W 8, p 1

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  1. Modes of Financing
    • out of pocket
    • individual health insurance
    • employment based health insurance
    • government financing
  2. Methods of Payment
    • Fee for service
    • payment by episode of illness
    • payment per patient: Capitation
    • payment per time: salary
  3. Fee for service
    • payment per each procedure
    • expensive if have many conditions
    • HCP may do more things to you bc they will receive more money
  4. Usual, Customary, and Reasonable (UCR)
    • HCP can set their own costs so costs went up
    • So gov made fee schedule
    • now HCP have to schedule more patients to keep paycheck high
  5. Fee schedule
    Estimated time, mental effort, physical effort and technical skill and stress related to the service
  6. What economic incentive to health care providers w/ the Fee for service method?
    Monetary benefits for health care service
  7. Fee for service good/bad
    • Patient (isn’t the one paying)- good bc get better quicker
    • Insurance company- bad bc paying more
    • HCP- good- everything you do get paid for
  8. Payment per episode of illness
    paid certain amount to do a certain task; like paid $1500 and does surgery
  9. What financial incentives in pay for episode? Is it bad?
    • Incentive to do less
    • --You lose money if you provide too many time
  10. payment per episode
    • Patient- bad bc surgeon does less for money
    • HCP- good for profit, bad if have to see patient many times
    • Insurance company- good bc they only have to pay one sum
    • ---More services bundled, more risk on HCP
Card Set
W 8, p 1
W8, p1
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