Low Payment Rates Research Articles

How Child Health Financing and Payment Mitigate and Perpetuate Structural Racism

Health financing for children and youth comes mainly from commercial sources (especially, a parent’s employer-sponsored insurance) and public sources (especially, Medicaid and Children’s Health Insurance Plan [CHIP]). These 2 sources serve populations that differ in race and ethnicity. This inherent segregation perpetuates a system of disparities in health and health care. Medicaid (and CHIP) have become the largest single provider of health insurance to US children and youth, currently insuring over 50% of all children and youth, with even higher rates for children of racial and ethnic minorities. Medicaid provides substantial benefit to the populations it insures, with good evidence of both short- and long-term improved health and developmental outcomes, and better health and well-being as adults. Nonetheless, some characteristics of Medicaid, especially the major state-by-state variation in eligibility, enrollment practices, and covered services, along with persistent low payment rates, have helped to maintain a separate and unequal health program for racial and ethnic minority children and youth. Several changes in Medicaid—including linking CHIP more closely with Medicaid, strengthening national standards of payment and care, assuring coverage of all children, and incorporating social and family risk adjustment—could make the program even more beneficial and diminish racial differences in child health financing.

넷이즈 클라우드뮤직과 한국의 뮤지션 지원 서비스 플랫폼 비교 분석

This study aims to compare NetEase Cloud Music with Korean musician support service platforms, to help Korean music platforms provide diverse support services for indie musicians. We analyzed the digital music markets and platform operations in Korea and China, finding that while Chinese platforms developed various revenue models in response to low payment rates and exclusive music sharing policies, Korean platforms have been less proactive, often influenced by telecom discounts/promotions. We also compared the characteristics of NetEase Cloud Music and Korean musician support service platforms, including Korea and China's music distribution methods. NetEase's musician support service offers integrated service features and more convenience and revenue channels compared to Korean platforms. Based on this, we suggest directions for Korean music platforms in terms of musician support.

Medicaid rates to psychiatrists lag, with wide variation among states

Medicaid payment rates for psychiatric services continue to lag behind comparable Medicare reimbursement in most states, with wide variation in rates across the country, a newly published study reported. While low payment rates are thought to contribute to a shortage of psychiatrists treating low‐income patients, the study's researchers suggest that simply increasing reimbursement rates might not be enough to shore up the workforce.

No Surprises Act Brings New Billing Rules, Disclosures; Doctors Sue

No Surprises Act Brings New Billing Rules, Disclosures; Doctors Sue

ЭКОНОМИЧЕСКИЕ И ЭКОЛОГИЧЕСКИЕ АСПЕКТЫ АРЕНДЫ ЛЕСОВ НА ПРИМЕРЕ РЕСПУБЛИКИ МОРДОВИЯ

The article analyses the impact of the lease model of relations in forestry on the economic and environmental impact of its management. The existing low economic efficiency of forestry of the Republic of Mordovia and negative ecological trends require a revision of the forest management model. The forest sector of Mordovia failed to create a competitive market environment. The lease relationship did not create conditions to increase the profitability of timber production through its innovative development. The fact is that low payment rates of timber put the economic barrier on the way to modernization of timber production, stimulating the preservation of backward, inefficient technologies in the field of wood harvesting and processing, in which a large amount of waste is generated, there is low productivity, non-competitive products are produced in export markets. Also, the ecological condition of forests continues to deteriorate as a result of the development of lease relations in the region. The authors of the article consider that a concession model should replace the lease model of forest management. Its use will increase the profitability of forestry, as the concession payment for forest use will most rightly correspond the cost of consumed resources in the region, as well as take into account the unique natural characteristics of the territory used.

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

Understanding public health insurance in India: A design perspective.

It is broadly accepted that health policy is crucially affected by contextual conditions. Yet, little is known about how the context limits the effectiveness of public health insurance (PHI) programs and the extent to which these limitations could be overcome. The objective of the paper is to address these issues on the basis of the examination of 17 PHI schemes introduced by federal and state governments in India since independence. Faced with the challenge of simultaneously expanding insurance coverage while containing costs, governments have overwhelmingly favored the latter. At the same time, governments have lacked the capacity to monitor performance, which has led providers to compromise quality in return for low payment rates. While there have been modest improvements in recent years, reform efforts have been hindered by contextual conditions that constrain the use of measures to control profiteering by for-profit agencies. The paper argues that system-wide data on the quality of providers (system-level operational capacity) and the ability of public agencies to monitor quality and link it with payment (organizational-level operational capacity) critically determined the program effectiveness. We demonstrate the interaction between contextual variables, program design elements, and policy capacity linking to performance, arguing for a broader approach to understand PHI performance. We extend the present frameworks on PHI effectiveness that have narrowly focused on the design of health financing functions without factoring unfavorable context and limited policy capacity in developing countries. The paper contributes to improving PHI performance operating in unfavorable contextual conditions in India and elsewhere.

APA Study Reveals Network Inadequacy in DC Exchange Plans

“Narrow” or “phantom” networks are a nationwide problem whereby health plans advertise specialists, including psychiatrists, in their networks who may in fact not be taking appointments, may have moved out of the area, or may even have retired or died.

Managing the Future of Medicaid.

Managing the Future of Medicaid.

Calling All Doctors

Calling All Doctors

Competition and the Mental Health System

In the 1970s, mental health services were largely both publicly funded and publicly provided, but today service provision has shifted toward the private sector (1). As a result, the mental health care system increasingly relies on competition to allocate health care resources. In 2003, mental health services constituted 6.2% of all U.S. health spending or $100 billion (2). Competition for consumers—whether among insurers, hospitals, physicians, or others—largely determines which mental health services are produced, how they are produced, and at what prices they are produced. Below we discuss three notable features of the competitive mental health care market and their policy implications.

Statistical Modelling of Incentive Design Under Limited Information - The Case of Public Access to Farmland

This paper explores the use of statistical modelling to aid efficient policy design for the provision of environmental goods on farms under conditions of adverse selection. The specific case of incentive-based schemes to enhance the supply of public access to farmland is used as an example. A range of site willingness-to-pay (WTP) distributions are used to explore the benefits derived from policies designed under different levels of information. Where no individual farm information is available, low payment rates are optimal, but efficient market creation may not be possible. Increasing the information set allows discretion in pricing and entry: optimal payment rates and net benefits are higher and the pay-off from procuring improved information can be substantial. Such benefits are reduced where there is a welfare cost associated with increased government expenditure. Optimal policies are sensitive to the skewness of the WTP distributions. Mechanisms for increasing the information set available to policy makers are discussed.

White-Collar Crime Writ Small: A Case Study of Bagels, Donuts, and the Honor System

For more than a decade, an MIT-trained economist has meticulously recorded the results of nearly 75,000 deliveries of bagels and donuts to corporate offices. These bagels and donuts are left in workplaces in the morning, along with a list of prices and a lockbox. Office workers purchase the products on the honor system. Later that day, the uneaten goods and the lock box are collected and the relevant data for each office are recorded in a spreadsheet. These data provide a unique opportunity for understanding the extent to which individuals behave honestly in this setting and the factors that influence the level of honesty. An analysis of the discrepancy between the prices of the goods consumed and the actual payments deposited in the lock box yields a number of insights. First, the base payment rate is quite high. On average, payments represent almost 90 percent of the posted price. In a model of pure self-interest, one would expect very low payment rates, because there would seem to be many opportunities for individuals to take the products with almost no chance of their nonpayment being detected. Moderating the tendency to take the products without paying is the fact that low payment rates will increase the probability the delivery company stops serving the company. Paying for one’s bagels and donuts, viewed in this light, is a public good for other office workers. Thus, one might expect a strong negative relationship between office size and payment rates, which is not present in the data. Rather, the data appear more consistent with a model in which there are internal, nonpecuniary costs associated with stealing the bagels and donuts, i.e., people overwhelmingly pay for the products because it would be wrong not to do so. The observed payment rates are systematically related to a variety of observable factors. For instance, payment rates fall in response to increases in the posted price. This is consistent with the increase in financial costs pushing some marginal consumers to be willing to sustain the moral cost associated with not stealing the goods or paying less than full price. Payment rates are higher when many of the bagels and donuts go uneaten, suggesting that the marginal consumer pays a lower share of the posted price than the inframarginal consumer. Purchasers of donuts appear to be more likely to pay less than the full price. There is a sharp and persistent increase in the payment rate following the September 11 terrorist attacks.

Poor Endure Access Problems In All Regions of U.S.

Back to table of contents Previous article Next article Professional NewsFull AccessPoor Endure Access Problems In All Regions of U.S.Kate MulliganKate MulliganSearch for more papers by this authorPublished Online:6 Aug 2004https://doi.org/10.1176/pn.39.15.0390015Serious problems with access to mental health services have surfaced in one of the periodic analyses by the Center for Studying Health System Change (HSC) about the viability of the “safety net.”Every two years HSC researchers visit 12 nationally representative metropolitan communities to track changes in local health care markets. The communities are Boston, Cleveland, Greenville, S.C., Indianapolis, Lansing, Mich., Little Rock, Ark., Miami, northern New Jersey, Orange County, Calif., Phoenix, Seattle, and Syracuse, N.Y.The researchers interview individuals who are involved directly or indirectly in providing safety-net services to low-income people.The issue brief, “Health Care Access for Low-Income People: Significant Safety Net Gaps Remain,” published in June, reports on interviews that occurred in 2002-03.Comments such as “the mental health delivery system is in shambles” expressed the extent of these problems, according to researchers Laurie E. Felland, Suzanne Feit-Lisk, and Megan McHugh.Access to mental health services surfaced as a significant problem in eight of the 12 communities, although Felland told Psychiatric News that it should not be assumed that access was not a challenge in all the communities.“We are hearing that more and more patients are showing up at community health clinics and other places that provide primary care with serious mental health problems that have not been treated,” she said.HSC researchers typically have not interviewed individuals directly involved in providing mental health services, so these reports of problems suggest that mental health access issues are being manifested in the primary health care system.Felland said that their respondents also reported that more people with psychiatric emergencies are showing up in emergency rooms, a trend that has been documented in other research (Psychiatric News, June 18).One positive development has been the addition of mental health and substance abuse treatment services to community health centers through the use of federal grants from a program begun in 2002 by President Bush to expand and improve services at those centers.Felland and colleagues wrote, “State and local policymakers are aware of the access problems for specialty, mental health, and dental services, but communities have been more active in addressing the issue.”They continued by noting that budget constraints have hampered states' ability to allocate funds over the last few years.Felland said that although some states had increased Medicaid provider rates, those rates often were still much lower than private insurer rates.In addition, the HSC analysis was based on 2002-03 interviews before the deepest cuts to Medicaid had begun.The researchers concluded, “Across communities, low-income and uninsured people face long-standing, and sometimes worsening, difficulties in obtaining specialty, dental, and mental health services.... Safety net providers are not equipped to meet the wide range of health care needs of all low-income people, and access to private practitioners remains limited.”They identify low payment rates as a major barrier to access.“Health Care Access for Low-Income People: Significant Safety Net Gaps Remain” is posted online at<www.hschange.com/CONTENT/682/>.▪ ISSUES NewArchived

Long Hours and Fatigue: A Survey of Tractor-Trailer Drivers

Fatigue and long driving hours have been implicated as risk factors in truck crashes. Under federal regulations, commercial drivers are permitted to drive no more than 10 hours before having an 8-hour break and cannot work more than 70 hours over an 8-day period. Several studies have suggested that violations of these rules are common. A survey of long haul tractor-trailer drivers was conducted to estimate what proportion of drivers report that they regularly violate the hours-of-service rules and to identify the drivers most likely to commit hours-of-service violations. During December 1990 through April 1991, a total of 1,249 drivers were interviewed at truck safety inspection stations, truck stops, and agricultural inspection stations in Connecticut, Florida, Oklahoma, and Oregon. In each state, interviews were conducted during varying periods of the day over the course of seven days at inspection stations. Overall, 89 percent of eligible drivers asked for interviews participated in the survey. According to self-reports, almost three-fourths of the respondents violate hours-of-service rules. About two-thirds of the drivers reported that they routinely drive or work more than the weekly maximum. A primary impetus for violating rules appears to be economic factors, including tight delivery schedules and low payment rates. Many other driver, job, and vehicle characteristics were significantly associated with being an hours-of-service violator. The high prevalence of hours-of-service violations among tractor-trailer drivers is a problem in need of urgent attention. Potential measures to reduce the prevalence of rules violations include more enforcement directed toward carriers, wider use of electronic recorders, and increasing the number of rest areas.

Recent developments in federal reimbursement for home health care

Important recent changes in federal reimbursement for home health-care (HHC) services are discussed, and practical suggestions for dealing with these changes are offered. Regulatory changes affecting Medicare are generally directed at controlling HHC expenditures through more restrictive coverage criteria and lower payment rates. Both HHC agencies and HHC suppliers have been affected by recent regulatory developments, many of which have emanated from the program initiative work group (PIW) cost-control program implemented by HCFA. Regulatory changes in Medicaid have emphasized the substitution of home care for institutional care, particularly skilled-nursing-facility care. Private payments for HHC will likely be tied to capitation programs in which employers will contract directly with health-care organizations (such as health-maintenance organizations) to provide comprehensive services to employees and dependents. Until capitation financing becomes predominant, providers of HHC will be forced to contend with myriad carriers and insurance companies, each of which has its own coverage criteria and its own method of interpreting those criteria. Provider success will depend upon obtaining timely and favorable coverage determinations for prospective patients, establishing strong referral ties with physicians and discharge planners, being selective in the scope of services offered and the types of patients accepted, and keeping abreast of the regulatory changes that affect coverage and payment for HHC products and services.