Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence

Background The United States’ multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. Methods We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated “added” BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada’s single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. Results BIR costs in the U.S. health care system totaled approximately $471 ($330 – $597) billion in 2012. This includes$70 ($54 –$76) billion in physician practices, $74 ($58 – $94) billion in hospitals, an estimated$94 ($47 –$141) billion in settings providing other health services and supplies, $198 ($154 – $233) billion in private insurers, and$35 ($17 –$52) billion in public insurers. Compared to simplified financing, $375 ($254 – $507) billion, or 80$350 billion annually, nearly 15% of health care spending. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0556-7) contains supplementary material, which is available to authorized users

A National Health Insurance Program for the United States

The US will spend $1.79 trillion on health care in 2004, yet 44 million Americans remain uninsured. What the country needs, argues McCanne, is publicly funded universal health coverag

Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study

Background: Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates. Methods and findings: Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness. Conclusions: Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections

State Separation of Powers and the Federal Courts

The cases discussed herein mostly surfaced in the regulatory era of the latter half of the nineteenth century and the early twentieth century. This Article first discusses arguments as to state delegations of legislative power, and the Court’s rejection of legislative-style deference that state agencies often argued for. This Article next discusses the Court’s decisions as to state adjudicative bodies, and its refusal to treat state agency adjudicators as full-fledged courts. This Article then addresses the Court’s response to arguments for unreviewable executive discretion and to laws allowing delegations to private parties. It then addresses whether the discussion sheds light on modern debates as to the use of private enforcement and as to the Independent State Legislature Doctrine. This abstract has been taken from the author\u27s introduction

Powers, Rights, and Section 25

The article offers information on the individual rights related to the issues discussed in the section 25 of The 1789 Judiciary Act. It states that the priority of the rules of federal courts focuses on the protection of individual rights and power against government. It also informs about the certain amendments done in the act to protect individual rights and power

Powers, Rights, and Section 25

The article offers information on the individual rights related to the issues discussed in the section 25 of The 1789 Judiciary Act. It states that the priority of the rules of federal courts focuses on the protection of individual rights and power against government. It also informs about the certain amendments done in the act to protect individual rights and power

Rethinking the Judicial Reception of Legislative Facts

In a recent article, Professor Peggy Davis called for reforms in judicial reception of legislative facts. Her suggestions, which follow an empirical analysis of the use of psychological parent theories in child custody disputes, echo similar proposals by Professor Kenneth Karst in 1960s and by Professors Arthur Miller and Jerome Barron in 1975 for judicial reception of legislative facts in constitutional cases.As originally defined by Kenneth Culp Davis, legislative facts are facts that inform[] a court\u27s legislative judgment on questions of law and policy. They contrast with adjudicative facts, which are facts about what the parties did, what the circumstances were, what the background conditions were. \u27 The most commonly cited examples of legislative facts are Louis Brandeis\u27 recitation of opinions that workingwomen needed special protection in his brief in Muller v. Oregon, and the social science appendix detailing the deleterious effects of segregation on black children in Brown v. Board of Education. Discussions of the judicial reception of legislative facts implicate questions of the role of social science in law, the scope of judicial notice, and, more generally, the process of judicial decision making. Because assumptions about disputable general facts are necessary to any reasoning process, the advisory committee on the Federal Rules of Evidence declined to prescribe formal rules for the reception of legislative facts when providing standards for judicial notice. The advisory committee believed that judicial absorption of general nonlegal knowledge should not be circumscribed by any limitation in the form of indisputability, any formal requirements of notice other than those already inherent in affording opportunity to hear and be heard and exchanging briefs, and any requirement of formal findings at any level