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Buying best value health care: Evolution of purchasing among Australian private health insurers

Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers represent...

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Detalles Bibliográficos
Autor principal: Willcox, Sharon
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079790/
https://www.ncbi.nlm.nih.gov/pubmed/15801982
http://dx.doi.org/10.1186/1743-8462-2-6
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author Willcox, Sharon
author_facet Willcox, Sharon
author_sort Willcox, Sharon
collection PubMed
description Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing.
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spelling pubmed-10797902005-04-15 Buying best value health care: Evolution of purchasing among Australian private health insurers Willcox, Sharon Aust New Zealand Health Policy Research Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. BioMed Central 2005-03-31 /pmc/articles/PMC1079790/ /pubmed/15801982 http://dx.doi.org/10.1186/1743-8462-2-6 Text en Copyright © 2005 Willcox; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Willcox, Sharon
Buying best value health care: Evolution of purchasing among Australian private health insurers
title Buying best value health care: Evolution of purchasing among Australian private health insurers
title_full Buying best value health care: Evolution of purchasing among Australian private health insurers
title_fullStr Buying best value health care: Evolution of purchasing among Australian private health insurers
title_full_unstemmed Buying best value health care: Evolution of purchasing among Australian private health insurers
title_short Buying best value health care: Evolution of purchasing among Australian private health insurers
title_sort buying best value health care: evolution of purchasing among australian private health insurers
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079790/
https://www.ncbi.nlm.nih.gov/pubmed/15801982
http://dx.doi.org/10.1186/1743-8462-2-6
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