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Les premières traces écrites rapportant l’existence d’un mode de rémunération des médecins date du 17e ou 18e siècle avant J.C. Il s’agit d’un code gravé à l’époque de la civilisation babylonienne qui reprend trois tarifs différents selon la classe sociale à laquelle appartient la malade et selon la nature de l’acte réalisé.
La succession des différentes époques a, par la suite vu naître une diversité dans mode de rémunération des médecins : elles consistait en offrande dans les débuts de la Grèce Antique, en une rémunération fixe ou en nature à partir de l’Antiquité. C’est à partir du Moyen-âge, que se côtoient des médecins indépendants percevant une rémunération en nature ou en espèces et des médecins recevant un traitement payé de la municipalité afin de soigner les pauvres. Cette distinction entre les médecins rémunérés pour une fonction se retrouvera encore du 16e au 19e siècle.
Par la suite, le mode de rémunération s’est encore diversifié, non seulement dans le temps, mais également dans l’espace. Nous connaissons en effet aujourd’hui des modes de rémunération différents d’un pays à l’autre : honoraires per capita en Irlande ou en Italie, médecins du secteur publics salariés en Finlande et en Suède, rémunération à l’acte largement répandue dans des pays tels que la Suisse et le Luxembourg.
En Belgique, comme beaucoup d’autre pays, différents modes de rémunération coexistent. Ils sont au départ fonction du statut du médecin. Ainsi, on retrouve des médecins contractuels et salariés, des médecins statutaires et appointés et finalement des médecins indépendants.
C’est le mode de rémunération des médecins indépendants qui sera abordé dans ce document.[…]
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FEES, MEDICAL --- HOUSEKEEPING, HOSPITAL --- DRUG UTILIZATION --- ECONOMICS, MEDICAL --- SOCIAL SECURITY --- ECONOMICS --- FEES, MEDICAL --- HOUSEKEEPING, HOSPITAL --- DRUG UTILIZATION --- ECONOMICS, MEDICAL --- SOCIAL SECURITY --- ECONOMICS
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Fee Schedules --- Medicaid --- Fees, Medical --- Health Expenditures --- Policy Making --- Cost Control --- Income --- economics
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Collective Bargaining --- Economics, Hospital --- Fees, Medical --- Hospital Administration --- Medical Staff, Hospital --- methods
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This reports presents findings from a study of design options and payment methods for a capitation payment plan for the Medicare End Stage Renal Disease (ESRD) Program. The study contributes to payment policy development by evaluating capitation as an alternative payment method to control Medicare costs while maintaining access and quality of care for ESRD patients. A capitation payment method has been developed that combines monthly capitation payments for dialysis and functioning graft patients with one-time payments for kidney transplant and graft failure events.
Chronic renal failure --- Hemodialysis --- Capitation fees (Medical care) --- Patients --- Services for --- Finance. --- Finance. --- United States.
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Throughout the 1970s and into the early 1980s continuing efforts to control inflation in Medicaid expenditures led states to adopt stricter Medicaid eligibility standards, which in combination with a recession in the early 1980s left nearly 40 percent of the nation's poor without medical coverage. To prevent further restrictions in Medicaid access, the Robert Wood Johnson Foundation (RWJ) sponsored a demonstration project, the Program for Prepaid Managed Health Care (PPMHC) in the first half of the 1980s. This RAND Corporation report contains the design and results from the cost and utilization evaluation of the PPMHC.
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BURN UNITS --- HOSPITALIZATION --- FEES, MEDICAL --- CHEMISTRY, CLINICAL --- DRUG UTILIZATION --- ECONOMICS --- ECONOMICS --- BELGIUM --- ECONOMICS --- ECONOMICS --- BURN UNITS --- HOSPITALIZATION --- FEES, MEDICAL --- CHEMISTRY, CLINICAL --- DRUG UTILIZATION --- ECONOMICS --- BELGIUM --- ECONOMICS --- BELGIUM --- BELGIUM --- ECONOMICS --- BELGIUM --- ECONOMICS --- BELGIUM
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Employing a Zellner-type indirect regression technique, and data from the 1972 California Copayment Experiment, the authors attempt to assess the impact of a copayment requirement on utilization of health care resources by the poor. Focus is on three questions regarding effects of an increase in out-of-pocket cost of physician office visits: (1) Will such an increase inhibit demand for ambulatory care? (2) Will it increase or decrease demand for hospitalization? (3) How will it affect total resource cost of health care services, both in and out of hospitals? The results indicate that a $1 copayment requirement apparently decreases demand for physician visits by 8 percent and increases demand for hospital inpatient services by 17 percent. Although the confidence intervals are large, point estimates indicate that copayment increases overall program costs by a statistically insignificant 3 to 8 percent. Thus copayments could be self-defeating as a method of controlling medical costs in a welfare population.
Medical care, Cost of --- Copayments (Insurance) --- Medical care --- Medicaid --- Fees, Medical --- Hospitalization --- Medical assistance, Title 19 --- Utilization --- Economics
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