Managed Competition and Pharmaceutical Care

Managed Competition and Pharmaceutical Care
Author: Alan Escovitz
Publisher: CRC Press
Total Pages: 188
Release: 1996
Genre: Managed care plans (Medical care)
ISBN: 9781560248217

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As the debate on health care delivery systems in the U.S. continues, the pharmaceutical industry and pharmaceutical care delivery system may well be faced with making significant changes if new drug regulations are enacted. Because there is little discussion on the effects of managed competition on the pharmaceutical care delivery system and the education of pharmacists, those involved in providing pharmaceutical care must arm themselves with the background information and ideas explored in Managed Competition and Pharmaceutical Care. The contributors to this vital sourcebook address these key questions: What are the major components of a managed competition system? What challenges will industry and the pharmaceutical care delivery system face? How should the industry re-engineer--using systems management as opposed to components management--to meet the needs of an evolving health care system? What actions should pharmaceutical companies take to survive difficult days in the future? Why and how should pharmacists move from dispensing drugs to providing total pharmaceutical care? What do employers want for their prescription benefit dollars? How have past and present initiatives to control drug pricing affected the pharmaceutical marketplace? Why is regulating prices not a satisfactory solution to containing health care costs? What criteria are used to determine whether to include a drug in a managed care formulary? How can community pharmacists compete in the marketplace, regardless of which health care system emerges? What is the future likely to bring and how can pharmacists prepare for that future? Managed Competition and Pharmaceutical Care assists those involved in the pharmaceutical care delivery system to prepare for and embrace new, or at the least, drastically changed health care delivery in the coming years.

Improving Healthcare

Improving Healthcare
Author: David Hyman
Publisher: Springer Science & Business Media
Total Pages: 436
Release: 2007-04-21
Genre: Political Science
ISBN: 0387257527

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Improving Healthcare: A Dose of Competition systematically examines the American health care system from a competition-oriented perspective. The volume surveys the performance of each major sector of the health care system, and identifies impediments to more effective competition. Improving Healthcare examines such issues as competition v. regulation, public and private sector approaches to health care financing, cross-subsidies, licensure, provider market concentration, financial and clinical integration, payment for performance, quality, pharmacy benefit managers, direct-to-consumer advertising of pharmaceuticals, certificates of need, mandates, unionization, the significance of organizational status (nonprofit v. for-profit), and the role of antitrust and consumer protection in health care. It offers concrete recommendations to improve the quality and cost-effectiveness of the American health care marketplace.

Making Medicines Affordable

Making Medicines Affordable
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 235
Release: 2018-03-01
Genre: Medical
ISBN: 0309468086

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Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.

Competition in Health Insurance

Competition in Health Insurance
Author: American Medical Association
Publisher:
Total Pages: 60
Release: 2013
Genre: Health insurance
ISBN: 9781603599443

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Redefining Health Care

Redefining Health Care
Author: Michael E. Porter
Publisher: Harvard Business Press
Total Pages: 540
Release: 2006-04-24
Genre: Business & Economics
ISBN: 1422133362

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The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums—not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying—and largely overlooked—causes of the problem, and provide a powerful prescription for change. The authors argue that competition currently takes place at the wrong level—among health plans, networks, and hospitals—rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Participants in the system accumulate bargaining power and shift costs in a zero-sum competition, rather than creating value for patients. Based on an exhaustive study of the U.S. health care system, Redefining Health Care lays out a breakthrough framework for redefining the way competition in health care delivery takes place—and unleashing stunning improvements in quality and efficiency. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move health care toward positive-sum competition that delivers lasting benefits for all.

For-Profit Enterprise in Health Care

For-Profit Enterprise in Health Care
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 580
Release: 1986-01-01
Genre: Medical
ISBN: 0309036437

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"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.

Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 161
Release: 2018-04-02
Genre: Medical
ISBN: 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

The Future of the Public's Health in the 21st Century

The Future of the Public's Health in the 21st Century
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 536
Release: 2003-02-01
Genre: Medical
ISBN: 0309133181

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The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

Handbook of Pharmaceutical Public Policy

Handbook of Pharmaceutical Public Policy
Author: Thomas Fulda
Publisher: CRC Press
Total Pages: 714
Release: 2007-07-25
Genre: Medical
ISBN: 9781439804261

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Get an invaluable view of the impact of economics and politics on pharmaceuticals in the United States Pharmacy and pharmaceutical drug use are highly regulated and the various regulatory forces interact with diverse goals. Pharmaceutical Public Policy is a comprehensive review of the legislation, trends, business developments, and policy interpretations that have shaped drug use during the last 50 years. This unique single source explains drug regulatory activity, the major insurance and payment systems, and the impact of economics and politics on drug use in the United States. Leading experts provide a thorough and objective look at public policy issues, making this text perfect for upper level undergraduate and graduate level pharmacy, medical, and public health educators and students. Pharmacists and pharmacy students must learn more than just the physical sciences and clinical aspects of the pharmaceutical industry. The rationale for policies, rules, and regulations is integral to understanding how to best serve patients and make the entire pharmaceutical sector more equitable and cost-effective. Pharmaceutical Public Policy examines the most pressing issues facing the industry, including control of the rising costs for drugs and ensuring correct drug usage by patients. This insightful text offers an in depth perspective of the policies and the debates that surround them. Chapters are well-referenced and many include helpful figures and tables to illustrate facts and ideas. Topics in Pharmaceutical Public Policy include: pharmacy law and regulation Medicare and prescription drug coverage FDA drug approval process Medicaid and prescription drugs public health pharmacy Department of Veterans Affairs pharmacy programs Department of Defense pharmacy programs innovative state drug program practices state and federal regulation of pharmacy the future of the pharmaceutical industry managed care pharmacy PBM’s (pharmacy benefit managers) risk minimization importation and reimportation biotechnology and pharmacogenetics policy and issues product promotion competition between drugs drug insurance design patient compliance abuse of prescription drugs health care systems and insurance in Europe much more Pharmaceutical Public Policy is a one-of-a-kind resource that explains just who the players are and the complexity of the issues that are examined in most pharmaceutical policy debates, and is perfect for pharmacy students, educators, other health professionals, trade association leaders, and policymakers.