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Pesquisa : N03.219.521.576.343.820 [Categoria DeCS]
Referências encontradas : 534 [refinar]
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[PMID]:28381338
[Au] Autor:Bes RE; Curfs EC; Groenewegen PP; de Jong JD
[Ad] Endereço:NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands. Electronic address: r.bes@nivel.nl.
[Ti] Título:Selective contracting and channelling patients to preferred providers: A scoping review.
[So] Source:Health Policy;121(5):504-514, 2017 May.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Selective contracting by health insurers and channelling patients to contracted providers is crucial in a health care system based on managed competition, as this should lead to better value for money delivery of healthcare. However, an important consequence for enrolees is that health insurers interfere with their choice of care provider. This scoping review aims to find out what is known about selective contracting from the enrolee's perspective. Is it being done and how do enrolees feel about the role of their health insurer in their care provider choice? A literature search was conducted, and, in addition, experts were consulted for extra information and documents. Results show that selective contracting and channelling are practised in several countries. This is mostly through negative financial incentives, which are also found to be the most effective strategy. However, enrolees are very negative about restrictions on provider choice introduced by their insurer. This results in enrolees feeling less satisfaction with, and trust in, care providers and health insurers. Choice is crucial in this respect since enrolees are more satisfied with their health plans and care providers when they have chosen them themselves. Future research should focus on the role of trust and how people weigh different attributes of health plans if selective contracting and channelling is to be implemented in a manner acceptable to enrolees.
[Mh] Termos MeSH primário: Comportamento de Escolha
Comportamento do Consumidor/economia
Seguro Saúde/organização & administração
Competição em Planos de Saúde
[Mh] Termos MeSH secundário: Pessoal de Saúde/economia
Seres Humanos
Seguradoras/economia
Motivação
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE


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[PMID]:27986338
[Au] Autor:Westra D; Angeli F; Carree M; Ruwaard D
[Ad] Endereço:Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: d.westra@maastrichtuniversity.nl.
[Ti] Título:Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective.
[So] Source:Health Policy;121(2):149-157, 2017 Feb.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Pro-competitive policy reforms have been introduced in several countries, attempting to contain increasing healthcare costs. Yet, research proves ambiguous when it comes to the effect of competition in healthcare, with a number of studies highlighting unintended and unwanted effects. We argue that current empirical work overlooks the role of inter-organizational relations as well as the interplay between policy at macro level, inter-organizational networks at meso level, and outcomes at micro level. To bridge this gap and stimulate a more detailed understanding of the effect of competition in health care, this article introduces a cross-level conceptual framework which emphasizes the intermediary role of cooperative inter-organizational relations at meso level. We discuss how patient transfers, specialist affiliations, and interlocking directorates constitute three forms of inter-organizational relations in health care which can be used within this framework. The paper concludes by deriving several propositions from the framework which can guide future research.
[Mh] Termos MeSH primário: Comportamento Cooperativo
Competição Econômica
Pessoal de Saúde/economia
[Mh] Termos MeSH secundário: Reforma dos Serviços de Saúde
Seres Humanos
Competição em Planos de Saúde
Modelos Organizacionais
Inovação Organizacional
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:161218
[St] Status:MEDLINE


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[PMID]:27956096
[Au] Autor:Siciliani L; Chalkley M; Gravelle H
[Ad] Endereço:Department of Economics and Related Studies, University of York, YO10 5DD York, United Kingdom. Electronic address: luigi.siciliani@york.ac.uk.
[Ti] Título:Policies towards hospital and GP competition in five European countries.
[So] Source:Health Policy;121(2):103-110, 2017 Feb.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway and Portugal. Drawing on the policies and empirical evidence described in five case studies, we find both similarities and differences in the approaches adopted. Constraints on patients' choices of provider have been relaxed but countries differ in the amount and type of information that is provided in the public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them to compete on quality but prices are set in different ways across countries. They can be collectively negotiated, determined by the political process, negotiated between insurers and providers or centrally determined by provider costs. Competition amongst GPs varies across countries and is limited in some cases by shortages of providers or restrictions on entry. There are varied and innovative examples of selective contracting for patients with chronic conditions aimed at reducing fragmentation of care. Competition authorities do generally have jurisdiction over mergers of private hospitals but assessing the potential impact of mergers on quality remains a key challenge. Overall, this study highlights a rich diversity of approaches towards competition policy in healthcare.
[Mh] Termos MeSH primário: Competição Econômica/economia
Clínicos Gerais/economia
Política de Saúde
Hospitais/tendências
Competição em Planos de Saúde/economia
[Mh] Termos MeSH secundário: Comportamento de Escolha
Europa (Continente)
Regulamentação Governamental
Instituições Associadas de Saúde
Seres Humanos
Disseminação de Informação
Qualidade da Assistência à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:161214
[St] Status:MEDLINE


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[PMID]:27923494
[Au] Autor:Schut FT; Varkevisser M
[Ad] Endereço:iBMG, Erasmus University Rotterdam, Rotterdam, The Netherlands.
[Ti] Título:Competition policy for health care provision in the Netherlands.
[So] Source:Health Policy;121(2):126-133, 2017 Feb.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:In the Netherlands in 2006 a major health care reform was introduced, aimed at reinforcing regulated competition in the health care sector. Health insurers were provided with strong incentives to compete and more room to negotiate and selectively contract with health care providers. Nevertheless, the bargaining position of health insurers vis-à-vis both GPs and hospitals is still relatively weak. GPs are very well organized in a powerful national interest association (LHV) and effectively exploit the long-standing trust relationship with their patients. They have been very successful in mobilizing public support against unfavorable contracting practices of health insurers and enforcement of the competition act. The rapid establishment of multidisciplinary care groups to coordinate care for patients with chronic diseases further strengthened their position. Due to ongoing horizontal consolidation, hospital markets in the Netherlands have become highly concentrated. Only recently the Dutch competition authority prohibited the first hospital merger. Despite the highly concentrated health insurance market, it is unclear whether insurers will have sufficient countervailing buyer power vis-à-vis GPs and hospitals to effectively fulfill their role as prudent buyer of care, as envisioned in the reform. To prevent further consolidation and anticompetitive coordination, strict enforcement of competition policy is crucially important for safeguarding the potential for effective insurer-provider negotiations about quality and price.
[Mh] Termos MeSH primário: Clínicos Gerais/economia
Política de Saúde
Competição em Planos de Saúde/economia
[Mh] Termos MeSH secundário: Competição Econômica/economia
Regulamentação Governamental
Reforma dos Serviços de Saúde
Hospitais
Seres Humanos
Países Baixos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:161208
[St] Status:MEDLINE


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[PMID]:27899219
[Au] Autor:Klink A; Schakel HC; Visser S; Jeurissen P
[Ad] Endereço:Faculty of Social Sciences, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands. Electronic address: klink.ab@gmail.com.
[Ti] Título:The arduous quest for translating health care productivity gains into cost savings. Lessons from their evolution at economic scoring agencies in the Netherlands and the US.
[So] Source:Health Policy;121(1):1-8, 2017 Jan.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:We analyze the assessments of recent health reforms by the Congressional Budget Office (CBO) in the United States and the Bureau for Economic Policy Analysis (CPB) in the Netherlands. Both reforms aim to capitalize on productivity gains, which is appealing for policymakers because of the potential for cost savings while maintaining - or enhancing - quality and access. These measures however generally translate into more health care, rather than care that is affordable and appropriate. Scoring agencies therefore have rightfully been reluctant to assign significant savings to these measures. Thus with regard to cost savings, both agencies instead have favored more traditional policy measures in the past. They are however increasingly mapping out loose ends and dilemmas for payers, including information asymmetries, reputation issues and provider business models that contradict the goals of policymakers. This calls for further exploring this avenue and the development of more integrated agendas that might commit actors and the spread of best practices.
[Mh] Termos MeSH primário: Orçamentos
Redução de Custos/economia
Reforma dos Serviços de Saúde/economia
Competição em Planos de Saúde
[Mh] Termos MeSH secundário: Órgãos Governamentais
Acesso aos Serviços de Saúde
Seres Humanos
Países Baixos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:161201
[St] Status:MEDLINE


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[PMID]:26994866
[Au] Autor:Westra D; Wilbers G; Angeli F
[Ad] Endereço:Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands. Electronic address: d.westra@maastrichtuniversity.nl.
[Ti] Título:Stuck in the middle?: A perspective on ongoing pro-competitive reforms in Dutch mental health care.
[So] Source:Health Policy;120(4):345-9, 2016 Apr.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Pro-competitive reforms have been implemented in many Western healthcare systems, of which the Netherlands is a prominent example. While the pro-competitive reforms in the Dutch specialized care sector have drawn considerable academic attention, mental health care is often excluded. However, in line with other segments of specialized care, pro-competitive legislation has formed the core of mental health care reforms, albeit with several notable differences. Ever since mental health services were included in the Health Insurance Act in 2008, the Dutch mental healthcare sector has been in an ongoing state of reform. Numerous major and minor adaptations have continuously altered the services covered by the basic insurance package, the actors responsible for providing and contracting care, and definitions and measurements of quality. Most notably, insurers and municipalities, which are responsible for selectively contracting those providers that offer high value-for-money, seem insensitive to quality aspects. The question whether the Dutch mental health sector has inherited the best or the worst of a competitive and non-competitive system lingers and international policy makers contemplating reforming their mental health sector should take note.
[Mh] Termos MeSH primário: Reforma dos Serviços de Saúde/métodos
Reforma dos Serviços de Saúde/organização & administração
Competição em Planos de Saúde
Serviços de Saúde Mental
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: Política de Saúde
Seres Humanos
Seguro Saúde
Serviços de Saúde Mental/normas
Países Baixos
Política
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:160321
[St] Status:MEDLINE


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[PMID]:25702821
[Au] Autor:Portrait FR; van der Galiën O; Van den Berg B
[Ad] Endereço:Department of Health Sciences, VU University, Amsterdam, The Netherlands.
[Ti] Título:Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.
[So] Source:Health Econ;25(4):408-23, 2016 Apr.
[Is] ISSN:1099-1050
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. DATA AND METHODS: We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. RESULTS AND CONCLUSION: There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition.
[Mh] Termos MeSH primário: Diabetes Mellitus/terapia
Pessoal de Saúde/normas
Competição em Planos de Saúde/normas
Indicadores de Qualidade em Assistência à Saúde
[Mh] Termos MeSH secundário: Idoso
Análise Custo-Benefício
Assistência à Saúde/normas
Diabetes Mellitus/economia
Feminino
Reforma dos Serviços de Saúde
Pessoal de Saúde/economia
Seres Humanos
Seguro Saúde
Masculino
Competição em Planos de Saúde/estatística & dados numéricos
Meia-Idade
Países Baixos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150224
[St] Status:MEDLINE
[do] DOI:10.1002/hec.3158


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[PMID]:26713347
[Au] Autor:Tiedtke E
[Ti] Título:The Affordable Care Act (Obamacare) Update - THIRD TIME'S A CHARM? OR THIRD STRIKE?.
[So] Source:Tex Dent J;132(10):858-61, 2015 Oct.
[Is] ISSN:0040-4284
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Patient Protection and Affordable Care Act/legislação & jurisprudência
Administração da Prática Odontológica/legislação & jurisprudência
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis/economia
Organizações de Assistência Responsáveis/organização & administração
Financiamento Pessoal
Seres Humanos
Seguradoras
Competição em Planos de Saúde/economia
Competição em Planos de Saúde/organização & administração
Patient Protection and Affordable Care Act/economia
Administração da Prática Odontológica/economia
Decisões da Suprema Corte
Texas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1602
[Cu] Atualização por classe:151229
[Lr] Data última revisão:
151229
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:151230
[St] Status:MEDLINE


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[PMID]:26355050
[Au] Autor:Thoumi A; Udayakumar K; Drobnick E; Taylor A; McClellan M
[Ad] Endereço:Andrea Thoumi is a research associate in the Center for Health Policy at the Brookings Institution, in Washington, D.C.
[Ti] Título:Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.
[So] Source:Health Aff (Millwood);34(9):1489-97, 2015 Sep.
[Is] ISSN:1544-5208
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.
[Mh] Termos MeSH primário: Diabetes Mellitus/economia
Saúde Global
Reforma dos Serviços de Saúde/organização & administração
Gastos em Saúde
Competição em Planos de Saúde/organização & administração
[Mh] Termos MeSH secundário: Redução de Custos
Diabetes Mellitus/diagnóstico
Diabetes Mellitus/terapia
Gerenciamento Clínico
Feminino
Seres Humanos
Índia
Masculino
México
Inovação Organizacional
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170120
[Lr] Data última revisão:
170120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150911
[St] Status:MEDLINE
[do] DOI:10.1377/hlthaff.2015.0403


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[PMID]:25901049
[Au] Autor:McClellan MB; Thoumi AI
[Ad] Endereço:The Brookings Institution, Washington, DC mmcclellan@brookings.edu.
[Ti] Título:Oncology payment reform to achieve real health care reform.
[So] Source:J Oncol Pract;11(3):223-30, 2015 May.
[Is] ISSN:1935-469X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.
[Mh] Termos MeSH primário: Reforma dos Serviços de Saúde/economia
Competição em Planos de Saúde/economia
Oncologia/economia
Mecanismo de Reembolso/economia
[Mh] Termos MeSH secundário: Redução de Custos
Análise Custo-Benefício
Planos de Pagamento por Serviço Prestado/economia
Planos de Pagamento por Serviço Prestado/legislação & jurisprudência
Reforma dos Serviços de Saúde/legislação & jurisprudência
Reforma dos Serviços de Saúde/normas
Seres Humanos
Competição em Planos de Saúde/legislação & jurisprudência
Competição em Planos de Saúde/normas
Oncologia/legislação & jurisprudência
Oncologia/normas
Formulação de Políticas
Melhoria de Qualidade/economia
Indicadores de Qualidade em Assistência à Saúde/economia
Mecanismo de Reembolso/legislação & jurisprudência
Mecanismo de Reembolso/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1604
[Cu] Atualização por classe:161020
[Lr] Data última revisão:
161020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150423
[St] Status:MEDLINE
[do] DOI:10.1200/JOP.2015.004655



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