Provider payment methods may be divided into eight basic methods, depending on the unit of payment.* Each method is characterized by a different division of risk between the payer and the provider (see chart below.) In increasing order of payer risk, the eight basic methods are: 1. Per dollar of charges. The provider is paid a percentage of its charges, usually less than 100 percent. This metho...

BACKGROUND Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. OBJECTIVE We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health ...

Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years ...

This article presents a model of the important health-policy dilemmas of risk selection and moral hazard. When providers can increase revenues by selecting favorable risks, capitation or purely prospective payment is unlikely to be optimal. A second best payment system may involve mixed levels of both demandand supply-side cost sharing: consumers may prefer to pay deductibles and co-payments ra...

New strategies to control U.S. health spending growth are urgently needed. Although provider payment cuts are likely, cutting fee-for-service (FFS) payments will hurt quality and access. A more sensible approach would be to restructure the delivery system into organized networks of providers delivering reliable, evidence-based care. But restructuring will not occur without payment policy reform...

payment mechanism health insurance is a serious challenge for policy makers, access to health, continuing care, need to technology, huge expenses a considerable part of health funds is collected. therefore organizing and designing appropriate policies for organizing, financing, payment mechanism for providers and role of diagnostic related groups system. in this study, our main objective study ...

BACKGROUND Health insurance is improving access to quality health care in Ghana. However, there are implementation challenges which call for reform of the current health insurance system. There is no doubt that reforming the current health insurance in Ghana is besieged with a myriad of problems due to misconceptions and misinformation. This study explored the perceptions and understanding of c...

The purpose of this policy statement is to address the serious underinsurance (ie, insurance that exists but is inadequate) problems affecting insured adolescents' access to needed preventive, reproductive, and behavioral health care. In addition, the statement addresses provider payment problems that disproportionately affect clinicians who care for adolescents. Among adolescents with insuranc...

Many health care providers and policy makers believe that health care financing systems fail to reward high-quality care. In recent years, federal and private payers have begun to promote pay for performance, or value-based purchasing, initiatives to raise the quality of care. This report describes conceptual issues in the design and implementation of pay for performance for chronic kidney dise...