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A variety of different options of hospital payment systems is available to a patient who is the beneficiary. The beneficiaries enjoy a wide range of services. Payments setting depend on the level of care that is suitable for a patient. For example, a routine and, continuous homecare, in patient general or specialized care.
Factors such as geographical location of patients, severity of illness and, care cost must be put in consideration when designing the system. Payment systems have an effect on the cost and, behavior of the service provider. Payment systems include the Fee-for –service per diem DRG-based.
The preference of the system influence is by the nature of care that is fitting to a patient. There are conditions to fulfill for a patient to be eligible for Medicare. Some of them include a certificate from a doctor who shows the nature of illness, and certifies that a terminal illness exists.
Fee-for-service per Diem the DRG –based system
The payment charges per day even in times when few or no patient the care giver still receives payments.
The payment is constant and, no addition payments incase the care giver exceeds the number of patient to attend. It is de motivating since at times, the care giver does a lot of work.
It is a slow method in terms of incorporating new medical technology.
Capitation Medicare Payment Advisory commission
In cases where the profit made from the patients is high, the hospitals have less pressure when it comes to containing the cost.
The hospitals are under pressure of containing the cost if the profit made from the patient is lower.
There is continuous care to the patient and payments have a predetermined fee. The patient pays only once for the services that the policy stipulates. Other extra costs due to negligence of the provider are the liability of the hospice.
Since, the predetermination of the fee hinders the delivery of the appropriate services due to rise of the cost unless the patient makes additional payments. The patient may be under treated by the care giver.
It encourages the shifting of costs from Medicare to service provider. The care giver assumes total responsibility to ensure that no omission occurs as this could eventually increase the cost. For example, provision of necessary vaccines like pneumonia and, measles in order to avoid opportunistic illness that Medicare is not liable to make payment for the treatment since the care giver did not fulfill the conditions. Every patient gets a vaccine immediately after joining the insurance.
The DRG-based payment system
The conditions are flexible and, where the situation demands arrangements for a transfer to a hospice that offers advanced facilities for the patient condition commences. This reduces the patient’s costs and helps the provider in service delivery.
Some medical cases are costly due to their extreme nature. Medicare has to make extra payments for these cases.
Medicare Payment Basics: Outpatient Hospital Services Payment System
This system provides a wide range of services at the hospital to the beneficiary. The predetermination of payment enables the patient to pay according to the nature of services.
This may be expensive incase the patient has multiple illness that requires making of separate payments. This may limit the care giver in terms of the treatment that the patient receives.
Hospital Outpatient Prospective Payment System: The Medicare Learning Network Payment System Fact Sheet Series.
This system mainly covers patients who are not in restriction to stay at the hospital. The adjustment of drugs Price is always in consideration of the costs in order to prevent the incurring of losses.
Medicare makes additional payments to hospitals depending on the geographical location and the complexity of the services that are on provision.
The revision on payments of some services occurs annually and, not quarterly. This may not be convenient as many economical changes rise and, requires some immediate changes.
Acute Care Hospital Inpatient Prospective Payment System
According to the Medicare Learning Network Payment Systems Fact Sheet Series
The adjustments on payments depend on the geographical location and, in case of a transfer from one facility to another.
Medicare has a fixed payment system that forces providers to reduce their in patient cost by transfer of services which may be costly to them.
Payment Reform Options: Episode Payment is a Good Place to Start
Each case receives a different treatment in terms of payments. This ensures that the patient gets all the effective treatment and, the care provider has necessary requirements of high quality service delivery. The provider is not at pressure in terms of payments and, there is motivation.
Healthcare Payment Reform and Provider Reimbursement: Summary of Strategies for Consideration by the Oregon Health Fund Board
The Board’s main responsibility is to develop a reform plan that is accessible, coordinated, motivation on efficiency and, cost effective care to patients thus ensuring the system sustainability. The plan caters for proper resource utilization and the provision of high quality services. It also works towards the implementation of plans that ensure a uniform performance in terms of quality and, satisfaction.
There is a need to strengthening of patient and care giver relationship that facilitates the partnership
Many factors like care cost, geographical location and, severity of illness need to be taken into consideration in order to design an effective system. The system has to be fair, efficient, sustainable and, transparent to all parties. This helps in creating an equitable and, an appropriate system.
The current systems are not particularly appropriate in health care provision and, service provider welfare. However, the system is constantly under review and, the necessary amendments are underway. This will enhance sustainability and prevent the collapse of the care systems.