Designing And Implementing Health Care Provider Payment Systems

Author : Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty
Publisher : World Bank Publications
Page : 348 pages
File Size : 54,9 Mb
Release : 2009-01-01
Category : Medical
ISBN : 9780821378243

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Designing and Implementing Health Care Provider Payment Systems by Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty Pdf

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.

Author : National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030
Publisher : Unknown
Page : 128 pages
File Size : 54,6 Mb
Release : 2021-09-30
Category : Electronic
ISBN : 0309685060

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The Future of Nursing 2020-2030 by National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030 Pdf

The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

Author : Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson
Publisher : McGraw-Hill Education (UK)
Page : 338 pages
File Size : 46,8 Mb
Release : 2014-09-16
Category : Medical
ISBN : 9780335264391

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Paying for Performance in Healthcare: Implications for Health System Performance and Accountability by Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson Pdf

Health spending continues to grow faster than the economy in most OECD countries. In 2010, the OECD published a study of strategies to increase value for money in health care, in which pay for performance (P4P) was identified as an innovative tool to improve health system efficiency in several OECD countries. However, evidence that P4P increases value for money, boosts quality of processes in health care, or improves health outcomes is limited.This book explores the many questions surrounding P4P such as whether the potential power of P4P has been over-sold, or whether the disappointing results to date are more likely rooted in problems of design and implementation or inadequate monitoring and evaluation. The book also examines the supporting systems and process, in addition to incentives, that are necessary for P4P to improve provider performance and to drive and sustain improvement. The book utilises a substantial set of case studies from 12 OECD countries to shed light on P4P programs in practice.Featuring both high and middle income countries, cases from primary and acute care settings, and a range of both national and pilot programmes, each case study features: Analysis of the design and implementationdecisions, including the role of stakeholders Critical assessment of objectives versus results Examination of the of 'net' impacts, includingpositive spillover effects and unintended consequences The detailed analysis of these 12 case studies together with the rest of this critical text highlight the realities of P4P programs and their potential impact on the performance of health systems in a diversity of settings. As a result, this book provides critical insights into the experience to date with P4P and how this tool may be better leveraged to improve health system performance and accountability. This title is in the European Observatory on Health Systems and Policies Series.

Author : National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health
Publisher : National Academies Press
Page : 195 pages
File Size : 55,7 Mb
Release : 2019-12-30
Category : Medical
ISBN : 9780309493468

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Integrating Social Care into the Delivery of Health Care by National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health Pdf

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.

Author : Institute of Medicine,Committee on Quality of Health Care in America
Publisher : National Academies Press
Page : 360 pages
File Size : 55,8 Mb
Release : 2001-08-19
Category : Medical
ISBN : 9780309072809

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Crossing the Quality Chasm by Institute of Medicine,Committee on Quality of Health Care in America Pdf

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Author : Duane C. Abbey
Publisher : CRC Press
Page : 168 pages
File Size : 46,5 Mb
Release : 2009-05-20
Category : Business & Economics
ISBN : 9781420092783

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Healthcare Payment Systems by Duane C. Abbey Pdf

Healthcare Payment Systems: An Introduction provides a complete introduction to healthcare payment systems. Written by Duane Abbey, one of the nation‘s leading experts and most sought out consultants on payment systems, this volume makes the monumental task of medical reimbursement approachable and manageable. Covering the fundamentals and terminology needed to understand this discipline, and the strategies needed to master it, Dr. Abbey will help you begin to develop the solid core of skills and knowledge needed to confidently approach payment systems as tools to use rather than hazards to avoid -- tools that will lead to improved revenue cycles and higher levels of profitability.

Author : Prof Dr Syed Mohamed Aljunid,Dr Irwan Saputra
Publisher : Partridge Publishing Singapore
Page : 147 pages
File Size : 46,9 Mb
Release : 2022-11-20
Category : Business & Economics
ISBN : 9781543771985

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Implementation of Casemix System as Prospective Provider Payment Method in Social Health Insurance: a Case Study of Acheh Provincial Health Insurance by Prof Dr Syed Mohamed Aljunid,Dr Irwan Saputra Pdf

The Government of Aceh Province in Indonesia has established the Social Health Insurance (SHI) called Jaminan Kesehatan Aceh (JKA) in 2006 that provide health coverage to all 4.6 million population of the province. Fee-for-service was initially used as the provider payment method in the programme until 2013. In 2014, in line with the National Health Insurance of Indonesia (Jaminan Kesehatan Nasional JKN), INA-CBG (Indonesia Case-Based Group) casemix system was adopted by JKA to replace the Fee-for-Service method. This book presents outcome of the evaluation done using a combination of qualitative and quantitative methods on the implementation of JKA programme. The quantitative study was conducted to assess income of three selected hospitals (Type B, C and D) reimbursed using INA-CBG groups covering more than 17,000 cases. Quantitative data analysis revealed that overall, the hospitals received 32.4% higher income when reimbursed with casemix system (INA-CBG) as compared to fee-for-service. Type D hospital is the biggest gainer with 81.0% increase in income. In conclusion, the use of Casemix (INA-CBG) as a prospective payment method has benefitted the hospitals a lot. It is hope that additional resources gained through this programme will allow the hospitals to provide optimum care to the population.

Author : Caryn Bredenkamp,Sarah Bales,Kristiina Kahur
Publisher : World Bank Publications
Page : 69 pages
File Size : 43,5 Mb
Release : 2019-12-19
Category : Medical
ISBN : 9781464815218

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Transition to Diagnosis-Related Group (DRG) Payments for Health by Caryn Bredenkamp,Sarah Bales,Kristiina Kahur Pdf

This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.

Author : Institute of Medicine,Roundtable on Evidence-Based Medicine
Publisher : National Academies Press
Page : 852 pages
File Size : 45,9 Mb
Release : 2011-01-17
Category : Medical
ISBN : 9780309144339

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The Healthcare Imperative by Institute of Medicine,Roundtable on Evidence-Based Medicine Pdf

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

Author : Zuzana Feachem,Martin Hensher,Laura Rose
Publisher : World Bank Publications
Page : 172 pages
File Size : 46,5 Mb
Release : 1999
Category : Medical
ISBN : 0821343378

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Implementing Health Sector Reform in Central Asia by Zuzana Feachem,Martin Hensher,Laura Rose Pdf

It is easy for reformers and their overseas advisers to develop conceptually strong plans for health sector reform that appeal to governments, donors, and academics. Transforming these plans into successful action has proved to be extremely difficult. Toward the goal of improving assistance to this sector, the Economic Development Institute (EDI) of the World Bank held a seminar in Ashgabat, Turkmenistan in June 1996. This publication provides a summary of the proceedings and papers presented at that seminar. It was attended by delegations from five countries in Central Asia and from Azerbaijan and Mongolia. The content of this volume emphasizes topics central to the restructuring of health sector financing and health care delivery systems at a time of transition to market economies and to democracy. Maintaining and improving the health status of the population while preventing rapid escalation of health care expenditure were the recurrent themes throughout the seminar.

Author : The World Bank
Publisher : World Bank Publications
Page : 67 pages
File Size : 45,5 Mb
Release : 2013
Category : Electronic book
ISBN : 8210379456XXX

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Fairness and Accountability by The World Bank Pdf

The new MENA health strategy for 2013-2018 is focused on the creation of “fair” and “accountable” health systems in the region. Conceived through a yearlong process, it captures the World Bank’s commitment to overarching principles in a sustainable manner. It first analyzes the status of health systems in the region; then describes how health care can be made more fair and accountable; next provides examples of World Bank global expertise and products to do so; and concludes with details of how the strategy will be implemented. Through this strategy, the World Bank is committed to supporting governments to implement their priorities in the health sector in order to create more fair and accountable systems for the people.

Author : Anonim
Publisher : World Health Organization
Page : 132 pages
File Size : 52,7 Mb
Release : 2020-12-16
Category : Medical
ISBN : 9789240017832

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Operational framework for primary health care by Anonim Pdf

Author : Hong Wang,Kimberly Switlick,Christine Ortiz,Beatriz Zurita,Catherine Connor
Publisher : World Bank Publications
Page : 141 pages
File Size : 41,5 Mb
Release : 2012-01-18
Category : Business & Economics
ISBN : 9780821389539

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Health Insurance Handbook by Hong Wang,Kimberly Switlick,Christine Ortiz,Beatriz Zurita,Catherine Connor Pdf

Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.

Author : OECD,World Health Organization
Publisher : OECD Publishing
Page : 128 pages
File Size : 52,9 Mb
Release : 2019-10-17
Category : Electronic
ISBN : 9789264805903

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Improving Healthcare Quality in Europe Characteristics, Effectiveness and Implementation of Different Strategies by OECD,World Health Organization Pdf

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Author : Aida Isabel Tavares
Publisher : BoD – Books on Demand
Page : 130 pages
File Size : 52,6 Mb
Release : 2019-11-27
Category : Medical
ISBN : 9781789849745

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Universal Health Coverage by Aida Isabel Tavares Pdf

The chapters in this book contribute to the wide discussion on universal health coverage. The variety of topics discussed here confirms the importance of UHC for academics and health professionals and also the controversies and challenges of its implementation.I invite you to read the book and be involved in the discussions around the goals of universal health coverage.