Introduction
It is generally accepted that the method of payment to physicians affect their professional attitude and behaviour. Consequently, health policy makers manipulate payment system in an attempt to achieve optimal health care for their citizens such as improve accessibility, quality of care, patient’s satisfaction and cost containment. In Ontario, there are a wide range of mechanisms that are used to pay physicians for their services that are funded by both federal and provincial government. According to Canada Health Act annual report (2013), the majority of primary healthcare physicians are funded using the fee for service payment arrangement but of that majority, only less than 30% are compensated exclusively according the fee for service plan. The remaining physicians are funded using one of the following mixed compensation models:
1. Enhanced Fee-for-service: Family Health Groups (FHG), Comprehensive Care Model
2. Blended Capitation Models: Family Health Network(FHN) , Family Health Organization (FHO)
3. Blended Complement Model : Rural and Northern Physician Group Agreements (RNPGA)
4. Blended Salary Model: Community sponsor Family Health Team (FHT)
Each model presents different types of earning incentives for physicians to provide cost effective care which improves clinical outcome.
This paper will conduct a cost benefit analysis of the three underlying methods that are either used solely or blended together to pay physicians in Ontario. It will compare and contrast Fee for service, capitation, and salary model. This paper will explore the impact of these models on quality and quantity of the primary health care system.
Fee for Service
Fee for Service is the most common and also the most accused metho...
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The Saskatchewan heath care system is made up of several provincial, regional and local organizations, which provide the people their basic right to reasonable health care (“Health Systems,” 2014). Not having enough health care providers seem to be a problem, which Canada as a whole has struggled with (“College of Family,” 2014). The shortages of medical providers have lead to major discrepancies in the level of patient care between major urban centers and rural areas (Howlett, 2013). In the case of Saskatchewan many communities are facing this challenge, not only rural areas but also the capital city of the province (“Saskatchewan ER,” 2013). Stats Canada has showed that the number of physicians is at a historic high, yet Saskatchewan still face shortages (Howlett, 2013).
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Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
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In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
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The number of doctors that present in the United States of America directly affects the communities that these doctors serve and plays a large role in how the country and its citizens approach health care. The United States experienced a physician surplus in the 1980s, and was affected in several ways after this. However, many experts today have said that there is currently a shortage of physicians in the United States, or, at the very least, that there will be a shortage in the near future. The nation-wide statuses of a physician surplus or shortage have many implications, some of which are quite detrimental to society. However, there are certain remedies that can be implemented in order to attempt to rectify the problems, or alleviate some of their symptoms.
The public health care system in Canada is still flawed, proven through the wait times that many patients have to go through. Canadians may wait up to six to nine months for “non-urgent” MRIs . The waiting list is dreary for Canadians, unlike Americans who can get their services immediately through paying out-of-pocket, the long public sector in Alberta waits up to a year for services, the wait for cataract surgery was six weeks ; these waits for some patients put the public health care system to shame, and helps push the idea of the privatized health care system a bettering option for the future of the nation. Additionally, 41 percent of adult Canadians said they experienced a difficulty in accessing hospital and physician care on weekday nights and weekends . Furthermore, it is still evident that Canadians in fact pay a higher income tax compared to Americans, due to the fact that they are paying the fund the health care system through their taxes; however, it is still significantly less to pay for a public health care system than it is privatized . Privatization is further proved as a superior choice with regards to the discharge situation many Canadians face. In Canada, it is common to see patients discharged earlier than recommended due the rising amount of patients using the free-of-charge public health care system, patients are released “quicker and sicker” because of this . Additionally, when discharged, the public health care system does not cover home care and private nurse care ; further proving the notion that there is still some forms of privatization already in the health care system in
retrospect to its governing authority (Shi & Singh, 2012). However, private and public agencies are the controlling constituent in today’s business. Free markets allow patients to choose providers without the prior approval of insurance companies. The current system offers a proposed plan of limited physicians in exchange for payment of services. Because the potential has been given to the payers, they regulate the cost of services rendered through contractual
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The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Outpatient Payments Philosophy As CMS dictates the nature of medical reimbursement, the adjustments made by CMS to outpatient payment models have drastic effects, many of which are often unintentional. Cost efficiency clearly finds itself on the top of the United States healthcare priority list, therefore placing extreme pressure on CMS to somehow find a “better” way to pay for care. The definition of “better” relies on not only causal relationships of care effectiveness, but also on simple morality of ensuring this payment model encourages the best possible setting for care.
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