Designing and Implementing Health Care Provider Payment Systems

Abstract

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom they should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns. Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems, and this how-to manual addresses this need. The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.

Assessment of systems for paying health care providers in Vietnam: Implications for equity, efficiency and expanding effective health coverage

“…Improved equity in resource allocation is typically considered to be one of the important potential benefits of capitation (Langenbrunner et al, 2009). Only 5% of respondents agreed that capitation contributes to fairness and equitable allocation 0 10 20 30 40 50 60 70 80 90 100…”

“…Although any payment system may be associated with adverse consequences, if designed and implemented appropriately, capitation for primary care has the potential to bring a number of benefits, including greater equity, incentives to increase primary care and prevention and to deliver services more efficiently, administrative simplicity and more predictable income for providers (Cashin, Borowitz, & Zuess, 2002;Goroll, Berenson, Schoenbaum, & Gardner, 2007;Langenbrunner et al, 2009;Tu et al, 2009). The results of the stakeholder interviews and quantitative data analysis, however, show that in fact none of these potential benefits of capitation are being realised (Table 4).…”

“…Health care provider payment systems -the way providers are paid to deliver the covered package of servicesare an important strategic lever for balancing system revenues and costs in a way that creates incentives for providers to improve quality and deliver services more efficiently. This ultimately makes it possible to expand coverage within limited funds (Langenbrunner, Cashin, & O'Dougherty, 2009). In practice, however, provider payment systems often are underutilised as an effective tool to achieve UHC goals (Lagomarsino, Over the past two decades, Vietnam has made significant progress towards achieving UHC for its population.…”

Evolution of healthcare provider payment mechanisms

“…Момент определения размера оплаты определяет приоритетное направление действий поставщика. Ретроспективная оплата стимулирует поставщика к наращиванию объемов (услуг, закончен- 1 Согласно [2], определяющим параметром также является момент установления ставки оплаты, однако к настоящему моменту установление ставки после оказания медицинской помощи с учетом фактически понесенных расходов вышло из употребления в развитых странах.…”

“…Оплата медицинской помощи представляет собой заключительный этап финансирования здравоохранения, функциями которого являются обеспечение поставщиков медицинской помощи необходимыми ресурсами (ставка оплаты) и создание стимулов для поставщиков к оказанию помощи, наиболее полно соответствующей потребностям покупателя (методы оплаты) [1]. В узком смысле к методам оплаты относят только механизмы, непосредственно обеспечивающие передачу средств от покупателя к поставщику медицинской помощи (расчет и осуществление оплаты).…”