“The complexity of financing in health care is one of the primary characteristics of medical care delivery in the United States” (Shi & Singh, 2012, p. 129). There are numerous reimbursement metho

“The complexity of financing in health care is one of the primary characteristics of medical care delivery in the United States” (Shi & Singh, 2012, p. 129). There are numerous reimbursement methods (e.g., capitation, fee-for-service, package pricing, etc.) that are used by health care organizations and providers to get paid for the health care services that they provide. Building upon your Individual Project from Unit 1, write a 3-5 page paper not including a title page and reference page that contains the following:

  • Summarize 3 different reimbursement methods that are used by health care providers and organizations.
  • Choose which method(s) will work best for the health care facility that you have proposed to be developed, and explain why you chose that method(s).
  • Discuss the pros and cons of the reimbursement method(s) that you chose.
  • Discuss the impact that the method(s) may have on the financial operations of the facility that you chose.

Expert Solution Preview

Introduction:
Financing in healthcare is a crucial aspect of the medical care delivery system in the United States. Healthcare organizations and providers use various reimbursement methods to get paid for the services they provide. In this paper, we will summarize three different reimbursement methods, choose the best method for the healthcare facility proposed in Unit 1, evaluate the pros and cons of the reimbursement method chosen and discuss its impact on the financial operations of the facility.

Reimbursement Methods Used by Healthcare Providers and Organizations:
1. Fee-for-Service (FFS): FFS is a reimbursement method where healthcare providers are paid for each service or procedure provided to the patient. This method is widely used in the United States and pays providers for services rendered. It is preferred by physicians as it pays them for every service performed. However, FFS may lead to overuse of services and result in increased healthcare costs.

2. Capitation: In capitation, healthcare providers are paid a fixed amount per patient per month, regardless of the amount of healthcare services used by each patient. Capitation encourages providers to provide preventive care and reduce unnecessary testing and care. However, it may lead to underutilization of services for some patients.

3. Package Pricing: Package pricing is a bundled payment system where providers receive a single payment for a group of related services provided to a patient. This method helps to reduce the cost of care, encourages efficient use of resources, and promotes coordination of care. However, it may lead to the restriction of services to specific groups of patients.

The Best Reimbursement Method for the Proposed Health Care Facility:
The proposed healthcare facility is a community health center that aims to provide comprehensive primary care services to the underserved population. The capitation method is the best reimbursement method for this facility as it offers a fixed amount of payment per patient. This method will ensure that patients receive preventive care and necessary treatments while ensuring that healthcare costs are kept low.

The Pros and Cons of Capitation Method:
Pros:
– Encourages preventive care.
– Fixed payments ensure stable revenue for the facility.
– Costs are kept low as providers are paid a fixed amount per patient.

Cons:
– May lead to underutilization of services for some patients.
– Providers may limit services to stay within fixed payments.
– Providers may avoid high-risk patients to minimize costs.

Impact of Capitation Method on the Financial Operations of the Facility:
Implementation of capitation method has the following impacts on the financial operations of the facility:
– Predictable revenue based on the number of patients enrolled.
– Financial stability as payments are received in advance.
– Increased accountability as providers focus on providing preventive care.
– Providers must be skilled in managing care and utilization to maintain financial viability.

Conclusion:
In conclusion, healthcare financing is a complex task that requires careful consideration of various reimbursement methods. The capitation method is the best reimbursement method for the proposed healthcare facility as it promotes preventive care and ensures fixed payments, which increases financial stability. While the method has its pros and cons, its benefits outweigh the risks, and it offers a viable financial model for a successful healthcare facility.

Share This Post

Email
WhatsApp
Facebook
Twitter
LinkedIn
Pinterest
Reddit

Order a Similar Paper and get 15% Discount on your First Order

Related Questions

HCM Saudi Electronic University Health Sector Transformation Program Discussion

Key objective 2 in the Health Sector Transformation Program within Saudi Vision 2030 is improving the quality and efficiency of health services. Discuss two healthcare quality improvements that have been achieved under the Health Sector Transformation program. Be sure to reference how these improvements were measured. Discuss how key objective

HCM Saudi Electronic University Health Sector Transformation Discussion

The goal of the Health Sector Transformation Program is to reorganize Saudi Arabia’s health sector so that it is a complete, effective, and integrated health system based on the health of the individual and society (including the citizen, the resident and the visitor). The Program is based on the idea

Saudi Electronic University Health Sector Transformation Program Discussion

Key objective 2 in the Health Sector Transformation Program within Saudi Vision 2030 is improving the quality and efficiency of health services. Discuss two healthcare quality improvements that have been achieved under the Health Sector Transformation program. Be sure to reference how these improvements were measured. Discuss how key objective

Saudi Electronic University Health Services & Financial Management Discussion

Unique Aspects of Health Services & Financial Management There are a number of unique factors relating to the health services sector: Compare the two types of accounting functions. Describe how the accounting functions affect operational oversight. How do these unique features affect the financial management of the sector? Expert Solution

discsstion 1

Key objective 2 in the Health Sector Transformation Program within Saudi Vision 2030 is improving the quality and efficiency of health services. Discuss two healthcare quality improvements that have been achieved under the Health Sector Transformation program. Be sure to reference how these improvements were measured. Discuss how key objective

discuustion 2

I’m working on a public health discussion question and need the explanation and answer to help me learn. Key objective 2 in the Health Sector Transformation Program within Saudi Vision 2030 is improving the quality and efficiency of health services. Discuss two healthcare quality improvements that have been achieved under

SEU Entities Involved in Healthcare Privatization Discussion Response

I need reply for this: The goal of the Health Sector Transformation Program is to reorganize Saudi Arabia’s health sector so that it is a complete, effective, and integrated health system based on the health of the individual and society (including the citizen, the resident and the visitor). The Program

SEU Health Sector Transformation Program Discussion Response

I need reply for this: Health Sector Transformation program in Saudi Vision 2030 COLLAPSE Introduction        The Saudi Vision 2030’s Health Sector Transformation Program aims to raise healthcare quality in Saudi Arabia. The initiative has improved healthcare quality in several ways, such as by developing telemedicine services. This paper will discuss

SEU Using the Gestation Demographics SEU Dataset Project

Using the Gestation Demographics SEU dataset that is located in the tabs at the bottom of the Framingham dataset provided, perform the following problems using R Studio or Excel.Create a simple distribution graph (histogram) where we will explore the age of women after giving birth to their first child. Remember

Using the Gestation Demographics SEU datase

This week we are learning about ordinal/categorical, continuous, and dichotomous variables. Using the Gestation Demographics SEU dataset that is located in the tabs at the bottom of the Framingham dataset provided, perform the following problems using R Studio or Excel. Create a simple distribution graph (histogram) where we will explore

Policy and Supply and Demand ppt

Policy and Supply and Demand (125 Points) Various programs to increase employment in the healthcare sector have recently been introduced in the Kingdom of Saudi Arabia. As a result, an increasing number of foreigners have been provided with the opportunity work in the Kingdom. Studies show that 30% of the

reply f 1

Under the Health Sector Transformation Program within Saudi Vision 2030, improving the quality and efficiency of health services is a crucial objective. The program aims to improve healthcare quality by enhancing access to healthcare services, enhancing healthcare financing, improving healthcare governance and management, and increasing healthcare workforce capacity (Ministry of

BMI 502 SIU Impact of Telemedicine in Bowel Disease Literature Review

Literature review article  Topic: Impact of Telemedicine in Inflammatory Bowel Disease  citations using endnote ; paper should contain headings: abstract, introduction, literature review, methodology, discussion and conclusion Expert Solution Preview Introduction: Telemedicine has emerged as a beneficial tool in various fields of medicine. The focus of this literature review article

reply f 2

Health Services and Financial Management  Health services and financial management are two distinct yet overlapping fields of expertise. Health services involve delivering medical services and treatments to maintain or improve a person’s health. At the same time, financial management is the process of identifying, monitoring, and controlling the use of

reply for this

Health Sector Transformation program in Saudi Vision 2030 COLLAPSE Introduction  The Saudi Vision 2030’s Health Sector Transformation Program aims to raise healthcare quality in Saudi Arabia. The initiative has improved healthcare quality in several ways, such as by developing telemedicine services. This paper will discuss two healthcare quality improvements made

reply 4 f

Financial management in any sector include the managing of regular monetary activities including contract negotiations, cash availability for expenses like payroll, and emergency fund maintenance. Financial management at the executive level entails sharing data with the other members of the leadership team so that they may formulate long-term strategies. Large