What are three payment structures used in the health care industry across the care continuum in US? How are they similar? How are they different? Is there a single problem that transverses all three of the identified payment structures? Explain. 1 page, 2 sources, APA.

Payment structures used in the health care industry 2 dq 1

The health care industry in the United States has various payment structures across the care continuum. Three of the most common payment structures are fee-for-service (FFS), capitation, and bundled payments. Each of these payment structures has similarities and differences that impact their effectiveness and efficiency in the health care industry.

Fee-for-service (FFS) is a payment structure where providers receive reimbursement for each service provided to a patient. This payment structure is common in traditional Medicare and private insurance plans. Capitation, on the other hand, is a payment structure where providers receive a fixed amount per patient regardless of the services provided. This payment structure is common in managed care organizations such as Health Maintenance Organizations (HMOs) and Accountable Care Organizations (ACOs). Bundled payments involve a single payment for an episode of care or a specific condition, regardless of the number of services provided. This payment structure is common in value-based payment programs.

One similarity between these payment structures is their focus on controlling costs. FFS seeks to control costs by reducing the volume of services provided, while capitation and bundled payments aim to control costs by reducing the overall cost of care. Another similarity is that they all incentivize providers to improve the quality of care provided to patients. FFS incentivizes providers to improve the volume and quality of services provided, while capitation and bundled payments incentivize providers to improve the overall health of their patient population.

One major difference between these payment structures is the level of financial risk assumed by the providers. FFS shifts the financial risk to payers, while capitation and bundled payments shift the financial risk to providers. Another difference is the degree of flexibility in terms of the services provided. FFS provides the greatest flexibility for providers to deliver services based on patient needs, while capitation and bundled payments may limit the range of services provided due to cost constraints.

A problem that transverses all three of the identified payment structures is the potential for overutilization or underutilization of services. FFS incentivizes providers to provide more services, which may result in unnecessary services and higher costs. Capitation and bundled payments incentivize providers to reduce the overall cost of care, which may result in underutilization of necessary services, leading to poorer health outcomes.

In conclusion, the health care industry in the United States has various payment structures across the care continuum. Fee-for-service, capitation, and bundled payments are three common payment structures that have similarities and differences. All three payment structures aim to control costs and improve the quality of care provided to patients. However, they differ in terms of financial risk and flexibility in service delivery. The potential for overutilization or underutilization of services is a problem that transverses all three of the identified payment structures, highlighting the need for ongoing evaluation and refinement of payment structures in the health care industry.

Sources: Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Centers for Medicare & Medicaid Services. (n.d.). Payment & value-based care models. Retrieved from https://www.cms.gov/medicare/payment-and-value-based-care/payment-and-value-based-care-programs