Question

How are health service providers paid and paid the same service?

Answer 1

Ans : There are 6 models through which health service providers paid and paid the same service.

1. Fee For Service : This is the traditional way, used by private health insurers and by the government (Medicare and Medicaid) and is called 'fee-for-service'. Under fee-for-service (FFS) the insurance payer pays whatever the physician, hospital, or other healthcare provider charges, without prearrangement of fees, once the provider of care submits an insurance claim.
2. Capitation : When a doctor, medical group, hospital or integrated health system receives a certain flat fee every month for taking care of an individual enrolled in a managed health care plan, regardless of the cost of that individual care. Generally, majority of people enrolled in a health plan will never use health care services within any given month, capitation arrangements should naturally balance out the high utilizers in health plans with those who use little or no health care every month.
3. Relative Value Units : The RVU model focuses on value-based healthcare, rather than the fee-for-service volume-based model.
4. Bundled Payments : A payment model where physician and hospital expenses are joined to make a single payment for an episode of care.
5. Comprehensive Primary Care : This is a model which encourages physicians to keep patients healthy by establishing a single risk-adjusted price for all healthcare services needed by a group or individual for a fixed period of time. With this model, physicians are offered incentives based on better patient care.
6. Concierge Care : An alternative to traditional payment models, where medical practices have a direct financial relationship with patients. they typically charge a monthly or annual fee so that the patient receives additional access and personalized care. These practices are known by a variety of names : concierge healthcare, Direct primary care etc.