Comparative assessment of payment methods of fee-for-services and per capita for household’s health insurance services: theoretical framework and application

Abstract

Background and Objectives: Payment methods of fee-for-service and per capita affect financial incentives of service providers differently, and hence, can produce excess or shortage of healthcare services and expenses for the health insurance organization and the insured. This study assessed expenses of healthcare services for households in the Iranian provinces regarding the payment methods of fee-for-service and per capita for the same indicator value of the insured satisfaction.


Materials and Methods: In this study, the proposed assessment of the payment methods of fee-for-service and per capita was carried out using the record data from the Iranian health insurance organization and the optimizing model of compensated demand for healthcare services. In this model, the contract between the insurance organization and the insured could be specified by a certain level of expenses and indicator value for users’ satisfaction. Hence, the demand for health insurance services could be determined independent of the supply of services by healthcare providers.


Results: It was shown that at the same indicator value of satisfaction in the two payment methods in 1391, the average expenses of household for sum of outpatient and inpatient services for per capita payment method in 22 provinces of 31 are less than the expenses for fee-for-service payment method.


Conclusion: Providing a contract between the insurance organization and the insured that represents minimum expenses for insurance services at a certain value of satisfaction indicator could be considered a plausible target for the both sides, irrespective of the providers’ incentive. This helps the insurance organization and the insured to choose the payment method that minimizes the difference between average unit cost of insurance services against the average cost in the market for health services, or minimizes the risk of healthcare costs.

Keywords

References

Rudmik L, Wranik D, Rudisill-Michaelsen C. Physician payment methods: a focus on quality and cost control. Journal of Otolaryngology-Head & Neck Surgery. 2014; 43: 34-39. Ginsburg PB. Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment. Health Affairs. 2012; 31: 1977-83. Selker HP, Kravitz RL, Gallagher TH. The National Physician Payment Commission Recommendation to Eliminate Fee-for-Service Payment: Balancing Risk, Benefit, and Efficiency in Bundling Payment for Care. Journal of General internal medicine. 2014; 29: 698-9. Hirunrassamee S, Ratanawijitrasin S. Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand. International Journal of Health care finance and economics. 2009; 9: 153-68. Tang S, Tao J, Bekedam H. Controlling cost escalation of healthcare: making universal health coverage sustainable in China. BioMedCentral Public Health. 2012; 12-23. Gosfield, Alice G. Understanding risk-based payer contracts. Medical Econimics. 2015: 48-51. Robyn PJ, Bärnighausen T, Souares A, Traoré A, Bicaba B, Sié A, Sauerborn R. Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study. Social Science & Medicine. 2014; 108: 223-36. Baji P, Pavlova M, Gulácsi L, Groot W. Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis-the case of Hungary. BioMedCentral Health Services Research. 2013; 13: 62. Stepurko T, Pavlova M, Gryga I, Groot W. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BioMedCentral Health Services Research. 2010; 10: 273. Sutherland JM, McGrail KM, Law MR, Barer ML, Crump RT. British Columbia Hospitals: examination and assessment of payment reform (B-CHeaPR). BioMedCentral Health Services Research. 2011; 11: 150. Langenbrunner, Jack, Cheryl Cashin, and Sheila O'Dougherty, eds. Designing and implementing health care provider payment systems: how-to manuals. World Bank Publications, 2009: 27-89. Robyn PJ, Bärnighausen T, Souares A, Savadogo G, Bicaba B, Sié A, Sauerborn R. Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment. BioMedCentral Health Services Research. 2012; 12: 159-173. Mohammed S, Souares A, Bermejo JL, Sauerborn R, Dong H. Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives. BioMedCentral Health Services Research. 2014; 14: 127-139. Agyei-Baffour P, Oppong R, Boateng D. Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana. BioMedCentral Health Services Research. 2013; 13: 1220-29. Abbey DC, editor. Healthcare payment systems: an introduction. Chemical Rubber Company Press. 2009; 13-48. Tomini S, Maarse H. How do Patient Characteristics influence Informal Payments for Inpatient and Outpatient Health Care in Albania. BioMedCentral Health Services Research. 2011; 375-95. Zweifel P, Breyer F, Kifmann M. Health Economics. Springer Science & Business Media. 2009; 331-378. Clarke, P,M. Methods for evaluating health and healthcare: Underlying theory and implications for practical application in McIntosh, Emma. Applied methods of cost-benefit analysis in health care. Vol. 4. Oxford University Press. 2010; 29-45. Phillip Jr SA. The relationship between method of payment and overall patient satisfaction with medical care provided in US hospitals. CENTRAL MICHIGAN UNIVERSITY; 2013. Cohen SA. Accountable care organizations as an alternative payment method: Designing for success [dissertation]. THE COLLEGE OF ST. SCHOLASTICA: 2014. Fleetcroft R, Steel N, Cookson R, Walker S, Howe A. Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis. BioMedCentral Health Services Research. 2012; 12: 94-103.
Daneshvar Medicine
Volume 24, Issue 4 - Serial Number 125
September and October 2016
Pages 39-50

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