Vesaliusleergangen Rob van den Oever Leuven 22 maart 2006 LCM Brussel

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1 Vesaliusleergangen Rob van den Oever Leuven 22 maart 2006 LCM Brussel
DE NOMENCLATUUR Instrument tot verdeling van het overheidsbudget gezondheidszorg Vesaliusleergangen Rob van den Oever Leuven 22 maart 2006 LCM Brussel Good morning, I’m Cindy Wiley, from the Texas Comptroller of Public Accounts Office. Our agency performs the Texas Health Care Claims Study, that I presented at our conference last year. (Check how many heard it) Today The background The methodology we used Our findings How we followed-up with the findings What we plan to do for our next study You should have a slide handout and I have brought bound copies of the study report with me that you can pick up at the end of this session. At the end of your slides is my contact information and some tools if you are planning a similar study in your states.

2 NOMENCLATUUR inleiding definitie historiek doelstelling
financiële betekenis inhoudelijk begrippenkader The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

3 NOMENCLATUUR: inleiding
ECONOMISCHE PRINCIPES vergoeding voor arts = honorarium (vrij beroep) soorten van vergoeding uitzonderingspositie: gemeenschap betaalt !!! waardoor …  The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

4 NOMENCLATUUR: inleiding (vervolg)
uitzonderingspositie: ziekteverzekering betaalt waardoor: consumer 1) moral hazard provider 2) gewone marktmechanismen niet werken vraag/aanbod The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

5 NOMENCLATUUR: inleiding (vervolg)
P1 VRAAG The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% AANBOD P2

6 NOMENCLATUUR: definitie
Een lijst van intellectuele en technische geneeskundige verstrekkingen vastgelegd in een koninklijk besluit op basis waarvan het honorarium voor de arts, het remgeld en de tegemoetkoming voor de patiënt berekend wordt. The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

7 NOMENCLATUUR: historiek
vóór 1944: - vrije honoraria - lokale akkoorden tss artsen/zkf over terugbetaling met vrijwillige toetreding tot verzekering : - vrije honoraria - nat. overeenkomsten tss artsen/zkf over terugbetaling met verplichte toetreding tot verzekering The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

8 NOMENCLATUUR: historiek (vervolg)
vanaf 1963: - honoraria vastgelegd in akkoord - nat. overeenkomsten tss artsen/zkf over honoraria en terugbetaling met verplichte toetreding tot verzekering Artsenstaking: - privacy - tekorten/financiële verantw. - nationale HMO The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

9 NOMENCLATUUR: historiek wetgeving
: Wet (art. 34 en 50) Wet betreffende de verplichte verzekering voor geneeskundige verzorging en uitkeringen gecoördineerd op : Koninklijk Besluit Koninklijk besluit tot vaststelling van de nomenclatuur van de geneeskundige verstrekkingen inzake de de verplichte verzekering voor geneeskundige verzorging en uitkeringen * KB (uitvoeringsbesluit o.a. modellen GVH) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

10 NOMENCLATUUR: doelstelling
instrument tot: verdeling financiële midd. voor de zorgverleners basis voor tariefzekerheid patiënt uitgavensturing en -beheersing overheid/beleid (epidemiologie) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

11 NOMENCLATUUR: financiële betekenis in mio EUR
The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

12 NOMENCLATUUR: financiële betekenis Plethora
The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

13 NOMENCLATUUR: financiële betekenis gemiddelde ZIV-uitgaven per discipline
The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

14 NOMENCLATUUR: kostprijselementen
Physical effort Complexity of case Technical skill Seriousness and Severity of illness Time Mental effort Uncertainty regarding diagnosis or treatment The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% Judgement Possible iatrogenic harm to patient Stress RBRSV Harvard

15 NOMENCLATUUR: vergoedingssystemen
nomenclatuur à l’acte nomenclatuur forfaitair budget per pathologie/discipline/ziekenhuis... gesalarieerd mengvormen (à l’acte/forfaitair) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

16 NOMENCLATUUR: inhoudelijk
558552 558563 Elektromyografie K 63 codenummer ambulant omschrijving coëfficientgetal codenummer ter verpleging opgenomen sleutelletter The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

17 NOMENCLATUUR: inhoudelijk
558552 558563 codenummer 6 cijfers voorlaatste cijfer onpaar  ambulante prest. voorl. cijfer paar ter verpleging opgenom. verschil 11 behalve laatste cijfer = 6 The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% 558596 558600

18 NOMENCLATUUR: inhoudelijk
558552 558563 Elektromyografie K 63 omschrijving benaming en/of beschrijving van medische akte 558552 558563 Elektromyografie K 63 The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% sleutelletter artikel 1 nomenclatuur (vervolg)

19 NOMENCLATUUR: inhoudelijk
558552 558563 Elektromyografie K 63 N adviezen, bezoeken, raadpleg., techn. akten D beschikbaarheid E verplaatsingskosten K andere technische akten B/F klinische biologie A/C toezichtshonoraria/permanentiehonoraria I percutane interventionele verstrekkingen Q accrediteringssupplement The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

20 NOMENCLATUUR: inhoudelijk
558552 558563 Elektromyografie K 63 coëfficiëntgetal bepaalt hoegrootheid honorarium wordt vastgelegd in Medico-mut verschillende waarden naargelang discipline The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% K = 1, op 63 x 1, = 64,21225 EUR Honorarium = 64,21 EUR

21 NOMENCLATUUR: procedure
TGR NCGZ Min. Soc. Zaken KB VC RvState CBC Werkgroepen The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

22 NOMENCLATUUR: procedure
Samenstelling TGR - 7 leden universiteit - 11 geneesheren (7 spec./4 HA) - 9 leden VI Werkgroepen TGR TGR Opdracht TGR - voorstellen van interpretatieregels nom. - voorstellen formuleren voor aanpassing nom. - opdrachten overheid The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

23 NOMENCLATUUR: procedure
Chirurgie Inw. geneesk. Med. Beeldv. Werkgroep Algemene Kl. BioIogie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3% Huis- artsen. TGR Plenaire ad hoc/ gemengde WG ...

24 NOMENCLATUUR: indeling
art algemene bepalingen: sleutelletter, fysische aanwezigheid, stagedoende art adviezen, raadplegingen en bezoeken art techn. geneeskundige verstrekkingen art. 4, 5,6 tandverzorging art kinesitherapie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

25 NOMENCLATUUR: indeling (vervolg)
art verpleegkundige zorg art verlossingen+vroedvrouwen art. 10 algemene bepalingen special. zorg art. 11 alg. speciale verstrekkingen art. 12 anesthesie art. 13 reanimatie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

26 NOMENCLATUUR: indeling (vervolg)
art. 14 heelkunde a) algemene heelkunde b) neurochirurgie c) plastische heelkunde d) heelkunde op abdomen e) heelkunde op thorax f) bloedvatenheelkunde g) gynecologie h) oftalmologie i) ORL j) urologie k) oftalmologie l) stomatologie m) transplantaties The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

27 NOMENCLATUUR: indeling (vervolg)
art. 15 toepassingsregels heelkunde art. 16 operatieve hulp art. 17 medische beeldvorming art. 18 radiotherapie en nucleaire geneesk. art. 19 toepassingsregels art. 18 The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

28 NOMENCLATUUR: indeling (vervolg)
art. 20 inwendige geneeskunde a) inwendige geneeskunde b) pneumologie c) gastro-enterologie d) kindergeneeskunde e) cardiologie f) neuropsychiatrie g) reumatologie art. 21 dermato-venerologie art. 22, 23 fysiotherapie art. 24 klinische biologie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

29 NOMENCLATUUR: indeling (vervolg)
art. 25 toezichtshonoraria art. 26 dringendheidshonoraria art. 27 bandagisterie art. 28 synthesemateriaal + rolwagens art. 29 orthopedische toestellen art. 30 opticiens The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

30 NOMENCLATUUR: indeling (vervolg)
art. 31 gehoorprothesisten art. 32 pathologische anatomie art. 33 genetische onderzoeken art. 34 interventionele verstrekkingen art. 35 implantaten (& bis) art. 36 logopedie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

31 NOMENCLATUUR: begrippenkader
bekwaming/beroepstitel fysieke aanwezigheid stagedoende geneesheer toepassingsregels: cumul, maximum, guidelines, controle, voorschrift, plaats van verstrekking, tarificatieregels (anesthesie + opereerstreken), connexiteit, a priori/posteriori goedkeuring AG The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

32 NOMENCLATUUR: begrippenkader (vervolg)
remgeld accreditering interpretatie/assimilatie regeling derde betalende controle The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

33 NOMENCLATUUR: begrippenkader guidelines
EBM b.v. PET kostenbesparing b.v. zwangerschapsecho controle door VI/RIZIV??? zinvol om dit op te nemen in de nomenclatuur? The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

34 NOMENCLATUUR: begrippenkader accreditering
kwaliteitspromotie differentiatie honoraria verstrekker en instelling forfait/à l’acte The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

35 NOMENCLATUUR: begrippenkader connexiteit
algemene bepaling art. 10 § 4 nomenclatuur: ‘De handelingen die verwant zijn met de uitoefening van een bepaald specialisme worden eveneens gehononeerd wanneer ze verricht zijn door een als specialist voor dat specialisme erkend geneesheer met in achtneming van de opgelegde voorwaarden inzake fysieke aanwezigheid en binnen de perken die eventueel zijn vastgesteld op het niveau van de verschillende betrokken specialismen.’ The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

36 NOMENCLATUUR: begrippenkader connexiteit (vervolg)
chirurgie: interconnexiteit art. 15 § 1 inwendige geneeskunde: interconn. art. 20 § 2 radiotherapie/nucl. geneesk.: art. 19 § 5 dermatologie: art. 20 § 1 (radiotherapie) en art. 20 § 4 via toepassingsregel The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

37 NOMENCLATUUR: begrippenkader remgeld
KB tot vaststelling van het persoonlijk aandeel van de rechthebbende of van de tegemoetkoming van de verzekering voor geneeskundige verzorging in het honorarium van bepaalde verstrekkingen gedifferentieerde tarieven (VT/niet-VT) gedifferentieerde tarieven (ambulant/gehosp.) vast bedrag (geïndexeerd)/percentage onderfinanciering remgeld  The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

38 NOMENCLATUUR: begrippenkader interpretatie/assimilatie
verduidelijking over bestaande prestaties officiële interpr. gepubliceerd in Staatsblad assimilatie: gelijkstelling van nieuwe medische akte/techniek met bestaande prestatie voorstel VC vs. regeling Frankrijk The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

39 NOMENCLATUUR: begrippenkader regeling derde betalende artsen (KB 10-10-86)
rechtstreekse betaling door het ziekenfonds aan de zorgverlener verplicht voor verstrekkingen tijdens opname en gelijkgestelden (maxi-, A-B-C-D-forfait, hemodialyse, labo’s met omzet > euro, borstkankerscreening) verbod voor raadplegingen, bezoeken en adviezen met uitz. statuut patiënt en plaats verstrekking (art. 6) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

40 NOMENCLATUUR: begrippenkader regeling derde betalende artsen (KB 10-10-86)
modaliteiten arts toepassing RDB voor andere verstrekkingen (art 4bis) - geconventioneerd (uitz. wachtdienst) - RDB toepassen voor alle toegelaten verstrekkingen en alle rechthebbenden - geen sanctie hebben opgelopen - geen verbod op RDB hebben - aanvraag per aangetekend schrijven The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

41 NOMENCLATUUR: herijking
pediatrie: - toezichtshonoraria - technische prestaties - liaison psychiatrie: - toezichtshonoraria - ontkoppelen neurologie - liaison (intake/outtake) - kinderpsychiatrie geriatrie: - toezichtshonoraria - ambulante check-up pre-RVT The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

42 NOMENCLATUUR: herijking (vervolg)
reumatologie oncologie endocrinologie neuropediater huisarts ... consultatie The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

43 NOMENCLATUUR: algemene beschouwingen
Voordelen en nadelen van nomenclatuur met een financiering à l’acte voordelen: * gedetailleerde databank * ‘loon naar werken’ * aanpassingsmogelijkheden * consensusmodel The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

44 NOMENCLATUUR: algemene beschouwingen (vervolg)
nadelen: * provider induced demand * inkomensongelijkheden * complexiteit/tarificatie-software * te weinig kwaliteitscriteria * te weinig erkenningscriteria * zuiverheid honorarium (kabinet, polikliniek, intramuraal) * verouderd begrippenkader (nieuw technieken, bloedig/onbloedig) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%

45 ) The first study laid a foundation for the study health care categories and review methodology. This last study refined the methodology through enhancements to the sampling and review methods. Texas actually measures the potential overpayments, which were 6.8% and 7.24%. Since the methodology in the second study was enhanced, the studies were not compared to each other. The results were calculated using a 95% confidence level. Our margin of error was =/- 3%