Question

identify three positive elements of our health care payment system? identify three negative elements of our current healthcare payment system? Propose a new payment system/structure that has been explored and comment on it's feasibility?

Answer 1

The three positive elements/characteristics/features of our health care payment system are as follows:

Firstly, Financing of the health care system/services needs to be delivered (in order to ensure that all the citizen are now able to receive/get any health care services whenever there is a need). Also to receive health care services that are low in cost (cost-effective) and those services meet standards of quality (whatever standards are pre-formed before the services are provided). Secondly, how much amount/payment rate is sufficient enough to cover the cost of services is to be provided by the health care providers only at first. Third and lastly, the details on timelines of payments (in which the payments are to be made) and payment schedule, performance needs and accountability mechanisms are must.

And such characteristics of Health Care Payment System can help in drawing out the benefits that are needed for having an access to equity, quality and efficiency in services (cost-effective services are therefore provided) that are delivered among the people that needs health care towards achieving a goal of Universal Health Coverage.

The three negative elements of our current Health Care Payment System are as follows:

There are two Provider Payment Mechanisms basically known as Fee For Service (FFS) and Capitation (per capita). In the Mechanism like FFS, the health care providers are meant to be repaid/reimbursed for each and every individual service to be provided to the person that needs health service. Whereas, Capitation is a Payment Mechanism where each provider receives a fixed amount of payment prior to the time in which a provider delivers that service, and under this Mechanism, a provider provides all the services that are already agreed to be delivered upon a paper for each and every individual registered and admitted for a fixed period of time. And the first negative element is that the quantity of health care services delivered by the providers are now reduced under Capitation but increased under Fee For Service (FFS). Secondly, it was seen that high quality of services were observed to be delivered whenever the health care providers were paid by the Mechanism like Capitation but least quality of services were provided under Mechanism like Fee For Service. Thirdly, high rates of expert doctors, specialists and hospital referrals were seem to be there when the health care providers were paid under the mode of Capitation instead Fee For Service.

A new Health Care Payment System/Mechanism that has been currently explored is Cost Reimbursement where a health care provider is reimbursed the actual costs that a provider incurs on delivering a service to a patient, plus an additional cost. And also the costs for which a provider is entitled to be repaid are set out clearly in the paper-contract. This is also known as a technique of Strategic Marketing. It's not feasible enough as the payment rates provided by the health care providers are most of the times high enough and not affordable by each and every individual patient. Main motive of the health care providers behind the establishment of Cost Reimbursement Payment System is to create chains of making more and more money.