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Value in Health : the Journal of the... Feb 2020Value-based pharmaceutical contracts (VBPCs) are performance-based reimbursement agreements between healthcare payers and pharmaceutical manufacturers in which the...
Value-based pharmaceutical contracts (VBPCs) are performance-based reimbursement agreements between healthcare payers and pharmaceutical manufacturers in which the price, amount, or nature of reimbursement is tied to value-based outcomes. VBPCs are often complex, and the nature of who benefits and in what ways can be unclear. We discuss how VBPCs compare with value-based payer-provider arrangements in terms of performance-based reimbursements and alignment of incentives. In addition, we examine how VBPCs can affect costs, clinical outcomes, and access to medications. Because these contracts are unlikely to reduce costs in isolation, we recommend taking a patient-centered approach when developing VBPCs and tying VBPCs to more overarching payer drug cost reduction strategies.
Topics: Contracts; Cost Savings; Cost-Benefit Analysis; Drug Costs; Drug Industry; Health Care Rationing; Health Expenditures; Health Services Accessibility; Humans; Insurance, Health, Reimbursement; Policy Making; Value-Based Health Insurance; Value-Based Purchasing
PubMed: 32113619
DOI: 10.1016/j.jval.2019.10.009 -
Ugeskrift For Laeger Mar 2024Gestational surrogacy, in which an infertile couple contracts with a woman to carry a foetus that the intended parents will raise, increases worldwide, and offers a... (Review)
Review
Gestational surrogacy, in which an infertile couple contracts with a woman to carry a foetus that the intended parents will raise, increases worldwide, and offers a route to parenthood for individuals and couples who otherwise have limited options. However, the situation in Denmark at present is that surrogacy with the help of healthcare professionals is illegal, and international adoption is no longer available. This review gives an overview of the legal situation of surrogacy in Denmark, the impact of the legislation, and medical issues to be aware of as healthcare professionals in the future.
Topics: Pregnancy; Female; Humans; Surrogate Mothers; Contracts; Infertility; Denmark
PubMed: 38533857
DOI: 10.61409/V10230662 -
International Journal of Environmental... Nov 2022A psychological contract is a set of individual beliefs that a person has about the reciprocal obligations and benefits established in an exchange relationship, such as... (Review)
Review
A psychological contract is a set of individual beliefs that a person has about the reciprocal obligations and benefits established in an exchange relationship, such as an employment relationship in an organizational setting. A psychological contract breach is a subjective experience referred to the perception of one of the parties that the other has failed to adequately fulfill its obligations and promises. Breaches have been systematically connected to employees' attitudes and behaviors that hamper the employment relationship. Despite its apparent clarity, some relevant topics about psychological contract breach, psychological contract fulfillment and the relationships with their consequences still remain unclear. The main objective of this review of reviews is to conduct a review of reviews on psychological contract breaches, considering both systematic reviews and metanalytical papers with the purpose of synthesizing the evidence to date under the psychological contract theory. Using the SPIDER tool, our systematic review of reviews focuses on: (a) Sample; (b) Phenomenon of Interest; (c) Design; (d) Evaluation; and (e) Research type. Finally, only eight systematic reviews and meta-analyses met the inclusion criteria. Of the eight reviews included, seven were meta-analyses while the other was a systematic quantitative review. This study describes the available empirical research on psychological contract breaches and fulfillment and summarizes the meta-analytical evidence on their relationships with attitudinal and behavioral outcomes, as well as the role of potential moderator variables. Due to the methodological caveats of the reviews themselves and of the primary studies they were based on, our conclusions about the impact of psychological contract breaches on outcomes still remain tentative.
Topics: Contracts; Employment; Attitude; Psychological Theory
PubMed: 36497602
DOI: 10.3390/ijerph192315527 -
International Journal of Integrated Care Jan 2018Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The...
INTRODUCTION
Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The risk structure of the providers plays a vital role in Pay for Performance. A prerequisite for optimal incentive-based service models is a (partial) dependence of the agent's returns on the provider's gain level. Integrated care systems as well as accountable care organisations (ACOs) in the US and similar concepts in other countries are advocated as an effective method of improving the performance of healthcare systems. These systems outline a payment and care delivery model that intends to tie provider reimbursements to predefined quality metrics. By this the total costs of care shall be reduced.
METHODS
Little is known about the contractual design and the main challenges of delegating "accountability" to these new kinds of organisations and/or contracts. The costs of market utilisation are highly relevant for the conception of healthcare contracts; furthermore information asymmetries and contract-specific investments are an obstacle to the efficient operation of ACOs. A comprehensive literature review on methods of designing contracts in Integrated Care was conducted. The research question in this article focuses on how reimbursement strategies, evaluation of measures and methods of risk adjustment can best be integrated in healthcare contracting.
RESULTS
Each integrated care contract includes challenges for both payers and providers without having sufficient empirical data on both sides. These challenges are clinical, administrative or financial nature. Risk adjusted contracts ensure that the reimbursement roughly matches the true costs resulting from the morbidity of a population. If reimbursement of care provider corresponds to the actual expenses for an individual/population the problem of risk selection is greatly reduced. The currently used methods of risk adjustment have widely differing model and forecast accuracy. For this reason, it is necessary to clearly regulate the method of risk adjustment in the integrated care contract.
CONCLUSIONS AND DISCUSSION
The series of three articles on contract design has shown that coordination and motivation problems in designing healthcare contracts cannot be solved at no-costs. Moreover, it became clear, that complete contracts in healthcare are unrealistic and that contracts do always include certain uncertainties. These are based on the risk of random, and no contracting party can control these risks completely. It is also not possible to fully integrate these risks in the contract or to eliminate these risks by the parties.
PubMed: 29632454
DOI: 10.5334/ijic.3616 -
Proceedings of the National Academy of... Jun 2023Across modern civilization, societal norms and rules are established and communicated largely in the form of written laws. Despite their prevalence and importance, legal...
Across modern civilization, societal norms and rules are established and communicated largely in the form of written laws. Despite their prevalence and importance, legal documents have long been widely acknowledged to be difficult to understand for those who are required to comply with them (i.e., everyone). Why? Across two preregistered experiments, we evaluated five hypotheses for why lawyers write in a complex manner. Experiment 1 revealed that lawyers, like laypeople, were less able to recall and comprehend legal content drafted in a complex "legalese" register than content of equivalent meaning drafted in a simplified register. Experiment 2 revealed that lawyers rated simplified contracts as equally enforceable as legalese contracts, and rated simplified contracts as preferable to legalese contracts on several dimensions-including overall quality, appropriateness of style, and likelihood of being signed by a client. These results suggest that lawyers who write in a convoluted manner do so as a matter of convenience and tradition as opposed to an outright preference and that simplifying legal documents would be both tractable and beneficial for lawyers and nonlawyers alike.
Topics: Humans; Lawyers; Contracts
PubMed: 37253008
DOI: 10.1073/pnas.2302672120 -
Journal of the Royal Society of Medicine Aug 2019
Topics: Contracts; Employment; Public Health
PubMed: 31414939
DOI: 10.1177/0141076819843894 -
International Journal of Environmental... Oct 2022The study examines the impact of the psychological contract (PC), including the often-studied PC breach in addition to the novel approach of PC status, as predictors of...
The study examines the impact of the psychological contract (PC), including the often-studied PC breach in addition to the novel approach of PC status, as predictors of performance among nurses, mediated by engagement, job satisfaction, and psychological distress. A sample of 177 nurses and midwives from a medium to a large hospital in Australia completed a self-report questionnaire. Structural equation modelling was used to determine associations between the predictors (i.e., negative affectivity (NA), PC breach, PC status)), mediating variables (i.e., engagement, job satisfaction, and psychological distress), and three types of performance behaviors: organizational citizenship behavior for the individual, for the organization (OCBI, OCBO) and in-role behavior (IRB) simultaneously. Specifically, psychological contract status positively predicted engagement, whereas breach negatively predicted engagement and positively predicted job satisfaction. NA positively predicted distress, and distress negatively predicted OCBO and IRB. Lastly, engagement positively predicted job satisfaction, OCBI, OCBO, and IRB. The findings indicate that psychological contract status may predict engagement (and in turn, performance) over and above psychological contract breach, and thus this novel construct should be examined further. The importance of engagement for predicting the performance behaviors and mental health of nurses may also offer new insights.
Topics: Humans; Job Satisfaction; Contracts; Surveys and Questionnaires; Social Behavior; Mental Health
PubMed: 36360809
DOI: 10.3390/ijerph192113931 -
The American Journal of Managed Care Jun 2021To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance: price, charge, cost,... (Observational Study)
Observational Study
OBJECTIVES
To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance: price, charge, cost, and length of stay.
STUDY DESIGN
Retrospective observational study using administrative claims data matched with hospital characteristics from the American Hospital Association Annual Survey and the Healthcare Cost Reporting Information System. Data include a balanced panel of 1889 general acute care hospitals for the years 2011 to 2015.
METHODS
Inpatient hospital commercial claims data from the Health Care Cost Institute were used to classify claims by contract type based on claim-line billed and allowed charges. Hospital-level performance measures-prices, charges, costs, and length of stay-were analyzed using linear regression models to identify the association of each measure with contract types. All measures were risk adjusted to control for differences in hospital case mix, and the regression specifications controlled for numerous hospital characteristics.
RESULTS
Our estimate of the distribution of contract types in the data is similar to estimates using other methods. We find that discounted charges contracts are associated with higher prices and higher costs but not higher charges. Fixed-rate contracts are associated with lower prices as well as lower costs.
CONCLUSIONS
Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.
Topics: Contracts; Diagnosis-Related Groups; Health Care Costs; Hospital Charges; Hospitals; Humans; Insurance Carriers; United States
PubMed: 34156217
DOI: 10.37765/ajmc.2021.88663 -
The American Journal of Managed Care Feb 2024To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting.
OBJECTIVES
To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting.
STUDY DESIGN
Retrospective analysis of 10 price transparency data files from HCA Healthcare.
METHODS
Cross-sectional qualitative analysis of 524 hospital-insurer contracts across 10 hospitals.
RESULTS
We ascertain 4 empirical regularities in these files. First, hospitals contract with many payers, ranging from 35 to 82 across the hospitals in the sample. Second, contract structure varies significantly within and across hospitals: Of the 524 contracts in our sample, the median contract contained 9 contract elements, whereas the mean contract contained 1285 contract elements. Third, most of the contracts in our sample contained multiple contracting methodologies (eg, both fixed fee and percentage of charges). Fourth, these contracts indicated substantial variation for the same service within and across hospitals, validating findings from analyses based on claims data and hospital price transparency files.
CONCLUSIONS
Hospital-insurer contracts dictate the flow and structure of a significant portion of total health care expenditure in the US. Increased attention by both researchers and policy makers would lead to a greater understanding of this vital-yet understudied-element of the market for hospital services.
Topics: Humans; Insurance Carriers; Cross-Sectional Studies; Retrospective Studies; Contracts; Hospitals; Contract Services
PubMed: 38381550
DOI: 10.37765/ajmc.2024.89502 -
Preventive Medicine Nov 2012This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of... (Review)
Review
This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.
Topics: Contracts; Female; Financial Support; Health Promotion; Humans; Male; Models, Theoretical; Motivation; Reward; Weight Gain; Weight Reduction Programs
PubMed: 22244800
DOI: 10.1016/j.ypmed.2011.12.024