Paying for hospital emergency care under a single-payer system

Area of Science:

• Health Economics
• Healthcare Management
• Public Health Policy

Background:

• Hospital emergency services are critical to healthcare systems but lack adequate funding models in single-payer environments.
• Ensuring financial viability and access to emergency departments (EDs) is a significant challenge for funders in single-payer healthcare systems.

Purpose of the Study:

• To analyze the dynamics, products, and cost drivers of hospital emergency services.
• To evaluate existing emergency activity categorization systems for funding applicability.
• To identify and assess three funding models (fully variable, fully fixed, mixed) for EDs within single-payer systems.

Main Methods:

• Analysis of hospital emergency service dynamics, products, and cost drivers.
• Review and evaluation of current emergency activity categorization systems for funding suitability.
• Assessment of three distinct funding models for EDs in single-payer contexts, considering fixed and variable payment structures.

Main Results:

• Existing categorization systems show susceptibility to gaming in triage and disposition.
• Variable payment models present challenges due to incentive effects and potential double payments for admitted patients.
• Fixed grant setting and rebasing require careful consideration within proposed funding models.

Conclusions:

• Effective funding models for EDs in single-payer systems must balance access and financial sustainability.
• Proposed models should address the complexities of variable payments and the challenges of setting fixed grants.
• Key characteristics for optimal ED funding models in single-payer settings are identified.