Designing and Implementing Health Care Provider Payment Systems How To Manuals 1st Edition by John Langenbrunner, Cheryl Cashin, Sheila O Dougherty ISBN 978-0821378151 0821378155
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Designing and Implementing Health Care Provider Payment Systems How To Manuals 1st Edition by John C. Langenbrunner, Cheryl Cashin, Sheila O’Dougherty – Ebook PDF Instant Download/Delivery: 978-0821378151, 0821378155
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Product details:
ISBN 10: 0821378155
ISBN 13: 978-0821378151
Author: John C. Langenbrunner, Cheryl Cashin, Sheila O’Dougherty
Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns. Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. ‘Designing and Implementing Health Care Provider Payment Systems: How-To Manuals’ addresses this need. The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume’s final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.
Table of contents:
1. Primary Health Care Per Capita Payment Systems
Overview of PHC Provider Payment Systems
Defining the Health Policy Context
Methodology for Developing a Per Capita PHC Payment System
Defining a PHC Package of Services
Setting the PHC Pool and Calculating the Base Per Capita Rate
Calculating Risk Adjustment Coefficients
Developing an Enrollment Database
Calculating Each Provider’s Per Capita Budget
Designing a Finance and Management System
Designing a Monitoring and Quality Assurance System
Expanding the Base Per Capita Rate and Package of Services
Implementation Issues
The Link between PHC Per Capita Payment and the Health System Axes:
Experience from Four Central Asian Republics
Note
References
2. Case-Based Hospital Payment Systems
Overview of Case-Based Hospital Payment Systems
Defining Case Grouping Criteria
Completing Cost-Accounting Analysis
Calculating Case Group Weights
Calculating the Base Rate
Designing an Information and Billing System
Refining Case Grouping
Implementation Issues
Case Studies from Kazakhstan and the Kyrgyz Republic
Notes
References
3. Hospital Global Budgeting
Overview
Setting the Hospital Global Budget
Performance Incentives
Nonbudget Funding
An Overview of Costing
Managing the New Global Budget
Annual Adjustments
References
4. A Primer on Contracting
Introduction
Which Contract?
Volumes
Which Contract When?
Consortia
Duration of Contract
Note
5. Health Management Information Systems: Linking Purchasers and Providers
Background
Implementing Appropriate Provider Systems
Implementing Appropriate Purchaser Systems
Implementing an Appropriate Link between Purchaser and Provider Systems
Concluding Remarks
Annex 5.1: A Primer on Health Management Information Systems
Notes
References
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Tags: John Langenbrunner, Cheryl Cashin, Sheila O Dougherty, Designing and Implementing, Care Provider