6 Jul 2022

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The Different Types of Reimbursement Models

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The traditional models such as fee-for-service are the models which involve paying for the medical services separately because they are unbundled. The modern reimbursement methods like value-based care, on the other hand, are significantly different in that they involve paying the doctors and the physicians for the quality of services provided as well their ability to improve the health of those suffering from severe conditions in a cost-effective manner (Greenwald et al., 2016) . Unlike the modern reimbursement models, the traditional models overlook the quality of the care given for the patients and instead focus on the number of treatments and procedures for higher profits. 

Fee-for-service reimbursement model is the most dominant method in the US. It encourages the physicians to offer more treatments and avoid performing some necessary procedures because they are not paid for any extra activity. The method is associated with the increasing costs since patients are willing to get more treatments as long as the payment does not come out of their pockets (Sharfstein et al., 2015) . The quality was monitored under this model by assessing whether the doctors are able to give many treatments and procedures to the patients regardless of the quality. In this regard, the quality was rewarded under this model as per the number of patients served and the amount of the care given. 

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The modern methods like the value-based care model are different from the fee-for-service model in that; it emphasizes on the quality of services and treatment given to the patients rather than the quantity (Danzon et al., 2015) . In this case, the quality is monitored by evaluating the ability of the physicians to advance better care for the individuals, reduce the costs of health care and improve the management strategies of the population health. The quality is rewarded on the basis of the clinical outcomes, the appropriateness of the patient care and proper utilization of the healthcare resources. 

One of the main reasons for the new models is that it lowers the costs of healthcare delivery hence bring more revenue to many practices (Hinkel et al., 2017) . It also encourages efficiencies of the integrated care because payment is dependent on quality rather than quantity. Other reasons include the changes in policy and triple aim among others. Despite the differences, the traditional and modern reimbursement models are similar in that; in both cases, doctors and physicians receive payment for giving care to the patients through treatments and other medical procedures. 

References 

Danzon, P., Towse, A., & Mestre‐Ferrandiz, J. (2015). Value‐based differential pricing: Efficient prices for drugs in a global context.  Health economics 24 (3), 294-301. 

Greenwald, A. S., Bassano, A., Wiggins, S., & Froimson, M. I. (2016). Alternative Reimbursement Models: Bundled Payment and BeyondAOA Critical Issues.  JBJS 98 (11), e45. 

Hinkel, J. M., Sexton, D. B., & McGivney, W. T. (2017). Forecasting financial impact of alternative payment models to cancer drug manufacturers. 

Sharfstein, J. M., Kinzer, D., & Colmers, J. M. (2015). An update on Maryland’s all-payer approach to reforming the delivery of health care.  JAMA internal medicine 175 (7), 1083-1084. 

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StudyBounty. (2023, September 16). The Different Types of Reimbursement Models.
https://studybounty.com/the-different-types-of-reimbursement-models-essay

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