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Related Concept Videos

Introduction To Health Care Delivery System01:18

Introduction To Health Care Delivery System

The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
Ethical Issues01:27

Ethical Issues

Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
Standards of Care I01:22

Standards of Care I

Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:

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Related Experiment Videos

Medicare's challenges in paying providers.

Joseph P Newhouse1

  • 1Harvard University, Boston, MA 02115, USA. Joseph_Newhouse@harvard.edu

Health Care Financing Review
|February 13, 2007
PubMed
Summary

Medicare faces challenges in setting provider payment rates to ensure quality care and avoid overpayment. This analysis examines physician, post-acute care, and health plan payments, anticipating future changes and potential quality-based incentives.

Area of Science:

  • Health Economics
  • Healthcare Policy
  • Public Health

Background:

  • Medicare utilizes diverse administered pricing systems for healthcare provider reimbursement.
  • Setting appropriate payment levels presents significant challenges for Medicare.
  • These challenges include preventing care distortion and avoiding overpayment.

Purpose of the Study:

  • To describe key issues in Medicare payment systems for physicians, post-acute care providers, and health plans.
  • To highlight areas of recent and anticipated change within these payment systems.
  • To discuss potential future payment adjustments, such as for prescription drugs and quality-based incentives.

Main Methods:

  • Review of current Medicare administered price systems.
  • Analysis of challenges in payment setting.

Related Experiment Videos

  • Examination of recent policy developments and future trends.

    • Main Results:

    • Significant challenges exist in Medicare payment systems for physicians, post-acute care, and health plans.
    • These sectors are experiencing dynamic changes.
    • Future changes may include adjustments to prescription drug benefits and performance-based payments.

    Conclusions:

    • Medicare's administered pricing systems require careful management to balance cost, quality, and access.
    • Ongoing evolution in payment policy is expected across provider types.
    • The integration of quality metrics and prescription drug coverage represents a future direction for Medicare payments.