after market share increase. Avoided medical events offset a small portion of DOAC-related drug cost increase. NNT-based calculations provide a transparent source of budgetary-impact information for new medications.

  5. Bantam System Technology Project Ground System Operations Concept and Plan

    NASA Technical Reports Server (NTRS)

    Moon, Jesse M.; Beveridge, James R.

    1997-01-01

    The Low Cost Booster Technology Program, also known as the Bantam Booster program, is a NASA sponsored initiative to establish a viable commercial technology to support the market for placing small payloads in low earth orbit. This market is currently served by large boosters which orbit a number of small payloads on a single launch vehicle, or by these payloads taking up available space on major commercial launches. Even by sharing launch costs, the minimum cost to launch one of these small satellites is in the 6 to 8 million dollar range. Additionally, there is a shortage of available launch opportunities which can be shared in this manner. The goal of the Bantam program is to develop two competing launch vehicles, with launch costs in the neighborhood of 1.5 million dollars to launch a 150 kg payload into low earth orbit (200 nautical mile sun synchronous). Not only could the cost of the launch be significantly less than the current situation, but the payload sponsor could expect better service for his expenditure, the ability to specify his own orbit, and a dedicated vehicle. By developing two distinct launch vehicles, market forces are expected to aid in keeping customer costs low.

  6. Cost-effectiveness of community versus hospital eye service follow-up for patients with quiescent treated age-related macular degeneration alongside the ECHoES randomised trial.

    PubMed

    Violato, M; Dakin, H; Chakravarthy, U; Reeves, B C; Peto, T; Hogg, R E; Harding, S P; Scott, L J; Taylor, J; Cappel-Porter, H; Mills, N; O'Reilly, D; Rogers, C A; Wordsworth, S

    2016-10-24

    To assess the cost-effectiveness of optometrist-led follow-up monitoring reviews for patients with quiescent neovascular age-related macular degeneration (nAMD) in community settings (including high street opticians) compared with ophthalmologist-led reviews in hospitals. A model-based cost-effectiveness analysis with a 4-week time horizon, based on a 'virtual' non-inferiority randomised trial designed to emulate a parallel group design. A virtual internet-based clinical assessment, conducted at community optometry practices, and hospital ophthalmology clinics. Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care schemes. The participating optometrists and ophthalmologists classified lesions from vignettes and were asked to judge whether any retreatment was required. Vignettes comprised clinical information, colour fundus photographs and optical coherence tomography images. Participants' classifications were validated against experts' classifications (reference standard). Resource use and cost information were attributed to these retreatment decisions. Correct classification of whether further treatment is needed, compared with a reference standard. The mean cost per assessment, including the subsequent care pathway, was £411 for optometrists and £397 for ophthalmologists: a cost difference of £13 (95% CI -£18 to £45). Optometrists were non-inferior to ophthalmologists with respect to the overall percentage of lesions correctly assessed (difference -1.0%; 95% CI -4.5% to 2.5%). In the base case analysis, the slightly larger number of incorrect retreatment decisions by optometrists led to marginally and non-significantly higher costs. Sensitivity analyses that reflected different practices across eye hospitals indicate that shared care pathways between optometrists and ophthalmologists can be identified which may reduce demands on scant hospital resources, although in light of the uncertainty around differences in outcome and cost it remains unclear whether the differences between the 2 care pathways are significant in economic terms. ISRCTN07479761; Pre-results. 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/.

  7. A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.

    PubMed

    Jozaghi, Ehsan

    2014-11-13

    Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

  8. Community oncology in an era of payment reform.

    PubMed

    Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

    2014-01-01

    Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

  9. 42 CFR 417.802 - Allowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... procedures under which the members of the group accept effective incentives, such as risk-sharing, designed... physicians and other suppliers in the same or a similar locality. (ii)(A) If a physician group to whom the... group may not exceed the reasonable charges for those services, as defined in subpart E of part 405 of...

  10. Breaking down IT silos: a "connected" way to improve customer experience and the bottom line.

    PubMed

    Hallowell, Bruce; Turisco, Frances

    2009-03-01

    Hospitals can provide customer service like Amazon.com without purchasing new technology. Making technology interactive requires sharing patient data across applications and enhancing existing IT with decision support. Breaking down technology silos between hospital and outpatient care provider systems significantly improves efficiency, lowers costs, and speeds care delivery.

  11. 76 FR 80249 - Use of Differential Income Stream as a Consideration in Assessing the Best Method

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-23

    ... Differential Income Stream as a Consideration in Assessing the Best Method AGENCY: Internal Revenue Service... method in connection with a cost sharing arrangement. The text of these temporary regulations also serves... unreasonable positions in applying the income method by using relatively low licensing discount rates, and...

  12. 33 CFR 277.8 - Procedures for apportionment of costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... life bears to the total estimated service life. The share of the bridge owner, thus computed... not have to be met until the bridge had reached the end of its useful life. Accordingly, the present worth of the amount is computed deferred over the unexpired life. The discount rate to be used in the...

  13. 33 CFR 277.8 - Procedures for apportionment of costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... life bears to the total estimated service life. The share of the bridge owner, thus computed... not have to be met until the bridge had reached the end of its useful life. Accordingly, the present worth of the amount is computed deferred over the unexpired life. The discount rate to be used in the...

  14. 33 CFR 277.8 - Procedures for apportionment of costs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... life bears to the total estimated service life. The share of the bridge owner, thus computed... not have to be met until the bridge had reached the end of its useful life. Accordingly, the present worth of the amount is computed deferred over the unexpired life. The discount rate to be used in the...

  15. 33 CFR 277.8 - Procedures for apportionment of costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... life bears to the total estimated service life. The share of the bridge owner, thus computed... not have to be met until the bridge had reached the end of its useful life. Accordingly, the present worth of the amount is computed deferred over the unexpired life. The discount rate to be used in the...

  16. 77 FR 15361 - Notice of Amendment No. 001 to the Solicitation for Cooperative Agreement Applications (SCAA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-15

    ... July 7, 2010 AGENCY: Defense Logistics Agency, DoD. ACTION: Amended solicitations for cost sharing cooperative agreement applications. SUMMARY: The Defense Logistics Agency (DLA) executes the Department of... be considered from entities proposing to provide service to an area that will not be covered by an...

  17. 34 CFR 379.40 - What are the matching requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY What Conditions Must Be Met by a Grantee? § 379.40 What are the matching requirements? The Federal share may not be more than 80 percent of the total cost of a project under this program. For assistance in calculating the...

  18. Impact of Critical Access Hospital Conversion on Beneficiary Liability

    ERIC Educational Resources Information Center

    Gilman, Boyd H.

    2008-01-01

    Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the…

  19. 42 CFR 447.53 - Cost sharing for drugs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Cost sharing for drugs. 447.53 Section 447.53... and Cost Sharing § 447.53 Cost sharing for drugs. (a) The agency may establish differential cost sharing for preferred and non-preferred drugs. The provisions in § 447.56(a) shall apply except as the...

  20. 14 CFR 151.43 - United States share of project costs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

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