Capitated Payor Advantages
Capitated System is cost effective and easy o manage since you only need to track and keep record of the enrolled members. This reduces the burden of dealing with complicated billing codes and filling out various paperwork claims that might be involved (Paul III et al., 2014). Additionally, the process of budgeting is simplified because providers can easily predict cash flows and members the healthcare cost. Finally, since the healthcare providers are interested in keeping the cost low, unnecessary tests, care and interventions are completely limited to maximize the profit gained. Patients on the other hand are cushioned from paying for tests or procedures that are not truly required.
Capitated Payor Disadvantages
Capitated Payor restricts patient’s choice. Any doctor prescribed by the healthcare facility can attend to you without regarding your selected doctor in several circumstances and referral can be denied if the primary healthcare provider disagrees with your request (Paul III et al., 2014). Several healthcare facilities admit more doctors than they can cater for just to increase their salaries. This dangerous because not all patients admitted will receive quality treatment. Facilities concerned with maximizing profits may choose to ignore conducting certain tests and procedures which may be potentially important.
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DRG Payor System Advantages
DRG system increases efficiency in hospital activities. Systems have been put in place to provide penalties for hospital admitting patient with the same diagnosis in a period within 30 days (Mathauer & Wittenbecher, 2013). The incentive to over treat patients in order to get more money is taken away from the hospitals increasing transparency and efficiency.
DRG Payor System Disadvantages
RG system can lead to lack of transparency in controlling costs by managers and regulators. Additionally, Insufficient and unsatisfactory control of hospital resources maintaining costs and providing quality is likely o be experienced (Mihailovic, 2016). DRG has the ability to create problems in controlling hospital activities and appropriateness in care.
As a healthcare czar, I would favor Capitated system because it is easy to tract and therefore enhances accountability on the members admitted and their cost catered for. Additionally, I will favor it since it eases the process of budgeting because I’m able to forecast cash flows
The Uninsured Population
Individuals without insurance coverage have the worse access to necessary medical care. Majority are less likely to receive preventive care. This means that the population is vulnerable to attacks and treating becomes expensive and burdensome on the state and the entire healthcare system (Commonwealth Fund, 2011). The healthcare system is less likely to function effectively since majority of the populace would require a lot of resources to treat conditions that could have been prevented. This poses challenges to country’s economy investing a lot in the health care on preventable diseases. In response to growing number of uninsured people, the healthcare system must increase local subsidies to the uninsured in various healthcare facilities. Additionally, the direction healthcare system is likely to take is to expand the number of free-care clinics to help the uninsured (Commonwealth Fund, 2011). The ethical issues include the provision that everyone deserves better healthcare services and provision of equal treatment opportunity to everyone. Practically, it is not possible to establish free medical healthcare catering for all needs to reach every individual
Reference
Commonwealth Fund. (2011). Strategy for Improving Healthcare for Uninsured, Low-Income, and Minorities in the US. Science Daily . www.sciencedaily.com/releases/2011/10/111007073216.htm
Mathauer, I., & Wittenbecher, F. (2013). Hospital Payment Based on Diagnosis Related Groups: Experience in Low and Middle Income Countries. Bulletin of World Health Organization . 91:746-756 https://dx.doi.org/10.2471/BLT.12.115931
Mihailovic, N., Kocic, S., & Jakovljevic, M. (2016). Review of Diagnosis-Based Financing of Hospital Care . Health serv Res Manag Epidemiol . Doi: 10.1177/2333392816647892
Paul III, D., Walker, I., Brunoni, J., Wood, T., & Coustasse, A., (2014). How Effective is Capitation at Reducing Health Care Cost. Marshall Digital Scholar . https://mds.marshall.edu/mgmt_faculty/123
