HealthCare Financing: Payment Mechanisms

Question 1

Paying for care: Hospitals and Other institutional Providers

Numerous methods are used to pay for hospital services.

 Capitation: The hospital receives a _____________ payment for persons enrolled in a health plan, per ______. This payment method shifts financial risk from the ______________ to the _________ itself.

 Per-diem payments: Hospitals receive payments based on the _________________________________ in the hospital. Usually not adjusted to allow for differences in patient characteristics, but may vary by hospital.

Answer 1

fixed monthly

head.

third-party payer; hospital

number of days a patient spends

Question 2

Paying for care: Hospitals and Other institutional Providers

 Per-case payments: Hospitals receive a ________ payment for each patient the hospital __________. The payment could be the same for all patients regardless of a patient’s ______________ , or patients are classified into groups based on ______________ for necessary are. The payment may also differ for different types of hospitals.

 Budget payments: This method provides hospitals with a _______ budget or payment designed to cover all services provided by the hospital over the course of the year

Answer 2

fixed ; discharges.

medical condition

expected costs

global

Question 3

In the Medicare program, payment is based on a patient classification system called DRGs (diagnosis-related groups).

Question 4

Paying for care: physicians and Other healthcare professionals

Fee-for-service: Professionals receive a fee(or payment) for __________ they provide.
◦ Based on charges that are either set by ______________ or by ______________________.

 Salary: a _______ payment or salary (usually monthly or yearly) that does not vary with the _____________ in the plan or the ___________________ or the ________________ provided.
◦ In the United States, this method is frequently used for ____________ professionals in a variety of the
employment settings.

Answer 4

each service

professionals ; third-party fee schedules.

Fixed ; number of people

number of patients treated

number of services

non-physician