Healthcare reimbursement incorporates capitation, salary, fees for service (FFS), diagnosis-based payment and Pay-for-performance (P4P). The reimbursement mechanisms are critical in the effectiveness of the health care system which is one of the key functions of the federal and state governments (Britton, 2015). As currently constituted, the reimbursement mechanisms exhibit both weaknesses and strengths.
The strengths lie in the fact that the authorities can track payments digitally through Health Information Technology which linked with all health facilities drawing payments from the government. As such, it makes the system accountable. The reimbursement system in place currently fosters preventive care and cost-containment on the part of the authorities. The P4P system that is observed through the Medicare reimbursement plan creates the needed link to quality (Britton, 2015). This is done through comparisons of performance on observed outcomes to previous performance or performance of other health providers.
The shortcomings of the reimbursement system center on the increased cases of under treatment brought about by the large patient numbers per facility or provider. This, in the end, compromises the quality of services availed by a single provider in its effort to acquire more incomes by treating as many patients as possible (Langenbrunner, Cashin, O’Dougherty, & World Bank, 2009). In the capitation system of payment, a predetermined amount is paid which may bring about over referral of patients with complex diagnoses.
Given the different complexities associated with the reimbursement system, there is need to effect changes. This can only be done through acquisition and analysis of health information through the electronic medical record. The EMR is currently used for only documentation rather than data, synthesis, accumulation and analysis. It is through analysis that data gathered can be compared to normative standards and, patterns and variances detection (Britton, 2015). There is also need for a concerted effort among health providers and the authorities to streamline the reimbursement system. It is only through harmony the two parties that services and products can be priced equitably.
- Britton, J. R. (2015). Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on “Fee-for-Service Payment – an Evil Practice That Must Be Stamped Out?.” International Journal of Health Policy and Management, 4(8), 549-551.
- Langenbrunner, J., Cashin, C., O’Dougherty, S., & World Bank. (2009). Designing and implementing health care provider payment systems: How-to manuals. Washington, DC: World Bank.
