Free Single-Payer vs. Reimbursement Payment Essay Sample

Health care can be defined as preservation of people's health by prevention of illness using services from the health profession. The single - payer model is whereby a government or a government-run entity acts as a payer in health care (Brandon, 1). In this case the entity is set up such that it collects all healthcare fees through taxation and other tolls then settles out all healthcare expenses. The reimbursement payment mechanism is whereby a government entity or an insurance firm makes payments to the health care providers as repayment for healthcare services rendered to patients. This paper will discuss the effect of using either single-payer model for healthcare or payment mechanism in which reimbursement depends on the care's quality on spending of providers on healthcare IT.

In the present system in the United States there are thousands of healthcare organizations, these results in a huge amount of administrative waste in the health care delivery system. This is because the different organizations have different forms to be filled and different billing which results into complex billing by the doctors. Thus if the single payer model was adopted there would be great reduction in the administrative waste and it would also save on the expenses as capital budgets would be based on health care priorities.

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Brandon observes that besides the single payer model would eliminate the need for private insurance since patients' health care costs are paid for by a single entity. Also there would be changes in the basis of how decisions are made for example clinical decisions would not be dictated by insurance policies. Another effect is that patients despite of their capability to pay would receive the best medical care and would also have the freedom to choose their doctors and which hospital to attend.

There is also the fact that most businesses would end up saving as they do not have to take up the task of administering insurance for their employees thus limiting the money they use on health cost. In this model the government or the entity responsible for submitting payments would act as an administrator in the health care sector as it is responsible for funding and managing the hospitals.

Reimbursement Payment

In the reimbursement payment model there are different methodologies used which are fee-for-service reimbursement and episode-of-care reimbursement. In the fee-for-service reimbursement payment is made for each service rendered while in the episode-of-care reimbursement the healthcare providers receive a lump sum amount for all the services rendered. In this case if the United States government was to adopt the reimbursement payment mechanism depending on care's quality it means they would be using the episode-of-care reimbursement methodology.

In this methodology the payments are prospective; this means the administrator has the power to decide the procedures medically suitable for each patient and the amount to be paid. In this payment the payer lays out what is suitable for the patient and informs the provider which costs will be catered for and which will not. Prospective reimbursement is comprehensive and can be termed the episode-of-care reimbursement which encourages effective and higher value care.

Lee states that the effect of the reimbursement payment model is that the providers will have to focus on making adjustments in their sectors such as facilities size, this is because most probable payment system use diagnosis related groups to identify services that can be classified together in to a single payment for an episode. The providers also have to pay attention to issues unique to a particular service for various facilities. Furthermore the model will hearten the providers to render services more efficiently.

The United States health care system is complex because many methods are used in making payments for the health care costs, if the discussed models are implemented the health care costs to individual patients will reduce and the services rendered improved greatly. In both instances the bigger part of payments will be the responsibility of the government and thus people will receive care based on need rather than their ability to pay.


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