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Modes of Financing
- out of pocket
- individual health insurance
- employment based health insurance
- government financing
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Methods of Payment
- Fee for service
- payment by episode of illness
- payment per patient: Capitation
- payment per time: salary
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Fee for service
- payment per each procedure
- expensive if have many conditions
- HCP may do more things to you bc they will receive more money
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Usual, Customary, and Reasonable (UCR)
- HCP can set their own costs so costs went up
- So gov made fee schedule
- now HCP have to schedule more patients to keep paycheck high
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Fee schedule
Estimated time, mental effort, physical effort and technical skill and stress related to the service
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What economic incentive to health care providers w/ the Fee for service method?
Monetary benefits for health care service
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Fee for service good/bad
- Patient (isn’t the one paying)- good bc get better quicker
- Insurance company- bad bc paying more
- HCP- good- everything you do get paid for
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Payment per episode of illness
paid certain amount to do a certain task; like paid $1500 and does surgery
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What financial incentives in pay for episode? Is it bad?
- Incentive to do less
- --You lose money if you provide too many time
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payment per episode
- Patient- bad bc surgeon does less for money
- HCP- good for profit, bad if have to see patient many times
- Insurance company- good bc they only have to pay one sum
- ---More services bundled, more risk on HCP
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