We study the effects of "balance billing", i.e., allowing physicians to charge a fee from patients in addition to the fee paid by Medicare. First, we show that on pure efficiency grounds the optimal Medicare fee under balance billing is zero. An active Medicare policy thus can only be justified...

Objective: To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods: We use 2004...

Background: Concerns have been raised about physician ownership of onsite advanced imaging equipment as allowed under Stark laws by the in-office ancillary service exception (IOASE). Methods: A web-based survey of orthopedic practices in the United States was used to assign a first date of...

Background: We analysed the impact of clinical study design for oncological pharmaceuticals on the subsequent price negotiations after early benefit assessment between pharmaceutical companies and the German National Association of Statutory Health Insurance Funds. The analysis was conducted for...

Introduction: Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and...

Background: To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility. Materials and methods: One hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n...

Background: Health care expenditures (HCE) are known to steepen with increasing age, but the contributions of biological age, morbidity, or proximity to death as cost drivers are debated. Age-associated HCE growth can be studied across two dimensions: within fixed groups of persons with the same...

Introduction: Prophylactic vaccinations play a significant role in health care. As a relatively cost-effective preventive measure they can help to avert transmissible diseases and thus protect not only the vaccinated individuals themselves but also those who have not been vaccinated. In order to...

Background: This contribution seeks to measure preferences for health insurance in Germany and the Netherlands, using two Discrete Choice Experiments (DCE). Since the Dutch DCE was carried out right after the 2006 health reform, which made citizens explicitly choose a health insurance contract,...