Traditional vs. New Payment Systems in Healthcare

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Introduction

Health economics is a branch of economics that deals with matters concerning the effectiveness, delivery, consumption, and cost of health and health care services. In the article “From Volume to value: Better ways to pay for health care” Dr. Harold D. Miller expounds on the health care payment systems. The payment systems determine the quality and the cost of health care services that the providers offer to patients. A good payment system is one that ensures quality service delivery at the appropriate cost. The traditional payment system sought to provide services to the public without checking on the quality of services.

The new payment systems encourage the provision of high-quality services to the patients at acceptable costs. Factors that influence the per capita health costs include; the likelihood of occurrence of health conditions, the number of episodes of care that patients require per condition, the nature of the treatment, and the cost of acquiring drugs and devices that are used in the treatment process.

Analysis

There are various health care payment systems. These include; fee-for-service, episode-of-care payment, traditional capitation, and comprehensive care payment. Fee-for-service is the most common payment system. Under this payment system, a fixed amount is paid for any service that the provider delivers. The fee-for-service arrangement does not give providers the required responsibility as concern for the quality of services that they offer.

The provider, therefore, gets the necessary payment irrespective of the quality of the services that they provide. In the episode-of-care payment system, payment is made once for all the health care services that a patient receives during the whole period of health care. Therefore, the provider takes care of all cases that are associated with a given condition under a single payment. However, the amount patients pay depends on the severity of the health condition. The traditional capitation payment system restricts the number of episodes of care. Under traditional capitation, provision is made for recurrent health conditions.

This system provides for a single payment of health conditions under a single episode. Comprehensive care payment is a hybrid of the episode-of-care payment and the traditional capitation. A single payment is made to the providers to cover all the services that their patients need for a given period. However, the payment remains adjustable depending on the nature of treatment and the health of the patient. This payment system ensures that the patients receive health care services at the right cost. All the methods above have different flaws. There is an increased effort to establish more new health care payment methods that will serve the patients well.

Equally, there are challenges associated with these new methods. It is difficult to set an amount that would not only suffice the provider but also prevent extortion of the patients by the providers. Also, it is difficult to guarantee high-quality services to patients. There have been cases of reoccurrence of health conditions earlier than anticipated. There is also the challenge of dealing with the state and federal policies on health care and payment. As a result, it is difficult to organize the public to adopt a given payment system. Episode-of-care and comprehensive payment methods are superior methods of health care payment. These methods focus on the quality and cost of health care services.

The article “From Volume to value: Better ways to pay for health care” directly relates to health economics as it investigates the effectiveness of various health care payment methods. Additionally, in the article, the author reiterates the need to adopt payment methods that are both effective and affordable. The article also stresses the need to provide high-quality services at low costs.

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