Alshreef, A. orcid.org/0000-0003-2737-1365 (2019) Provider payment mechanisms : effective policy tools for achieving universal and sustainable healthcare coverage. In: Tavares, A.I., (ed.) Universal Health Coverage. IntechOpen
Abstract
Globally, governments are seeking to develop equitable and sustainable healthcare systems for delivering universal healthcare coverage under budget constraints. This chapter provides an analysis of fee-for-service, a commonly used payment mechanism for reimbursement of healthcare providers, and proposes appropriate reform in order to promote cost containment in the context of low- and middle-income countries (LMICs). The analysis used secondary data derived from the literature. The analysis revealed that capitation, case-based, and global budget provider payment mechanisms have the potential to control healthcare costs by creating incentives for providers to reduce the volume of services. Capitation payment has the potential to promote provider efficiency, while global budget may reward inefficient hospitals if risk adjustors (such as gender and age) are not considered in the resource allocation formula. Both capitation payment and global budget have lower administrative costs compared to fee-for-service. Development of supporting measures is crucial including legal, financial, referral, quality assurance, and management information systems.
Metadata
Item Type: | Book Section |
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Authors/Creators: |
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Editors: |
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Copyright, Publisher and Additional Information: | © 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | health reforms; funding; health insurance; provider payment; expenditure and costs; cost containment; LMICs |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 26 Sep 2019 14:41 |
Last Modified: | 26 Sep 2019 19:57 |
Status: | Published online |
Publisher: | IntechOpen |
Refereed: | Yes |
Identification Number: | 10.5772/intechopen.86840 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:150513 |