Health insurance (31 - 40 of 65 items)
Medicare: Inadequate Review of Claims Payments Limits Ability to Control Spending
HEHS-94-42: Published: Apr 28, 1994. Publicly Released: Jun 8, 1994.
GAO reviewed the adequacy of Medicare contractors' postpayment review activities, focusing on: (1) whether the Health Care Financing Administration (HCFA) is identifying providers that are inappropriately billing the Medicare program; and (2) why Medicare spends so much for certain medical services.GAO found that: (1) HCFA does not monitor Medicare carriers' postpayment analyses and often misses o...
Health Care in Hawaii: Implications for National Reform
HEHS-94-68: Published: Feb 11, 1994. Publicly Released: Mar 15, 1994.
Pursuant to a congressional request, GAO provided information on Hawaii's health care insurance system, focusing on the system's effect on: (1) accessibility to health services; (2) health care costs; and (3) the business community.GAO found that: (1) Hawaii has the highest level of insurance coverage of any state in the United States; (2) the percentage of Hawaiian residents that lack health insu...
1993 German Health Reforms: Initiatives Tighten Cost Controls
T-HRD-94-2: Published: Oct 13, 1993. Publicly Released: Oct 13, 1993.
GAO discussed the German health care system, focusing on the approaches used to control health care costs. GAO noted that: (1) before 1993, Germany had budget caps on physician and hospital services that were negotiated by provider associations and sickness funds that provide health insurance to most Germans; (2) German health care reforms limit physician and hospital expenditures to increases in...
1993 German Health Reforms: New Cost Control Initiatives
HRD-93-103: Published: Jul 7, 1993. Publicly Released: Aug 10, 1993.
Pursuant to a congressional request, GAO examined recent German health care reforms, focusing on: (1) the reasons for the German reforms; (2) the nature of the reforms; (3) the initial reaction to and expected effects of the reforms; and (4) implications for U.S. health care reforms.GAO found that: (1) large increases in mandated health care premiums and variations in contribution rates between he...
VA Health Care: Veterans' Efforts to Obtain Outpatient Care From Alternative Sources
HRD-93-123: Published: Jul 14, 1993. Publicly Released: Jul 22, 1993.
Pursuant to a congressional request, GAO reviewed veterans' efforts to obtain outpatient care from alternative sources when the Department of Veteran Affairs (VA) could not provide medical services due to a lack of resources or the veterans' ineligibility.GAO found that: (1) of the 198 veterans who were turned away from VA medical centers, 149 obtained medical care from other sources; (2) 76 perce...
Health Insurance: Remedies Needed to Reduce Losses From Fraud and Abuse
T-HRD-93-8: Published: Mar 8, 1993. Publicly Released: Mar 8, 1993.
GAO discussed health care fraud and abuse and the need for better remedies and more resources to combat the problem. GAO noted that: (1) fraud and abuse encompassed a wide range of improper billing practices by physicians, medical equipment suppliers, and other suppliers that add 10 percent to U.S. health care costs; (2) whether or not health care insurers pursued a fraudulent act depended on the...
Utilization Review: Information on External Review Organizations
HRD-93-22FS: Published: Nov 24, 1992. Publicly Released: Jan 6, 1993.
Pursuant to a congressional request, GAO reviewed utilization review organizations (URO), focusing on: (1) the size and ownership of URO; (2) the professional qualifications of staff involved in utilization review decisions; (3) the complexity of decisions made by various staff; (4) appeal procedures; (5) clinical review criteria used by URO; and (6) quality assurance procedures implemented to ens...
Canadian Health Insurance: Estimating Costs and Savings for the United States
HRD-92-83: Published: Apr 28, 1992. Publicly Released: Aug 24, 1992.
Pursuant to a congressional request, GAO provided information on the methodology it used to derive estimates of the difference between the current level of U.S. health care expenditures and the cost of having a new program with key elements of a Canadian-style system.GAO noted that: (1) in Canada, each provincial plan provides for universal insurance coverage with no deductibles or copayments, con...
Health Insurance: Vulnerable Payers Lose Billions to Fraud and Abuse
HRD-92-69: Published: May 7, 1992. Publicly Released: May 7, 1992.
Pursuant to a congressional request, GAO examined the: (1) nature of fraud and abuse associated with the health care industry; and (2) problems insurers have in detecting and pursuing such fraud and abuse.GAO found that: (1) vulnerabilities within the health insurance system allow unscrupulous providers to cheat health insurance companies and programs out of an estimated 10 percent of total health...
Canadian Health Insurance
HRD-92-20R: Published: Feb 20, 1992. Publicly Released: Feb 20, 1992.
In response to a congressional request, GAO responded to a January 1992 briefing paper that criticized an earlier GAO report on Canadian health insurance claiming that GAO overstated administrative savings and understated the additional costs of adopting a Canadian-style health insurance system. GAO noted that: (1) estimates in its report and the briefing paper were not comparable because of the d...