ABSTRACT
New regulations, which have been implied by the Health Structure Act, are aiming to improve the coordination between ambulant and in-patient-surgery. In the view of the health insurance scheme, this could be the beginning of a new era in the health care system of Germany. Following a short presentation of these new regulations and of the opportunities to cut down expenses by ambulatory surgery, the author describes the development of ambulatory surgery in the private-practice-setting. He presents the framework for ambulatory surgery in hospitals, which has been created by negotiations on a national level, and he draws future perspectives of ambulatory surgery.
Subject(s)
Ambulatory Surgical Procedures/economics , Financial Management, Hospital/economics , Insurance, Surgical/economics , Cost-Benefit Analysis/legislation & jurisprudence , Financial Management, Hospital/legislation & jurisprudence , Germany , Humans , Insurance, Surgical/legislation & jurisprudence , Private Practice/economics , Private Practice/legislation & jurisprudenceABSTRACT
A definition of insurance medicine is presented with due consideration for national peculiarities (social insurances) in Switzerland. The historical development from original trauma-directed accident medicine to the present-day insurance medicine with its more comprehensive nature is shown with particular consideration being given to the close connection with traumatology (trauma surgery/orthopaedic surgery). The guarantee of smooth-running and constructive cooperation between traumatologists and welfare organizations is one of the major tasks of doctors employed in insurance companies, whose sphere of influence and qualifications are under discussion.
Subject(s)
Accidents/legislation & jurisprudence , Insurance, Accident/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Wounds and Injuries/surgery , Expert Testimony/legislation & jurisprudence , Humans , Patient Care Team/legislation & jurisprudence , SwitzerlandABSTRACT
This notice implements section 1833(i)(2(A) of the Social Security Act, which requires that the payment rates for ambulatory surgical center services be reviewed and updated annually, and responds to public comments we received concerning the ambulatory surgical center payment rate update notice published on February 8, 1990 (55 FR 4577).
Subject(s)
Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Medicare/legislation & jurisprudence , Rate Setting and Review/legislation & jurisprudence , Surgicenters/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S. , Humans , Lenses, Intraocular/economics , United StatesSubject(s)
Ethics, Medical , Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Politics , Quality Assurance, Health Care/legislation & jurisprudence , Surgical Procedures, Operative/standards , Germany, West , HumansSubject(s)
Health Services Misuse/legislation & jurisprudence , Health Services/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , Surgical Procedures, Operative , Humans , United StatesSubject(s)
Health Services Misuse/legislation & jurisprudence , Health Services/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Quality Assurance, Health Care/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , Surgical Procedures, Operative , Germany, West , HumansSubject(s)
Health Services Misuse/legislation & jurisprudence , Health Services/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Quality Assurance, Health Care/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , Surgical Procedures, Operative , Germany, West , HumansSubject(s)
Diagnosis-Related Groups/economics , Insurance, Health/legislation & jurisprudence , Insurance, Surgical/legislation & jurisprudence , Medicare/legislation & jurisprudence , Prospective Payment Assessment Commission , Prospective Payment System , Fee Schedules/legislation & jurisprudence , United StatesABSTRACT
This study evaluates a mandatory second-opinion consultation program administered on behalf of a large Taft-Hartley welfare fund providing medical care coverage for 120,000 beneficiaries and covered dependents. During a two-year intake period (1977-1978), 2,284 individuals received second-opinion consultations for an elective surgical procedure recommended by a first-contact physician or surgeon. Of this group, 366 received a nonconfirmation of their need for surgery. Medical claims data were available for 342 individuals in this group, and they constitute the base for the current analysis. A comparable number of individuals who received a positive confirmation were randomly selected and served as a control for estimating program savings. Both groups were followed for a one-year period from the date of their consultations. Total program savings were estimated at $534,791. Of this amount, medical care utilization savings were $361,756 and productivity savings were $173,035. The cost of the program was $203,300, yielding a benefit-cost ratio of 2.63. These findings indicate that mandatory second-opinion consultation programs, which are consumer oriented and intervene before care is rendered, are clearly cost-effective.