Price Setting and Price Regulation in Health Care Lessons for Advancing Universal Health Coverage

Price Setting and Price Regulation in Health Care Lessons for Advancing Universal Health Coverage PDF

Author: Barber Sarah L

Publisher: OECD Publishing

Published: 2019-06-26

Total Pages: 100

ISBN-13: 9264508864

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The objectives of this study are to describe experiences in price setting and how pricing has been used to attain better coverage, quality, financial protection, and health outcomes. It builds on newly commissioned case studies and lessons learned in calculating prices, negotiating with providers, and monitoring changes. Recognising that no single model is applicable to all settings, the study aimed to generate best practices and identify areas for future research, particularly in low- and middle-income settings. The report and the case studies were jointly developed by the OECD and the WHO Centre for Health Development in Kobe (Japan).

Price Setting and Price Regulation in Health Care

Price Setting and Price Regulation in Health Care PDF

Author: Sarah L. Barber

Publisher:

Published: 2019

Total Pages: 86

ISBN-13: 9789241515924

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The objectives of this study are to describe experiences in price setting and how pricing has been used to attain better coverage, quality, financial protection, and health outcomes. It builds on newly commissioned case studies and lessons learned in calculating prices, negotiating with providers, and monitoring changes. Recognising that no single model is applicable to all settings, the study aimed to generate best practices and identify areas for future research, particularly in low- and middle-income settings. The report and the case studies were jointly developed by the OECD and the WHO Centre for Health Development in Kobe (Japan).

Health Care Policy and Regulation

Health Care Policy and Regulation PDF

Author: Thomas A. Abbott III

Publisher: Springer Science & Business Media

Published: 2012-12-06

Total Pages: 260

ISBN-13: 1461522196

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5 care reforms. Part II: Price Regulation The second partofthis volume examines the role ofprice regulation in controlling health care costs. It contains three chapters. In chapter seven, I examine the alternatives for regulating pharmaceutical prices. In chapter eight, Jack Hadley examines the impactofvarious forms ofhospital price regulation; while in chapter nine,MarkPaulyexaminestheroleofpriceregulation incontrollingphysician fees. Chapter seven focuses on the issue of regulating pharmaceutical prices. There are two key issues examined in this paper. First, is there a clear need for price regulation, and second, can price regulation work in this industry? In response to the first question, I come to the conclusion that the proponents ofprice regulation have not really proven their case. Although the financial returns in the pharmaceu tical industry have been slightly higher than expected during the 1970s and 1980s, there is not overwhelming evidence of"price gouging" or excessive profits on the part of the industry. In response to the second question, the answer is clearly no. The traditional approaches to price regulation will not have the intended affect of eliminating excess profits from the industry while maintaining the incentives for research and development. First, rate-of-return regulation, the most natural approach, would result in many adverse incentives-includingexcessive investment in research and developmentinorderto inflatetheratebaseused tocalculatedtheallowablereturns.

Understanding Value Based Healthcare

Understanding Value Based Healthcare PDF

Author: Vineet Arora

Publisher: McGraw Hill Professional

Published: 2015-04-03

Total Pages: 417

ISBN-13: 007181700X

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Provide outstanding healthcare while keeping within budget with this comprehensive, engagingly written guide Understanding Value-Based Healthcare is a succinct, interestingly written primer on the core issues involved in maximizing the efficacy and outcomes of medical care when cost is a factor in the decision-making process. Written by internationally recognized experts on cost- and value-based healthcare, this timely book delivers practical and clinically focused guidance on one of the most debated topics in medicine and medicine administration today. Understanding Value-Based Healthcare is divided into three sections: Section 1 Introduction to Value in Healthcare lays the groundwork for understanding this complex topic. Coverage includes the current state of healthcare costs and waste in the USA, the challenges of understanding healthcare pricing, ethics of cost-conscious care, and more. Section 2 Causes of Waste covers important issues such as variation in resource utilization, the role of technology diffusion, lost opportunities to deliver value, and barriers to providing high-value care. Section 3 Solutions and Tools discusses teaching cost awareness and evidence-based medicine, the role of patients, high-value medication prescribing, screening and prevention, incentives, and implementing value-based initiatives. The authors include valuable case studies within each chapter to demonstrate how the material relates to real-world situations faced by clinicians on a daily basis. .

WHO guideline on country pharmaceutical pricing policies

WHO guideline on country pharmaceutical pricing policies PDF

Author:

Publisher: World Health Organization

Published: 2020-09-29

Total Pages: 70

ISBN-13: 9240011870

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In recent years, high prices of pharmaceutical products have posed challenges in high- and low-income countries alike. In many instances, high prices of pharmaceutical products have led to significant financial hardship for individuals and negatively impacted on healthcare systems' ability to provide population-wide access to essential medicines. Pharmaceutical pricing policies need to be carefully planned, carried out, and regularly checked and revised according to changing conditions. Strong, well-thought-out policies can guide well-informed and balanced decisions to achieve affordable access to essential health products. This guideline replaces the 2015 WHO guideline on country pharmaceutical pricing policies, revised to reflect the growing body of literature since the last evidence review in 2010. This update also recognizes country experiences in managing the prices of pharmaceutical products.

The Private Regulation of American Health Care

The Private Regulation of American Health Care PDF

Author: Betty Leyerle

Publisher: M.E. Sharpe

Published: 1994-05-06

Total Pages: 244

ISBN-13: 9780765636461

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I will begin this book by analyzing the historical and political context for the emergence of managed competition (chapter 1). The chapters that follow will list the corporate initiatives that were launched during the 1970s (chapter 2); describe the evolutionary changes and expansions they went through during the 1980s and early 1990s in the process of becoming "managed competition" (chapter 3); describe the ways in which managed care systems attempt to regulate the cost of health care services and discuss why they fail to do so (chapter 4); describe managed care attempts to control the quality of services and discuss why they fail to do so (chapter 5); and conclude with a summary of the book's major points as well as descriptions of some alternative approaches to getting our nation's health care needs met (chapter 6).

Pricing Health Services: Transaction Cost Approach

Pricing Health Services: Transaction Cost Approach PDF

Author: Monika Raulinajtys-Grzybek

Publisher: Anchor Academic Publishing (aap_verlag)

Published: 2015-05

Total Pages: 165

ISBN-13: 3954893746

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According to the assumptions of classical economics, the price should be set at the intersection of the supply and demand curve under the assumption of full information and rationality of market participants. However, in health care pricing is often regulated and price is set by the regulatory body. Due to the fact that the regulations in terms of pricing include activities that lead to price-setting of a good (health service), costs associated with these activities should be treated as transaction costs. The study is the result of the research on the transaction costs of the pricing of health services. The primary objective of the study is to identify the transaction costs occurring during the pricing of health services and characterize the factors that affect the level of transaction costs. An additional objective of this study is to link the conclusions about the level of transaction costs to the conclusions regarding the accuracy of the cost-based pricing in health care. The empirical part of the work was carried out based on the analysis of primary and secondary sources. Its aim was to present how pricing is organized in seventeen countries selected.

American Health Care

American Health Care PDF

Author: Roger D. Feldman

Publisher: Transaction Publishers

Published:

Total Pages: 460

ISBN-13: 9781412816939

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President Clinton's health care reform proposals of 1993 represented the most far-reaching program of social engineering attempted in the United States since the passage of Medicare and Medicaid in 1965. Under the guise of reforming the health care system, the Clinton plan would have herded almost all Americans under age sixty-five into large, government-sponsored health insurance purchasing alliances that would have contracted with insurers to offer a standard set of benefits at regulated prices. The plan came under fire from both Republicans and Democrats, including moderates from both parties, but it soon became apparent that what doomed it was a public unwilling to trust government to manage their health care. The critical literature has failed to offer a cogent analysis of why government control of health care does not work. American Health Care delivers that analysis. This volume examines why untoward consequences usually follow when government sets out to do good things. The contributors demonstrate how hospital rate regulation raises hospital prices, that "no-fault" medical malpractice increases the occurrence of faulty medicine, and that FDA regulation is a major cause for the escalating cost of new drugs. Part 1, trace the genesis of Medicare and its later developments and argue the consumer advantages of medical savings accounts and written health contracts. Part 2, explore the fallacies of antitrust policies that serve the interests of competitors, attack community rating for making health insurance unaffordable to large numbers of young workers. Part 3, contains a powerful critique of the FDA for withholding vital information on the health benefits of aspirin and shows how HMOs and other plans have caused pharmaceutical marketing to shift its focus from medical effectiveness to cost effectiveness. The final section explores how the private sector is improving in the areas of regulating physician and other health professional fees and the supply and quality of health professionals. American Health Care proposes reasonable balances between government and market options for in supply of health services. Without denying the need for some governmental action, the contributors show how far the market can go farther in performing critical functions in the health care industry. This volume will be important reading for health policymakers, economists, and health care professionals. Roger Feldman is professor at the Institute for Health Services Research, University of Minnesota. Mark V. Pauly is professor in the Department of Health Care Systems of the Wharton School, University of Pennsylvania.

Equitable Access to High-Cost Pharmaceuticals

Equitable Access to High-Cost Pharmaceuticals PDF

Author: Zaheer-Ud-Din Babar

Publisher: Academic Press

Published: 2018-02-27

Total Pages: 238

ISBN-13: 0128119624

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Equitable Access to High-Cost Pharmaceuticals seeks to aid the development and implementation of equitable public health policies by pharmaco-economics professionals, health economists, and policymakers. With detailed country-by country analysis of policy and regulation, the Work compares and contrasts national healthcare systems to support researchers and practitioners identify optimal healthcare policy solutions. The Work incorporates chapters on global regulatory changes, health technology assessment guidelines, and competitive effectiveness research recommendations from international bodies such as the OECD or the EU. Novel policies such as horizon scanning, managed-entry agreement and post-launch monitoring are considered in detail. The Work also thoroughly reviews novel pharmaceuticals with particular research interest, including cancer drugs, orphan medicines, Hep C, and personalized medicines. Evaluates impact and efficacy of current access policies and pricing regulation of high-cost drugs Incorporates existing guidelines and recommendations by international organizations Compares and contrasts how different countries fund and police high-cost drug access Explores novel and emergent policies, including managed entry agreement, analysis of real world data and differential pricing Reviews novel pharmaceuticals of current research interest