Results 51 to 60 of about 11,500 (181)

Effect of capitation payment method on health outcomes, healthcare utilization, and referrals in Ghana.

PLOS Global Public Health
Different provider payment systems generate different incentives for patients, providers, and purchasers. Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 and has made reforms to its provider payment methods to create incentives in ...
Micheal Kofi Boachie, Eugenia Amporfu
doaj   +1 more source

Determinants of Fraud Prevention of Puskesmas Capitation Funds In The City of Mataram

Finance, Accounting and Business Analysis
Purpose: To explain how P-Care, corporate ethical culture, accountability, and the internal control system interact in preventing capitation fund fraud in Puskesmas in Mataram City.
Khopipah Wandan Sari, Budi Santoso, Endar Pituringsih   +2 more
doaj   +1 more source

Health System Integration and Prior Authorization in Medicare Advantage

Health Services Research, Volume 61, Issue 3, June 2026.
ABSTRACT Objective To examine whether Medicare Advantage (MA) plans affiliated with health systems adopt less restrictive prior authorization (PA) policies than non‐affiliated plans. Study Setting and Design We conducted a descriptive analysis comparing PA policies between system‐affiliated and unaffiliated MA plans from 2016 to 2023.
Eunhae Shin
wiley   +1 more source

Configuring Desired Payment Systems in Healthcare with the “Iranian Tar Model” [PDF]

Rāhburdhā-yi Mudīriyyat dar Niẓām-i Salāmat
Objective: Payment systems in healthcare organizations are critical, behavioral, and dynamic. Given the existing challenges in payment systems, characterized by imbalances in payment amounts and inequitable ratios within and across job categories, there ...
Masoud Ferdosi, Amin Ferdowsi
doaj  

Assessing the link between social capital and health outcomes in the Italian regions: An empirical analysis

Annals of Public and Cooperative Economics, Volume 97, Issue 2, Page 503-536, June 2026.
Abstract An extensive literature demonstrates a positive relationship between social capital and health. However, empirical analyses within the Italian context remain limited. This study contributes to the existing literature by expanding the empirical evidence on this topic for Italy, employing an ecological approach.
Maria Alessandra Antonelli, Giorgia Marini   +1 more
wiley   +1 more source

Asymmetric Information With Multiple Risks: The Case of the Chilean Private Health Insurance Market

Health Economics, Volume 35, Issue 5, Page 712-729, May 2026.
ABSTRACT We extend the Rothshild and Stiglitz (1976) model to two sources of risk –inpatient and outpatient risk– to better proxy real‐world health insurance markets. We uncover an interesting theoretical possibility: Take individuals A and B, who are low risks in, say, the inpatient dimension but A is riskier in the outpatient dimension.
Dolores de la Mata, Matilde P. Machado, Pau Olivella, Nieves Valdés   +3 more
wiley   +1 more source

Out‐of‐Pocket Costs and Antidepressant Adherence in Head and Neck Cancer Survivors

Psycho-Oncology, Volume 35, Issue 5, May 2026.
ABSTRACT Background Head and neck cancer (HNC) survivors have a high burden of depression, yet real‐world antidepressant adherence and the role of patient out‐of‐pocket (OOP) costs in this population remain poorly characterized. Methods We analyzed a retrospective cohort of US adults with HNC and a new antidepressant prescription in Merative MarketScan
Gennaro Di Tosto, Neil K. Mehta, Christopher W. Noel, Ann Scheck McAlearney, Lauren E. Miller   +4 more
wiley   +1 more source

Functional Persistent Luminescent Thin Films and Glasses: Materials, Processing, and Future Challenges

Advanced Optical Materials, Volume 14, Issue 16, 24 April 2026.
Beyond conventional powders, persistent luminescent thin films and glass‐based composites offer transformative potential for transparent, stable photonic devices. This work evaluates diverse processing routes and structure‐property correlations essential for achieving optical transparency and environmental stability.
Luidgi Giordano, Leonnam G. Merízio, Elaine A. de Mattos, Yaman M. Nicolai, Victor M. P. da Silva, Israel D. Marques, Verônica C. Teixeira, Everton Bonturim, Rogéria R. Gonçalves, Danilo Manzani, Lucas C. V. Rodrigues   +10 more
wiley   +1 more source

Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana’s capitation payment for primary care

BMC Health Services Research, 2018
Background Ghana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers.
Francis-Xavier Andoh-Adjei, Renske van der Wal, Eric Nsiah-Boateng, Felix Ankomah Asante, Koos van der Velden, Ernst Spaan   +5 more
doaj   +1 more source

Healthcare Providers’ Engagement in Strategic Purchasing of Outpatient Services: A Cross-sectional Analysis of the National Health Scheme in Kenya

Pan-African Journal of Health and Environmental Science
Background: National Health Insurance Fund (NHIF) outpatient services operate under capitation, and are strategically designed to enhance quality, equity, and affordability.
Eunice Mwangi, Wanja Tenambergen
doaj   +1 more source