What are three payment structures used in the health care industry across the care continuum in US? How are they similar? How are they different? Is there a single problem that transverses all three of the identified payment structures? Explain. 1 page, 2 sources, APA.

Health care payment structures 2 dq 1.

In the United States, the health care sector has a variety of payment structures that are used across the continuum of care. The three most common payment systems are capitation, fee-for service (FFS), and bundle payments. These payment structures have similarities and differences which impact the effectiveness and efficiency of each in the healthcare industry.

A fee-for service (FFS), is a type of payment scheme whereby providers are reimbursed for the services they perform on a patient. The payment structure used in Medicare is the same as that of private health insurance. In contrast, capitation is a type of payment whereby providers are paid a certain amount for each patient, regardless of services rendered. The payment structure used by managed care organisations such as Health Maintenance Organizations and Accountable Care Organizations is very common. The bundle payment is a one-time payment that covers an entire episode of treatment or specific conditions, regardless of how many services are provided. The value-based program is a common example of this payment structure.

These payment systems are similar in that they both focus on cost control. FFS aims to reduce costs through a reduction in the number of services, while capitation and bundle payments are aimed at lowering the total cost of the care. All three systems encourage their providers to enhance the care they provide to patients. FFS rewards providers for improving the quantity and quality of the services, while capitation or bundled payments reward providers who improve the health of the patient population.

These payment structures differ in that the financial risk is assumed by providers. FFS places the risk on the payers while capitation, bundled payments and bundles shift it to the provider. The degree of service flexibility is another difference. FFS allows providers the most flexibility to provide services according to patient requirements, while capitation or bundled payments can limit services due to financial constraints.

Over- and underutilization is a common problem across all the payment systems. FFS encourages providers to offer more services which can lead to unnecessary services or higher costs. The capitation payment and the bundled payments are designed to encourage providers to cut costs, but this can lead to underutilization, poor health outcomes, or unnecessary services.

The United States health industry has a wide range of payment systems that are used across its care continuum. Three common payment systems, capitation and bundled payments, have both similarities and differences. The three types of payment are all designed to improve patient care and control costs. They differ, however, in their financial risks and the flexibility of service delivery. All three payment structures are susceptible to the problem of over- or under-utilization. This highlights the importance of ongoing assessment and refinement in the industry.

Sources: Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple goal: Care, Health, and Cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Centers for Medicare & Medicaid Services. (n.d.). Payment & value-based care models. Retrieved From https://www.cms.gov/medicare/payment-and-value-based-care/payment-and-value-based-care-programs