The modalities of payment of health care without any doubt occupies a place in any health reform process. The mode of payment used in a particular system has an intimate relationship with the organizational characteristics of the same, and the objectives pursued. The differences determine the relationships between the various actors, the user beneficiary, the funder, and provider, or the matching of the goals pursued, and this reflected in the practical payment system. The United States has eight primary method in the health care payment systems which one of the most useful is capitation and how this system is functioning in term of, weakness, effectiveness and strength. First of all, the capitation is one of the most used payment methods that the primary doctors are utilizing in the healthcare today. (National Health Insurance Scheme in their publication on May, 2015) refer to the capitation which relates to the payment method of the health care system. This capitation system, through a fixed amount per patient, the insurer (or another payer) pays a provider for medical care or an individual hospital for a specified period. Medical care organizations have their …show more content…
Another aspect of effectiveness and strength that this system has is to minimize costs. For this reason, doctors only prescribe the necessary medicines or treatments, and patients share costs with other members of the network. So managed to reduce what they have to pay. The Health Care Strategies Center conducted a study in 2003 that established that the average costs of $ 20.46 for pharmacies were the fee-for-service system and $ 17.36 for the capitation
Lischko A. (2011). Physician payment reform: A review and update of the models. Massachusetts medical society.
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
The United States is projected to spend nearly 20 percent of the Gross Domestic Product on healthcare by 2020.According to a Mckinsey study $447 billion of the 1.7 trillion the U.S. spent on healthcare in 2003 was in excess of what it should have spent based on its wealth. A 1 % increase in the rate of health-spending results in an increase of about $2 trillion in spending on health over the next 10 years.
Has anyone noticed that there seems to be a drugstore being built on every corner these days? Revco, Walgreens, and Rite Aid seem to be just a few of the drug store chains that are expanding. One has to wonder if this has anything to do with the possibility of including medicine under coverage by healthcare systems. This means that they may become part of a capitated payment system to the pharmaceutical providers. "By capitation, we mean a prospective payment to physicians or providers - either individually or as a group - of a fixed amount of money to care for each patient (Pearson, 1998)." In other words, every physician is provided a set sum of money whether they see any patients or not and every pharmacy would be given money whether they prescribe any drugs or not. Drug costs will rise.
Medicare was designed as a universal healthcare program for individuals 65 years old and older. This program is funded by Medicare taxes and general federal funding withholding taxes. Medicare is a partnership between federal and state with the goal to provide medical insurance to the elderly that is poor and disabled. Generally all people who are 65 years or older and qualify for social security will automatically qualify for Medicare.
There are several issues concerning the uninsured and underinsured patient population in America. There are many areas of concern the congressional efforts to increase the availability of health insurance, the public image of the insurance industry illustrated by the movie "John Q", the lack of good management tools, and creating health insurance coverage for all low income Americans. Since the number of uninsured Americans has risen to 43 million from 37 million in the flourishing 1990s and could shoot up even more severely if the economy continues to decrease and health care premiums keep increasing (Insurance No Simple Fix, 2001).
Medicare is a federal health insurance program for people, who are age sixty five or older, or people that have End Stage Renal Disease and permanent disabilities. There are four different entities of Medicare to include; Medicare Part A which is the Hospital Benefit that covers inpatient hospital services, hospice treatment, skilled nursing facilities and other home health services. Medicare Part B that covers the Professional component of the physicians' services, preventive services and medical supplies then there is Medicare Part C which is considered a Medicare Advantage Plans that is offered by a private company that has a contract with Medicare to provide the patient with both Part A and Part B benefits. A Medicare Advantage Plans consist of Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Private Fee for Special Needs Plans, Service Plans, and Medicare Medical Savings Account Plans.
There is an ongoing debate on the topic of how to fix the health care system in America. Some believe that there should be a Single Payer system that ensures all health care costs are covered by the government, and the people that want a Public Option system believe that there should be no government interference with paying for individual’s health care costs. In 1993, President Bill Clinton introduced the Health Security Act. Its goal was to provide universal health care for America. There was a lot of controversy throughout the nation whether this Act was going in the right direction, and in 1994, the Act died. Since then there have been multiple other attempts to fix the health care situation, but those attempts have not succeeded. The Affordable Care Act was passed in the senate on December 24, 2009, and passed in the house on March 21, 2010. President Obama signed it into law on March 23 (Obamacare Facts). This indeed was a step forward to end the debate about health care, and began to establish the middle ground for people in America. In order for America to stay on track to rebuild the health care system, we need to keep going in the same direction and expand our horizons by keeping and adding on to the Affordable Care Act so every citizen is content.
Healthcare plays an important role in almost every person’s life at one point or another. Many times, one can get caught without, or underinsured and it can be detrimental to their livelihood. With the rising cost of healthcare, it is likely that having a national healthcare policy in place, and as an individual, being able to afford and obtain adequate health insurance has not been required until now. With the new national healthcare plan, it is required for all citizens to obtain and maintain some sort of public or private insurance policy. The rising costs can be attributed to many things. A significant reason for the astronomical cost of health care is because of the staggering amount of uninsured or underinsured individuals receiving medical attention and almost many never paying the bill. Those who do have insurance have seen a gradual increase in their premiums and deductibles to make up for this.
To comprehend our current health care system, it is important to understand the history and how health care has evolved in the United States. The healthcare system we have now didn't always exist. Believe it or not, before 1920, most people would not of known what health care coverage meant! So how did the United States turn into one of the few developed countries lacking nationwide healthcare? Understanding U.S. healthcare history will help you understand the dynamics that built the system that, we struggle with today. Furthermore, I will make conclusions on the current problems we are facing.
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
...ue to numerous medical errors. With the amount of medical errors that currently do occur which is a current health care issue it cost the health care billions of dollar each year to fix the mistakes that were made.
Health care has always been an interesting topic all over the world. Voltaire once said, “The art of medicine consists of amusing the patient while nature cures the disease.” It may seem like health care that nothing gets accomplished in different health care systems, but ultimately many trying to cures diseases and improve health care systems.
Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.