The document discusses plans for implementing a universal health insurance (UHI) system in Ireland. It outlines that UHI will provide equal access to healthcare for all through compulsory health insurance paid through income-based premiums. However, implementing UHI will be an immensely complex process requiring changes to healthcare funding, providers, doctors' contracts, and legal frameworks. The timeline implied for transitioning to UHI by 2016 is optimistic given capacity constraints and lack of progress on necessary precursors like reforming payment systems and hospital governance.
The document discusses the challenges facing Ireland's goal of introducing universal health insurance by 2016. It will be an immense undertaking requiring extensive economic, legal and administrative changes across the entire healthcare system. Many crucial details about benefits, costs, and rules still need clarification for patients, providers and insurers. Creating such vast reforms to a functioning healthcare system within just six years will be an ambitious challenge.
HealthCare Reform - 10 Things You Should Know Glenn Roland
The document discusses key aspects of the Patient Protection and Affordable Care Act (PPACA), including what it is, some of its key provisions, challenges that have been faced in its implementation, progress that has been made, and the timeline for some of its initiatives. As an example of a new care model introduced by the legislation, it describes Accountable Care Organizations (ACOs), which are intended to drive more coordinated care through incentives provided by the Centers for Medicare and Medicaid Services.
The document discusses incentives for hospitals to adopt electronic health records (EHRs) under the American Recovery and Reinvestment Act (ARRA). Hospitals can receive up to $15.9 million in incentive payments over 4 years if they demonstrate meaningful use of certified EHR technology. They must meet requirements like using EHRs to exchange health information and submit clinical quality measures. Hospitals that do not show meaningful use by 2015 will face Medicare payment reductions. States can also receive grants to help hospitals finance EHR purchases through loan programs.
The document discusses current issues in telemedicine regulation and reimbursement. It begins with an overview of the broader telehealth environment and categories of telehealth services. It notes that the legal and regulatory environment has not kept pace with technological advances. The document then discusses Medicare reimbursement requirements for telemedicine, including covered services, provider and site requirements. It also outlines proposed changes to reimbursement. Finally, it analyzes the diversity of state regulation of telemedicine and issues around licensure, standards of care and other areas that vary significantly between states.
This document summarizes key points from a presentation on rural health issues and healthcare reform. It discusses potential government shutdowns if a budget is not passed, changes to Medicare and Medicaid under the Affordable Care Act, provisions already in effect, and new delivery models like accountable care organizations. Key uncertainties are noted, such as the impact of healthcare reform on rural providers and workforce shortages.
The document outlines the new legal landscape for clinical commissioning groups (CCGs) in the UK National Health Service (NHS). It discusses how CCGs will be established through an application process to the NHS Commissioning Board. CCGs will be responsible for securing health improvements and commissioning secondary, specialist, and community care services. They must balance their annual budgets and manage potential conflicts of interest. The document also summarizes the roles of key new bodies in the reformed NHS system, including the NHS Commissioning Board, Monitor, the Care Quality Commission, and HealthWatch organizations.
The document summarizes the new legal landscape for clinical commissioning groups (CCGs) in England following health reforms. CCGs will be established to commission most hospital and community NHS services. They must apply to the NHS Commissioning Board and have a constitution and governance structure approved. If authorized, CCGs will receive funding to commission services while following legal duties around conflicts of interest, public law, and workforce issues from transferring NHS bodies and contracts. The system aims to give providers more autonomy but risks increased bureaucracy limiting innovation.
mHealth Israel_US Telehealth + Reimbursement Post CoVID_King & SpaldingLevi Shapiro
The document discusses telehealth, telemedicine, and reimbursement in the US pre- and post-pandemic. It notes that historically Medicare limited telemedicine but expanded coverage significantly during the pandemic. It explores ongoing debates around permanent expansions, differences between telehealth and telemedicine, employer adoption challenges, and compliance issues. Deployment structures like contracting through wellness programs are examined. Reimbursement changes during the pandemic and proposals for the future are summarized, including defining "reasonable and necessary" coverage and considering commercial insurance coverage.
The document discusses the challenges facing Ireland's goal of introducing universal health insurance by 2016. It will be an immense undertaking requiring extensive economic, legal and administrative changes across the entire healthcare system. Many crucial details about benefits, costs, and rules still need clarification for patients, providers and insurers. Creating such vast reforms to a functioning healthcare system within just six years will be an ambitious challenge.
HealthCare Reform - 10 Things You Should Know Glenn Roland
The document discusses key aspects of the Patient Protection and Affordable Care Act (PPACA), including what it is, some of its key provisions, challenges that have been faced in its implementation, progress that has been made, and the timeline for some of its initiatives. As an example of a new care model introduced by the legislation, it describes Accountable Care Organizations (ACOs), which are intended to drive more coordinated care through incentives provided by the Centers for Medicare and Medicaid Services.
The document discusses incentives for hospitals to adopt electronic health records (EHRs) under the American Recovery and Reinvestment Act (ARRA). Hospitals can receive up to $15.9 million in incentive payments over 4 years if they demonstrate meaningful use of certified EHR technology. They must meet requirements like using EHRs to exchange health information and submit clinical quality measures. Hospitals that do not show meaningful use by 2015 will face Medicare payment reductions. States can also receive grants to help hospitals finance EHR purchases through loan programs.
The document discusses current issues in telemedicine regulation and reimbursement. It begins with an overview of the broader telehealth environment and categories of telehealth services. It notes that the legal and regulatory environment has not kept pace with technological advances. The document then discusses Medicare reimbursement requirements for telemedicine, including covered services, provider and site requirements. It also outlines proposed changes to reimbursement. Finally, it analyzes the diversity of state regulation of telemedicine and issues around licensure, standards of care and other areas that vary significantly between states.
This document summarizes key points from a presentation on rural health issues and healthcare reform. It discusses potential government shutdowns if a budget is not passed, changes to Medicare and Medicaid under the Affordable Care Act, provisions already in effect, and new delivery models like accountable care organizations. Key uncertainties are noted, such as the impact of healthcare reform on rural providers and workforce shortages.
The document outlines the new legal landscape for clinical commissioning groups (CCGs) in the UK National Health Service (NHS). It discusses how CCGs will be established through an application process to the NHS Commissioning Board. CCGs will be responsible for securing health improvements and commissioning secondary, specialist, and community care services. They must balance their annual budgets and manage potential conflicts of interest. The document also summarizes the roles of key new bodies in the reformed NHS system, including the NHS Commissioning Board, Monitor, the Care Quality Commission, and HealthWatch organizations.
The document summarizes the new legal landscape for clinical commissioning groups (CCGs) in England following health reforms. CCGs will be established to commission most hospital and community NHS services. They must apply to the NHS Commissioning Board and have a constitution and governance structure approved. If authorized, CCGs will receive funding to commission services while following legal duties around conflicts of interest, public law, and workforce issues from transferring NHS bodies and contracts. The system aims to give providers more autonomy but risks increased bureaucracy limiting innovation.
mHealth Israel_US Telehealth + Reimbursement Post CoVID_King & SpaldingLevi Shapiro
The document discusses telehealth, telemedicine, and reimbursement in the US pre- and post-pandemic. It notes that historically Medicare limited telemedicine but expanded coverage significantly during the pandemic. It explores ongoing debates around permanent expansions, differences between telehealth and telemedicine, employer adoption challenges, and compliance issues. Deployment structures like contracting through wellness programs are examined. Reimbursement changes during the pandemic and proposals for the future are summarized, including defining "reasonable and necessary" coverage and considering commercial insurance coverage.
Relicare provides a critical illness insurance policy that pays a lump sum amount if diagnosed with one of 10 listed critical illnesses. It aims to protect lifestyle from life-threatening illnesses. Key features include a lump sum payout for first diagnosis of cancer, heart attack, stroke, or other illnesses. The policy offers individual contracts for ages 18-65 and covers medical costs from major diseases. Premiums vary based on age, sum insured, and term chosen.
Sustainability and Transition Policy in Action (GF Session) - Tural Gulu, Az...OECD Governance
This presentation was made by Tural Gulu, Azerbaijan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
The document summarizes the funding model of the NSW Ambulance Service. It provides details on:
- The sources of funding for the NSW Ambulance Service which include government appropriation, transport fees, ambulance subscription schemes, and bulk agreements.
- Government funding has failed to keep pace with increasing demand for ambulance services, resulting in a decrease in the cost recovery of the Service.
- Non-direct government funding such as transport fees and subscription schemes decreased significantly between 1999/2000 and 2003/04.
The document provides information about Switzerland across several topics. It includes statistics about Switzerland's land, labor force, education system, healthcare system, taxation, banking and finance, intellectual property laws, and competition laws. Switzerland has a highly skilled labor force, universal healthcare coverage, and strong intellectual property protection. Its banking sector, stock exchange, and insurance industry are major contributors to the economy.
The meaning of meaningful use 2010 05-14 missouri rural hospital hit conferencelearfield
This document summarizes a presentation about meaningful use of health information technology. It discusses the national drivers behind implementing health IT, including several reports identifying medical errors as a major issue. It outlines the HITECH Act which provides financial incentives through Medicare and Medicaid to encourage providers and hospitals to meaningfully use certified electronic health records. It describes the proposed objectives and measures for stage 1 meaningful use, including both clinical quality reporting and other objectives requiring data submission or attestation. Regional extension centers are introduced as resources to help providers achieve meaningful use.
This document discusses several topics related to compliance in medical practices:
- It provides an overview of the economy, healthcare reform legislation, the HITECH Act, and new laws/regulations around HIPAA, ICD-10, FERA, HEAT, RACs, and the Red Flag Rule.
- It notes the incentives for adopting electronic health records under the HITECH Act and details new requirements and penalties under updated privacy and security rules.
- It emphasizes the increased risks of investigations and liability for providers given expanded enforcement of fraud laws like the False Claims Act. Proper documentation and compliance programs are advised.
The swiss healthcare system without the health care financesRafael Rodriguez
The document summarizes key aspects of Switzerland's healthcare system. It outlines that the system is governed by the 1996 Health Insurance Law (LAMal) which mandates universal basic health insurance coverage. It describes the basic insurance package that covers hospital stays, outpatient care, nursing care, and other services. Supplementary private insurance can provide additional benefits. Healthcare is provided through independent general practitioners, specialists, and public or private hospitals. Insurers must provide basic policies and premiums are regulated, though deductibles and premium costs still vary between plans and regions.
NYSHIP provides affordable and comprehensive health insurance to over 1.2 million public employees in New York State through two plan options - Empire Plan and Excelsior Plan. It offers low and stable premium increases, negotiated rates with healthcare partners, and a large pool of enrollees. Administration is simple for participating agencies through the Department of Civil Service Employee Benefits Division. NYSHIP delivers periodic reports and support to help agencies manage benefits. The plans provide in-network and out-of-network coverage nationwide with few out-of-pocket costs for preventive services and specific medical care.
Medical Costs 2021- Analyst Insights from PwC Health Research InsittuteLevi Shapiro
Presentation for mHealth Israel covering medical cost trends in the midst of the COVID-19 pandemic. Presenters are Ben Isgur, Health Research Institute Leader, and Ingrid Stiver, Senior Manager, Health Research Institute. Medical cost trends could range from 4% to 10% in 2021. Employer healthcare spending could fall in calendar year 2020 compared with 2019, and then rebound in 2021. Individuals with complex chronic conditions on employer-sponsored insurance were more likely to have delayed care. As a trusted source, providers have an opportunity to better communicate with their patients during the pandemic. During the Great Recession, unemployment increased by 8 million and employer-sponsored health insurance dropped by over 11 million. Breakdown of Inflators and Deflators affecting 2021 medical cost trends. COVID-19 boosts mental health utilization. Individuals with complex chronic disease and mental illness cost employers 12x more than healthy ones. Most medications in the pipeline are specialty drugs. Expanding indications for approved specialty drugs increase spending. Telehealth goes mainstream. Most commercial insurers are temporarily waiving cost sharing on telehealth visits during the COVID-19 pandemic. Networks narrow out of necessity. 35% of individuals with employer-sponsored insurance would choose a narrow network to avoid a premium increase. Includes LOW, MEDIUM and HIGH cost growth trend scenarios.
IBM's Watson technology will be used by WellPoint to help improve patient care and reduce costs. Watson will initially be used by nurses to review doctor treatment requests and manage patient cases. WellPoint believes Watson can process medical information quickly and help ensure patients receive the right care.
The document discusses the state of the NHS after the 2010 UK general election. It summarizes the key health policies of the new Conservative-Liberal Democrat coalition government, the previous New Labour government, and the Conservative and Liberal Democrat opposition parties. It notes that the coalition government has introduced significant reforms through the "Equity and Excellence" white paper, including abolishing Primary Care Trusts and Strategic Health Authorities and establishing independent GP commissioning consortia. It also discusses the financial challenges facing the NHS from austerity measures and the need to make substantial efficiency savings.
The document discusses healthcare financing in different countries and contexts. In high income countries, most healthcare is financed through government and private insurance pools. In low and middle income countries, healthcare is often paid for through private out-of-pocket spending. Globally, high income countries spend more on healthcare and have lower disease burdens compared to low and middle income countries.
Kegler Brown Hill & Ritter's 2011 Ohio Healthcare Summit offered an in-depth look at National and Ohio Healthcare Reform, Legal Challenges, Regulation and Implications for Healthcare Providers, Medical Malpractice, and the Health Information Exchange.
mHealth israel_EU Go-To-Market for Digital Health, Julien Venne, European Con...Levi Shapiro
Presentation for mHealth Israel about "EU Go-To-Market for Digital Health", by Julien Venne, Strategic Advisory, European Connected Healthcare Alliance, Oct, 2016
The document discusses the Affordable Care Act (ACA) which was signed into law in 2010. It aims to reform the US healthcare system and health insurance industry. Key points of the ACA include expanding Medicaid, introducing subsidies for insurance, and requiring all Americans to have health insurance or pay a fee. It also sets minimum coverage standards that all health insurance plans must meet. The ACA established online health insurance exchanges for Americans to shop for and purchase plans. It discusses the goals and challenges of implementing the exchanges.
The document summarizes recent guidance from CMS, OIG, FTC, DOJ, and IRS regarding Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Key points include:
- CMS released the final rule for the Medicare Shared Savings Program, making changes to reduce costs and burdens for participating ACOs.
- OIG issued three advisory opinions related to management services arrangements between physicians and clinical laboratories, and a specialty therapeutics model for high-cost drug assistance.
- FTC and DOJ provided a joint statement on antitrust enforcement policy for ACOs with greater flexibility. IRS also issued a fact sheet for tax-exempt organizations participating in ACOs.
mHealth Israel_Dr. Haidar Al Yousuf_UAE healthcare system Innovation in Healt...Levi Shapiro
Dr. Haidar Al Yousuf, Managing Director, Alfuttaim Health
addresses the UAE healthcare system and a case study in health technology Innovation. Includes an overview of the Health Insurance System
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
The Pacific Ring of Fire is a volcanic belt that surrounds the Pacific Ocean. Around 80% of the world's largest earthquakes occur in this region due to tectonic plate subduction, where one plate sinks beneath another. Japan, located on the Ring of Fire, experiences frequent earthquakes and volcanic eruptions from over 130 active volcanoes, such as Mount Fuji, which last erupted around 250 years ago.
This document provides guidance on how to evaluate websites by outlining why website evaluation is important, questions to ask, and things to look for. It recommends considering who created the site, its purpose, whether the information is current and in-depth, and looking for an "About" page. Key factors to weigh include whether the site is commercial or personal, if the author is reputable or unknown, when the site was founded and last updated, and if the content is objective or biased. The overall goal is to ensure the information is trustworthy, objective, current, and fit-for-purpose.
Relicare provides a critical illness insurance policy that pays a lump sum amount if diagnosed with one of 10 listed critical illnesses. It aims to protect lifestyle from life-threatening illnesses. Key features include a lump sum payout for first diagnosis of cancer, heart attack, stroke, or other illnesses. The policy offers individual contracts for ages 18-65 and covers medical costs from major diseases. Premiums vary based on age, sum insured, and term chosen.
Sustainability and Transition Policy in Action (GF Session) - Tural Gulu, Az...OECD Governance
This presentation was made by Tural Gulu, Azerbaijan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
The document summarizes the funding model of the NSW Ambulance Service. It provides details on:
- The sources of funding for the NSW Ambulance Service which include government appropriation, transport fees, ambulance subscription schemes, and bulk agreements.
- Government funding has failed to keep pace with increasing demand for ambulance services, resulting in a decrease in the cost recovery of the Service.
- Non-direct government funding such as transport fees and subscription schemes decreased significantly between 1999/2000 and 2003/04.
The document provides information about Switzerland across several topics. It includes statistics about Switzerland's land, labor force, education system, healthcare system, taxation, banking and finance, intellectual property laws, and competition laws. Switzerland has a highly skilled labor force, universal healthcare coverage, and strong intellectual property protection. Its banking sector, stock exchange, and insurance industry are major contributors to the economy.
The meaning of meaningful use 2010 05-14 missouri rural hospital hit conferencelearfield
This document summarizes a presentation about meaningful use of health information technology. It discusses the national drivers behind implementing health IT, including several reports identifying medical errors as a major issue. It outlines the HITECH Act which provides financial incentives through Medicare and Medicaid to encourage providers and hospitals to meaningfully use certified electronic health records. It describes the proposed objectives and measures for stage 1 meaningful use, including both clinical quality reporting and other objectives requiring data submission or attestation. Regional extension centers are introduced as resources to help providers achieve meaningful use.
This document discusses several topics related to compliance in medical practices:
- It provides an overview of the economy, healthcare reform legislation, the HITECH Act, and new laws/regulations around HIPAA, ICD-10, FERA, HEAT, RACs, and the Red Flag Rule.
- It notes the incentives for adopting electronic health records under the HITECH Act and details new requirements and penalties under updated privacy and security rules.
- It emphasizes the increased risks of investigations and liability for providers given expanded enforcement of fraud laws like the False Claims Act. Proper documentation and compliance programs are advised.
The swiss healthcare system without the health care financesRafael Rodriguez
The document summarizes key aspects of Switzerland's healthcare system. It outlines that the system is governed by the 1996 Health Insurance Law (LAMal) which mandates universal basic health insurance coverage. It describes the basic insurance package that covers hospital stays, outpatient care, nursing care, and other services. Supplementary private insurance can provide additional benefits. Healthcare is provided through independent general practitioners, specialists, and public or private hospitals. Insurers must provide basic policies and premiums are regulated, though deductibles and premium costs still vary between plans and regions.
NYSHIP provides affordable and comprehensive health insurance to over 1.2 million public employees in New York State through two plan options - Empire Plan and Excelsior Plan. It offers low and stable premium increases, negotiated rates with healthcare partners, and a large pool of enrollees. Administration is simple for participating agencies through the Department of Civil Service Employee Benefits Division. NYSHIP delivers periodic reports and support to help agencies manage benefits. The plans provide in-network and out-of-network coverage nationwide with few out-of-pocket costs for preventive services and specific medical care.
Medical Costs 2021- Analyst Insights from PwC Health Research InsittuteLevi Shapiro
Presentation for mHealth Israel covering medical cost trends in the midst of the COVID-19 pandemic. Presenters are Ben Isgur, Health Research Institute Leader, and Ingrid Stiver, Senior Manager, Health Research Institute. Medical cost trends could range from 4% to 10% in 2021. Employer healthcare spending could fall in calendar year 2020 compared with 2019, and then rebound in 2021. Individuals with complex chronic conditions on employer-sponsored insurance were more likely to have delayed care. As a trusted source, providers have an opportunity to better communicate with their patients during the pandemic. During the Great Recession, unemployment increased by 8 million and employer-sponsored health insurance dropped by over 11 million. Breakdown of Inflators and Deflators affecting 2021 medical cost trends. COVID-19 boosts mental health utilization. Individuals with complex chronic disease and mental illness cost employers 12x more than healthy ones. Most medications in the pipeline are specialty drugs. Expanding indications for approved specialty drugs increase spending. Telehealth goes mainstream. Most commercial insurers are temporarily waiving cost sharing on telehealth visits during the COVID-19 pandemic. Networks narrow out of necessity. 35% of individuals with employer-sponsored insurance would choose a narrow network to avoid a premium increase. Includes LOW, MEDIUM and HIGH cost growth trend scenarios.
IBM's Watson technology will be used by WellPoint to help improve patient care and reduce costs. Watson will initially be used by nurses to review doctor treatment requests and manage patient cases. WellPoint believes Watson can process medical information quickly and help ensure patients receive the right care.
The document discusses the state of the NHS after the 2010 UK general election. It summarizes the key health policies of the new Conservative-Liberal Democrat coalition government, the previous New Labour government, and the Conservative and Liberal Democrat opposition parties. It notes that the coalition government has introduced significant reforms through the "Equity and Excellence" white paper, including abolishing Primary Care Trusts and Strategic Health Authorities and establishing independent GP commissioning consortia. It also discusses the financial challenges facing the NHS from austerity measures and the need to make substantial efficiency savings.
The document discusses healthcare financing in different countries and contexts. In high income countries, most healthcare is financed through government and private insurance pools. In low and middle income countries, healthcare is often paid for through private out-of-pocket spending. Globally, high income countries spend more on healthcare and have lower disease burdens compared to low and middle income countries.
Kegler Brown Hill & Ritter's 2011 Ohio Healthcare Summit offered an in-depth look at National and Ohio Healthcare Reform, Legal Challenges, Regulation and Implications for Healthcare Providers, Medical Malpractice, and the Health Information Exchange.
mHealth israel_EU Go-To-Market for Digital Health, Julien Venne, European Con...Levi Shapiro
Presentation for mHealth Israel about "EU Go-To-Market for Digital Health", by Julien Venne, Strategic Advisory, European Connected Healthcare Alliance, Oct, 2016
The document discusses the Affordable Care Act (ACA) which was signed into law in 2010. It aims to reform the US healthcare system and health insurance industry. Key points of the ACA include expanding Medicaid, introducing subsidies for insurance, and requiring all Americans to have health insurance or pay a fee. It also sets minimum coverage standards that all health insurance plans must meet. The ACA established online health insurance exchanges for Americans to shop for and purchase plans. It discusses the goals and challenges of implementing the exchanges.
The document summarizes recent guidance from CMS, OIG, FTC, DOJ, and IRS regarding Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Key points include:
- CMS released the final rule for the Medicare Shared Savings Program, making changes to reduce costs and burdens for participating ACOs.
- OIG issued three advisory opinions related to management services arrangements between physicians and clinical laboratories, and a specialty therapeutics model for high-cost drug assistance.
- FTC and DOJ provided a joint statement on antitrust enforcement policy for ACOs with greater flexibility. IRS also issued a fact sheet for tax-exempt organizations participating in ACOs.
mHealth Israel_Dr. Haidar Al Yousuf_UAE healthcare system Innovation in Healt...Levi Shapiro
Dr. Haidar Al Yousuf, Managing Director, Alfuttaim Health
addresses the UAE healthcare system and a case study in health technology Innovation. Includes an overview of the Health Insurance System
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
The Pacific Ring of Fire is a volcanic belt that surrounds the Pacific Ocean. Around 80% of the world's largest earthquakes occur in this region due to tectonic plate subduction, where one plate sinks beneath another. Japan, located on the Ring of Fire, experiences frequent earthquakes and volcanic eruptions from over 130 active volcanoes, such as Mount Fuji, which last erupted around 250 years ago.
This document provides guidance on how to evaluate websites by outlining why website evaluation is important, questions to ask, and things to look for. It recommends considering who created the site, its purpose, whether the information is current and in-depth, and looking for an "About" page. Key factors to weigh include whether the site is commercial or personal, if the author is reputable or unknown, when the site was founded and last updated, and if the content is objective or biased. The overall goal is to ensure the information is trustworthy, objective, current, and fit-for-purpose.
MAGNOLIA is a statewide association funded by the Mississippi Legislature that provides online research databases for schools and libraries in Mississippi. It includes Academic Search Premier, an extensive scholarly database from EBSCO with full text for over 4,600 journal titles. Academic Search Premier is a good source for research because it contains articles, reports and books across many subject areas, with cited references and PDF backfiles for some journals back to 1975. The document provides instructions for accessing Academic Search Premier through the Gulfport school library website and searching for articles on a topic. It explains how to find the full text of articles, and print, email or save citations in MLA format for research papers.
Initial Analysis of Universal Health Insurance 24 March 2011Oliver O'Connor
This document discusses issues surrounding the implementation of universal health insurance (UHI) in Ireland. It notes that UHI would involve many stakeholders, including government officials, healthcare providers, insurers, taxpayers, and the public. It also identifies challenges such as balancing costs and services, determining funding mechanisms, ensuring fair competition between public and private insurers/providers, and providing clarity around benefits and responsibilities. The document emphasizes that successfully implementing UHI will require navigating many complex tradeoffs and choosing a model tailored to Ireland's unique circumstances.
The document provides an overview of the German healthcare system. It describes how the system is based on both public and private insurance, with public insurance covering around 88% of the population. Public insurance is funded through income-related contributions from employers and employees. The system aims to provide equal coverage to all citizens regardless of income or age. It covers a wide range of medical services and utilizes various strategies to ensure quality of care and reduce disparities.
The document discusses lessons learned from reforms to the UK National Health Service (NHS) over time. Key points include ensuring incentives are aligned for all stakeholders, recognizing the impact of unnecessary structural changes, and taking an evidence-based approach to policymaking through piloting and gradual change. The Dutch healthcare system is presented as moving to a uniform insurance system in 2006 that is funded through payroll taxes, government subsidies, and individual premiums.
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
MECHANISMS OF PAYMENT
1. Private fee - for services
2. Post payment plans
3. Private third party prepayment plans
-Commercial insurance companies
-Non-profit health service corporations
-Prepaid group practice
-Capitation plans
4. Salary
5. Public programs
1. Private fee - for service
• The two party arrangement, traditional form of reimbursement for dental services.
• Integral part of private practice as a delivery method.
Advantages:
1) Culturally acceptable
2) Flexibility
3) Administratively simple
4) Can be used in expensive situations
Disadvantages:
1. Major percent of the population cannot afford dental care.
Post Payment Plans or Budget Plans
• First started in Late 1930's - local dental societies in Pennsylvania & Michigan
• Mechanisms for the individual purchase of service
Advantages:
1. Helpful for middle income people
2. Primarily used to finance prosthetic and other costly treatment
Disadvantages:
1. Lower income people cannot use to the full
2. Problem of defaulted loans
Private Third Party Prepayment Plans
Defined as payment for service by some agency rather than directly by the beneficiary of those services.
1st Party-Dentist; 2nd Party-Patient; 3rd Party-Administrator of Finances
Third Party/ Carrier/ Insurer/ Underwriter/ Administrative Agent.
• Defined as The party to a dental prepayment contract that may collect premiums, assume financial risk, pay claims and provide administrative services
Reimbursement of Dentist in Third Party Plans
The major forms of third-party reimbursement currently in use are:
Usual fee: The fee that an individual dentist most frequently charges for a given dental service.
Customary Fee: The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Reasonable Fee: the fee charged by the dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications may differ from the dentists usual fee or the benefit administrators customary fee.
A table of allowances: A list of covered services with an assigned amount that represents the total obligation of the plan with respect to payment for such service but that does not necessarily represent the dentists full fee for that service”.
Fee schedule: A list of charges established or agreed to by a dentist for specific dental services. A fee schedule is usually taken to represent payment in full, whereas a table of allowances may not.
Capitation: A capitation fee is usually a fixed monthly payment paid by a carrier to a dentist based on the number of patients assigned to the dentist for treatment.
SALARY
Dentists in some group practices, those in the armed forces and those employed by public agencies are salaried.
PUBLIC PROGRAMS
Medicare
Medicaid
NHI
Presentation by James Smith of the American Continental Group at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
This document discusses healthcare reform in the United States. It provides background on rising healthcare costs driven largely by chronic conditions. It outlines key provisions and timelines of the Affordable Care Act, including expanding insurance coverage, new taxes and fees, and delivery system reforms focused on value over volume. It also presents data on the impact of reforms in Massachusetts as well as lessons learned around rising costs, physician compensation, and hospital operating margins.
high value care to reduce waste in health caremukeshkakkar
This document discusses health care costs and payment models. It defines different types of health care costs including charges, reimbursements, and out-of-pocket costs. It describes how traditional payment models like fee-for-service can promote cost variation and lack transparency. It also discusses recent value-based reforms like accountable care organizations (ACOs) and pay for performance models that aim to improve quality and reduce costs. The document provides examples of estimating out-of-pocket costs and explores how insurance status impacts clinical recommendations and adherence.
This document discusses health care costs and how to control them. It addresses who pays for health care through insurance, how costs have increased much faster than wages and inflation, and what the major cost drivers are such as drugs, hospitals, physicians and administrative costs. It explores strategies that employers and employees can take to lower costs, such as competitive bidding for insurance and drugs, accountable care organizations for primary care, and consolidated record keeping.
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
On Thursday July 19th, 2012, the Taylor-Wilks Group held a free Health Care Symposium to provide resources and answer questions regarding the Affordable Care Act. This is some content from the event.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
This document discusses key issues around Medicaid expansion and income determination under the Affordable Care Act. It notes that the ACA was intended to expand coverage to 30-33 million uninsured through Medicaid expansion to 138% of the federal poverty level and subsidies on the exchanges from 100-400% FPL. However, the Supreme Court made Medicaid expansion optional for states. This creates concerns around coordinating eligibility across Medicaid, exchanges and the individual mandate. It also discusses the reduction in disproportionate share hospital payments which were intended to offset the costs of expansion, but may occur even without state expansion. The document recommends better aligning the income determination periods between Medicaid and exchanges to reduce costs and churning.
This document discusses state health care policy issues in 2012, including:
1. State budgets have faced large cumulative budget gaps between 2002-2013 totaling over $820.5 billion, putting pressure on states to cut programs.
2. The Affordable Care Act provides opportunities for states through expanding Medicaid eligibility and benefits, establishing health insurance exchanges, and pilot programs.
3. Key policy issues for states in 2012 include implementing health reform, addressing ongoing budget shortfalls, and debating scope of practice and workforce laws.
This document discusses key provisions of the Affordable Care Act that will impact employers and individuals in 2013 and beyond, including the individual mandate, employer shared responsibility requirements, reporting obligations, costs and fees, and state health insurance exchanges. It outlines compliance considerations and financial implications for businesses related to offering health coverage, penalties for non-compliance, and rising health care costs. State exchanges creating new health plan options starting in 2014 could disadvantage employers if not addressed as part of a comprehensive benefits strategy.
This document discusses universal health insurance (UHI) in Ireland and outlines some key issues. It distinguishes between universality, meaning health benefits for everyone funded through compulsory contributions, and insurance, which involves personal contracts, choice of insurers, and separate organizations for payors and providers. Two main problems are identified: fees limiting primary care access and two-tier hospital access. Implementing UHI will involve merging public funding streams with private insurance money flows and clarifying issues around payments, benefits, and the roles of providers, insurers, and the public.
National Association of GPs Presentation 20 July 2013Oliver O'Connor
A presentation I gave at the EGM of Ireland's National Association of General Practitioners. Shows progress in some areas of health; payments to GPs since 2002; and argues that general practice should embrace measures which show its value and contribution to healthcare.
The document discusses health spending trends and sustainability. It finds that while spending is growing, it is not unsustainable and growth is not out of control. Age-related cost increases can be managed through anticipation. However, the application of resources may not be efficient. Reforms aimed at improving efficiency, such as reducing staffing and supply costs, could achieve annual savings of up to 5% of GDP.
Ceohealth matters paper 4 sept12 forum jb oocOliver O'Connor
This document discusses how the introduction of a Money Follows the Patient (MFtP) payment system in Ireland could be influenced by European law and the Single Market. It notes that MFtP is envisioned as a step towards establishing universal health insurance in Ireland. The document outlines some key questions around how MFtP might work in practice, such as whether private providers could bid for publicly funded services, and how MFtP might interact with a future system of competing health insurers commissioning care. It also briefly discusses the potential relevance of the Fair Deal nursing home scheme, which already uses a form of money following the patient.
The document summarizes the key economic and political factors surrounding Ireland's "Celtic Tiger" boom and subsequent banking crisis from the late 1980s to 2010. It discusses how Ireland experienced rapid economic growth until the 2008 global financial crisis, which then led to a massive banking and property crash in Ireland. Loose fiscal policy, easy access to credit, and overreliance on construction contributed to an unsustainable boom. The crash forced Ireland to accept an EU-IMF bailout and has left lasting economic and political impacts.
1 armstrong presentation on price and tariff setting v2Oliver O'Connor
Presentation at a forum I organised on Money Follows the Patient hospital payment systems 4 September 2012
John Armstrong is actuary with Aviva in Ireland
Application of EU Single Market rules to providers of healthcare in Ireland anticipating move to Universal Health Insurance - legal and practical arguments
Submission to Dilnot Commission on Social Care UKOliver O'Connor
The document discusses Ireland's reform of financing long-term residential care. It introduced a new scheme in 2009 that shares costs between individuals and the state based on means testing, without requiring individuals to sell their homes to pay for care. The reform aimed to establish a coherent system with protections for users and choice among public and private homes meeting quality standards. Significant political commitment was needed to overcome initial opposition during the multi-year design and implementation process.
Tariff setting in Dutch Healthcare system, Johan van ManenOliver O'Connor
This document discusses health care reform and tariff setting in the Netherlands. It outlines two models used to calculate tariffs. Model I calculates average costs per diagnostic treatment combination (DBC) procedure based on a sample of hospitals, while Model II calculates total costs per DBC for each hospital. The document also describes how the proportion of regulated versus negotiable hospital costs and physician fees has changed over time as the system transitioned from centralized regulation to more market-based negotiations between insurers and providers.
Cost dynamics in Irish Health Care Society of Actuaries presentation Oct 2012Oliver O'Connor
The document discusses rising health care costs as a threat to economies and sustainability. It notes that while aging populations contribute somewhat to increased costs, other factors like new technologies and income growth are larger drivers. International data shows health spending as a percentage of GDP has risen significantly over 40 years. While most countries see continued increases projected, Ireland is estimated to have relatively low excess cost growth. The document advocates for policies like budget caps, more competition, and supply-side reforms to manage costs over the long run.
2. What does UHI mean?
Easy answer:
• Universal = Same benefits for EVERYONE, no faster access for ANYONE
• Universal = Compulsory source of funding
Where we are now:
• Universal public hospital care legally established
– Secondary care, tertiary care
• Private hospitals and private beds in public hospitals available to insured
• GP/primary care:
– No single legal framework
– Means tested medical card for 36-38% population
– For others: available GP and primary care: but out of pocket cost affordable?
• Long term care: one framework with graduated ‘co-pay’
• Compulsory taxation revenue base – progressive, effective
ooc@sky.com
3. Programme for Government – UHI
• UHI will deliver “equal access to care for all”
• There will be no discrimination between patients on the
grounds of income or insurance status. The two-tier system
of unequal access to hospital care will end.
• A system of Universal Health Insurance (UHI) will be
introduced by 2016, with the legislative and organisational
groundwork for the system complete within this
Government’s term of office.
• UHI will provide guaranteed access to care for all in public
and private hospitals on the same basis as the privately-
insured have now.
• Everyone will have a choice between competing insurers.
• …system will not be subject to European or national
competition law.
ooc@sky.com
4. Programme for Government – UHI
• Insurance with a public or private insurer will be
compulsory with insurance payments related to ability
to pay.
• Exchequer funding for hospital care will go into a
Hospital Insurance Fund which will subsidise or pay
insurance premia for those who qualify for subsidy.
• The Hospital Insurance Fund will also control those
health care costs for which central control is most
effective.
• A White Paper on Financing UHI will be published early
in the Government’s first term.
ooc@sky.com
5. Programme for Government –
Primary Care
• Free GP care then free primary care
– “Universal Primary Care will remove fees for GP care
and will be introduced within this Government’s term
of office” (March 2016)
– “Universal Primary Care will be introduced in phases so
that additional doctors, nurses and other primary care
professionals can be recruited.”
– “Access to care without fees will be extended to all in
the final phase” [not specified when]
• [Costings to be specified and part funded from efficiency
savings]
ooc@sky.com
6. Health Basics – providing and paying
• Simplified diagram
Services
Individuals Intermediaries Providers
Resources
ooc@sky.com
7. Slightly less basic – current system
General taxation Govt Annual budget HSESalaries, grants
Govt usage charges
Tax relief
Fees, charges
Insurance policy premia
Insurers
Direct out of pocket fees
ooc@sky.com
8. Current system - € flows approx
€13.3bn €13.6bn €13.6bn
General taxation Govt Annual budget HSESalaries, grants
€300m
Govt usage charges €300m
Tax relief
€1.7bn €1.8bn
Fees, charges
Insurance policy premia
Insurers
€1.7bn?
Direct out of pocket fees, payments
€17bn health economy = 10.6% GDP, 13% GNP
ooc@sky.com
9. Is this the new world?
General taxation Govt Salaries, cap
ital grants
Health Insurance Fund
Compulsory premia Fees, charges
State VHI;
Top-up premia Private
Insurers
Direct out of pocket fees??
ooc@sky.com
10. Complex issues for all stakeholders
• For the Exchequer: Funding
• For Patients / the public: Benefits and Payment
• For Insurers: role and commercial freedom
• For Providers: payments, commercial freedoms
• For Doctors, staff: remuneration, management
• For Dept of Health: integrated
care, performance, outcomes
• For State and citizen: health law and equity
ooc@sky.com
11. Exchequer
• Funding
– What will it cost? Free GP care – free primary care – UHI
– How much in direct taxation? How much in compulsory premium?
– Capital funding
• Cap and control
– Need to ensure annual budget cap still robust
– Need assurance that system does not include cost escalation dynamic
– Finance to control insurance premium level and means test levels
– Failure regime for insurers/hospitals
• Collection
– Through PAYE? Non-PAYE sector?
• Economic
– Is premium effectively extra PRSI? Scope? Headroom for other taxes?
No Govt decision will be made until these all addressed in advance
ooc@sky.com
12. Patients – the public
• What benefits do I get?
– Every hospital, every procedure covered?
• Premium level and means test
– How much to I pay?
– Do I pay more than now, less or the same?
– How is the means test implemented?
– Enforcement – what if I don’t pay?
• Choice and control
– Can I buy additional/top-up insurance?
– Can I have choice of consultant/choice of hospital?
All need policy, law, administrative systems, communication, implementation
ooc@sky.com
13. Insurers
• Funding
– Freedom to set rates? Not really
– How will they get enough funding to pay the benefits?
– Claims control function?
– What reserves level needed? 40% or 9%?
• Commercial
– Compete on what … quality administration?
– Allowed offer additional benefits?
– Freedom to select providers?
– Scope for profit making
• Risk equalisation
– System needs to be comprehensive but not stifling
– Balance of customers and claims – 80% claims at VHI
Major strategic issues for insurers who need clarity and advance notice
ooc@sky.com
14. Providers - hospitals
• Payment mechanisms
– ‘Money Follows the Patient’ to be in place first
– Price/tariff system needed, requiring data
– Complex and still far away
• Governance
– Public hospitals to become independent trusts before UHI
– Complex and still far away
• Competitive forces
– Do they compete for patients?
– What drives efficiency?
– What happens to underperforming hospitals?
– Hidden or open subsidies from State for good/bad reasons?
– Any scope for income-generation beyond State package?
– Profit making allowed/accommodated?
Both public and private hospitals have major strategic issues
ooc@sky.com
15. Doctors and staff
• GPs
– GPs to give up private fee earning and replace with capitation/salary/fee
– IR negotiation of new contract – still far off
– Will they take less money than currently earned? €300m?
– Replacing private fee payment with Exchequer fees is an increase in
public spending
• Consultants
– How will they be paid? All salary? All fee?
– Will no longer earn salaries + substantial fee income (c.€1bn total cost)
– New contract needed - complex and still far away
– Employment, by whom? Independent contractors?
• Other clinical staff
– Recruitment to State salaries of all new health professionals? Headroom?
Major IR issues on both primary care and hospital care side
ooc@sky.com
16. Dept of Health – policy
• Performance and outcomes
– What health outcomes are specified for the new system?
– How is the performance of health providers to these outcomes to be
managed and delivered?
• Integrated Care
– How exactly is integrated care to be organised and managed?
– How are competing insurers to implement this?
• Regulation and governance
– New agencies (Patient Safety, Integrated Care, Insurance Fund)
– Future of HSE and all its non-hospital staff
– New system of hospital regulation (clinical, governance and financial
standards)
– Close insurance regulation needed in this system
– Competition regulation needed where any commercial activity takes place
Strong, but redesigned role still needed at centre for health policy determination
ooc@sky.com
17. State and Citizen
• Legal basis for health provision
– Potential fundamental change from Health Acts 1970-2005
– How close to private contract based law?
– Enforceability of personal right to healthcare any stronger?
• Equity
– How will this be defined?
– And implemented?
– Scope for any patient-doctor-provider-insurer relationship outside of State-
mandated system?
– Are there losers as well as winners: does the public understand the
consequences?
General approval for fair healthcare, but public not yet engaged on actual realities
ooc@sky.com
18. Implied Timing for Life of Government
• 2011:
– NTPF suspended and HSE board removed
– Universal Health Insurance Commission
– Special Delivery Unit up and running
– VHI EU Court decision
• 2012:
– Legislation on new HSE board published, not yet enacted
– Cost pressures - Significant savings – but little scope for new spending
– White Paper on UHI – delayed to 2013
• 2013:
– Risk equalisation in place – new legislation but may be amended
– VHI derogation ended and capitalised in State ownership: pressure
– HSE new legal status in place
– Money Follows the Patient system designed start implementation
ooc@sky.com
19. Implied Timing
• 2014
– Money Follows the Patient system across 52 hospitals
– Hospital Care Purchase Agency takes over hospital role of HSE
– New contracts for GPs and Consultants
• 2015
– Free GP care for all
– Integrated Care Agency set up
– Public Hospitals are all not-for-profit trusts in networks or standalone
– HIQA/Patient Safety Authority licensing of hospitals and regulation
– Health Insurance Fund established
– Full analysis of funding and Exchequer control completed and agreed
– Benefits package under UHI specified
– Costs and means test for individuals set out
– Scheme of legislation for UHI published
ooc@sky.com
20. Implied Timing
• 2016
– General election before March
– UHI enacted and implemented
ooc@sky.com
21. Conclusions
• Moving to UHI is immensely complex: will not happen for
2016
• Capacity to design and deliver policy, legal, technical changes
questionable: over-stretch
• Even with technical legal and policy work done, headroom
for new spending, new recruitment not available yet
• Equity of access issues may be addressed in advance of UHI
• For indicators, watch progress on necessary precursors:
– GP and consultant contracts
– Money Follows the Patient system
– Independent trust status for hospitals
ooc@sky.com