... as the preferred way to allocate limited resources. At the same time, it also gave rise to the Oregon Health Insurance Experiment: an unprecedented opportunity to do a randomized evaluation — the gold standard in medical and scientific research — of the impact of expanding Medicaid. In this article we provide...

...Katherine Swartz There is mounting pressure at the federal (and state) level to require employers to provide health insurance to their employees. However, two quite different groups of workers could be affected by such a mandate. In addition, there are at least five major problems with requiring...

... topics at issue include the scope of services guaranteed by parity laws, coverage of certain habilitative therapies such as applied behavioral analysis for autism spectrum disorders, credentialing standards for MH/SUD providers, determinations regarding the medical necessity of MH/SUD services...

...Neville Doherty Copyright © 1981 by the Dept. of Health Administration, Duke University 1981 Competition in the Provision of Dental Services-Impacts on Providers and Consumers: An Introduction Neville Doherty, University of Connecticut Health Center...

...Roger Feldman Abstract A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private...

...Robert F. Leibenluft Abstract Antitrust enforcement has a crucial role to play in consolidated health care markets as providers undertake mergers, acquisitions, and other types of collaborations to integrate care and achieve greater size and scale. But antitrust enforcers and policy makers need...

...Howard A. Kahn Abstract The safety net is the delivery system that provides health care to low-income and uninsured populations. Following the recent implementation of health care reform, hundreds of thousands of people in Los Angeles County gained or became eligible for health care coverage...

...Julia Murphy; Michelle Ko; Kenneth W. Kizer; Andrew B. Bindman Abstract With the expansion of coverage as a result of federal health care reform, safety net providers are confronting a challenge to care for the underserved while also competing as a provider of choice for the newly insured. Safety...

...Robert Murray Point- Counterpoint The Case for a Coordinated System of Provider Payments in the United States Robert Murray...

.... That emphasis reflects not only the personal predilections of the author, but also the contention that those are the most sensible things to talk about. Reforming Medicare Provider Payment Bruce C. Vladeck, United Hospital Fund of New York Abstract. The basic thesis of this paper...

... financial sustainability, member states are employing market-based mechanisms to finance, manage, and provide health care. However, the introduction of elements of competition is constrained by the application of EU competition law, which raises significant concerns regarding the applicability...

... Act included provisions to increase insurance enrollment among American Indians. Although the Indian Health Service remains underfunded, increases in insured rates have had significant impacts among American Indians and their health care providers. Methods: From June 2016 to March 2017, we conducted...

.... California decision, indicates that the primary barriers to cost containment today are not obstructive tactics by providers or provider-controlled health insurance plans. Rather, the primary barriers are increases in the development and diffusion of new technology and society's apparent preference for paying...

.... Dynan, and L. R. Burns. 1999 /2000. Capitated Contracting of Integrated Health Provider Organizations. Inquiry (winter 1999/2000): 426 -444. Bazzoli, G. J., R. H. Miller, and L. R. Burns. 2000 . Capitated Contracting Relationships in Health Care. Journal of Healthcare Management 45 (May/June...

...Simon F. Haeder; David L. Weimer; Dana B. Mukamel Abstract In order to increase access to medical services, expanding coverage has long been the preferred solution of policy makers and advocates alike. The calculus appeared straightforward: provide individuals with insurance, and they will be able...

...Karl Kronebusch There is a substantial heterogeneity of interests within the Medicaid program. Its major beneficiary groups include the elderly, people with disabilities, children in low-income families, and adults receiving Aid to Families with Dependent Children. Providers who deliver medical...

...Colleen M. Grogan; Michael K. Gusmano Safety-net providers play a central role in the U.S. health care system because they provide the bulk of services to the poor and the uninsured. The health policy literature focuses a great deal on the capacity of these institutions to provide services...

... that report card data are collected, analyzed, and presented may further marginalize the experiences of these groups who in any case are already underserved by the health system. This observation also has important implications for health care providers who serve primarily large numbers of vulnerable patients...

...Anne Carroll; Jan M. Ambrose Any-Willing-Provider (AWP) legislation requires that health plans accept any health care provider who agrees to conform to the plan's conditions,terms, and reimbursement rates. Many states have adopted such legislation,raising questions about its effect on the managed...

...Lawrence D. Brown; Elizabeth Eagan The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III...