The reimbursement system in the United States has undergone numerous changes throughout history. The United state’s healthcare system consists of three participants. They include the federal, the state as well as the local. The federal government offers a variety of funding mechanisms that were first established in 1965 and seek to provide healthcare access to a group of individuals. For instance, the government provides the Medicaid and Medicare programs that offer healthcare access to the elderly people aged between 65years and above. These programs have further expanded to include even the disabled, military personnel, the veterans and those that depend on them.
In regards to reimbursement, the government as well as insurance companies often use the Fee-for-Service reimbursement system. This is whereby the physicians are reimbursed on the basis of the number of services they provide. Therefore, the third-parties are billed every time the patient has a doctor’s appointment. According to Preskitt (2008), the system is one of the traditional models that encourage the physicians to maximize the number of procedures they perform without considering preventive care. Therefore, the system encourages doctors to treat the patients when they are sick without keeping them.
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Another reimbursed system is the value-based care. LaPointe (2016) identifies this system as one whereby healthcare is centered on the patient. This system encourages physicians to improve the quality of care in regards to particular measures such as using certified health IT and improving preventive care. In this system, the doctors receive incentive reimbursement for providing care that is better for the patients at a lower cost.
When comparing the two reimbursement systems, the value-based care is more holistic as compared to the Fee-for-Services system as the physicians are reimbursed for the quality and not quantity of care provided. In the current system, non-governmental organizations are more likely to offer the value-for-care reimbursement system while the government systems may offer both systems in different situations.
References
LaPointe, J. (2016). What Is Value-Based Care, What It Means for Providers? Retrieved from https://revcycleintelligence.com/features/what-is-value-based-care-what-it-means-for-providers
Preskitt, J. T. (2008). Health Care Reimbursement: Clemens to Clinton. Baylor University Medical Center Proceedings , 21 (1), 40-44. doi:10.1080/08998280.2008.11928358
