The Diagnostic Care Group (DCG) model is applied to data from the Massachusetts Group Insurance Commission from fiscal years 1994-1995 and used to assess the extent of biased selection between one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance...

This paper compares the cost and quality incentive effects of cost reimbursement and prospective payment systems in the health industru when providers are altuistic. Provider's behavioral rule is governed by a desire to maximize a weighted sum of profit and consumers' health benefit.

"Medicare" has two meanings for Canadians: the entire range of health care services, or only those (mainly physicians and hospitals) mandated and governed by the Canada Health Act (CHA). This paper focuses on the narrower legal meaning of Medicare, as does the recent Alberta proposal to fund...

This paper has attempted to identify characteristic patterns of performance in tax-financed (TF) systems, contrasting them with systems relying more heavily on other revenue sources.

Over the past decade, the 'pharmacoeconomics' phenomenon has incited a stream of commentaries about the economic evaluation of drugs, conflicts of interest and ways of retaining respectability for this component of health economics profession. Private coporations now finance so many aspects of...

This paper attempts to answer the following questions. Why and did North America's first public health insurance scheme develop in Saskatchewan? What were the unique features of Saskatchewan's economy, geography, history which may helped the development of public health insurance in this...

This paper analyses possible options how to improve the risk adjustment of the health insurance system in the Czech Republic. Out of possible options it argues for including Pharmaceutical Cost Groups (PCGs) as additional risk factors since it is an improvement that can be implemented almost...

We discuss that Japan should make a comprehensive reform of the existing institutions of health insurance in view of the apparent structural problems centering on the financial instability of health care finance, and discrepancies in premiums and benefits among the insured.

In recent years numerous employers have reformed their health plan by changing the structure of employee contributions to premiums across different plans and across different rate classes (e.g., single versus family). This paper develops the notion of "premium cost sharing", in which the focus...

Nous reflechissons a la meilleure facon de permettre l'emergence, dans un systeme de snate finance de maniere socialiste, d'acteurs capables de mettre en oeuvre les tehniques du managed care. Nous designons ces nouveaux acteurs par le terme "operateurs de soins", en reference a l'economie des...