A typology for provider payment systems in health care

A typology to classify provider payment systems from an incentive point of view is developed. We analyse the way, how these systems can influence provider behaviour and, a fortiori, contribute to attain the general objectives of health care, i.e. quality of care, efficiency and accessibility. The first dimension of the typology indicates whether there is a link between the provider's income and his activity. In variable systems, the provider has an ability to influence his earnings, contrary to fixed systems. The second dimension indicates whether the provider's payments are related to his actual costs or not. In retrospective systems, the provider's own costs are the basis for reimbursement ex post whereas in prospective systems payments are determined ex ante without any link to the real costs of the individual provider. These different characteristics are likely to influence provider behaviour in different ways. Furthermore the most frequently used criteria to determine the provider's income are discussed: per service, per diem, per case, per patient and per period. Also a distinction is made between incentives at the level of the individual provider (micro-level) and the sponsor (macro-level). Finally, the potential interactions when several payment systems are used simultaneously are discussed. This typology is useful to classify and compare different types of payment systems as prevailing in different countries, and provides a useful framework for future research of health care payment systems.     

Health care provider payment systems

Health care provider payment systems regulate the relationship between patients, providers, and third payers in order to maximise benefits and minimise costs of the whole health care system. Health care providers could be paid by a price or a fee for service, by capitation systems, or by reimbursement of production costs. It would be interesting to develop innovative payment systems aimed to the payment of the entire health care pattern of patients. This would be particularly desirable for certain health conditions where it is impossible to divide the health care delivery pattern into single health services e.g. psychiatric care, long term and rehabilitation care.     

Customer-centered strategic diversification: specialty health care provider moves towards primary care

A logistic regression model is used to analyze an OB/GYN'S move towards primary care. Current clients' use/no use response of the clinic as a primary care provider is the criterion variable. Predictor variables include new primary care services, expanded OB/GYN services, overall system utilization, and current insurance and physician status. Overall, only 37% of the clinic's current clients indicated they would utilize the clinic for primary care. Having a personal physician is a significant predictor of a client's decision to utilize the clinic's new primary care services. Other significant predictor variables are discussed.     

The impact of health care provider market served on health care channel relationships

A conceptual framework is provided in which manufacturer-wholesaler relationships are addressed in the context of the health care provider segment served by the wholesaler. A study of the medical supply channel demonstrates how the particular market served by the wholesaler shapes the manufacturer-wholesaler relationship along the behavioral dimensions of manifest conflict, coercion, satisfaction and openness of communications. The health care provider segment served was found to have a significant impact on these dimensions. The results of this research suggest that channel member strategies, policies and operating procedures must account for variations in input (supply) and output (market) environments.     

Measuring resilience in health care provider organizations.

Health care providers offer an ideal setting to study the effectiveness of resilient behavior. The notion of a resilient organization is an emerging concept for understanding and coping with the modern-day pace of change and associated work stress. Resilience is the ability of an individual or organization to expeditiously design and implement positive adaptive behaviors matched to the immediate situation, while enduring minimal stress. This paper reports on the development and testing of several scales designed to measure aspects of resilience in the health care provider industry. Six factors explaining over half the instrument variance were found, including: goal-directed solution seeking; avoidance; critical understanding; role dependence; source reliance; and resource access. Results are discussed and future research is outlined.     

Working the markets: purchaser/provider separation in English health care.

In 1991 the U.K. health system embarked upon a series of apparently radical changes in its organization, centering upon the notion of "purchaser/provider separation." After summarizing these changes, and their ostensible rationale, this article reports early experiences of the new system and outlines the alternative proposals of the main opposition Labour Party. Early experience suggests that the new system is unlikely to function as ostensibly intended. The Labour alternative, however, fails to address crucial organizational issues.     

Reengineering health care: management systems for survivors

To survive in the coming era, health care organizations must support the powerful concepts of continuous quality improvement with better internal management systems that include: (1) new processes for making decisions from mission to clinical guidelines; (2) hoshin planning, which emphasizes strong financial management and innovation to meet customer needs; (3) new organizations that make cross-disciplinary teams as important as traditional clinical support services; and (4) expanded information covering several new dimensions, including enhanced analytic capability, and supporting both traditional organization and cross-disciplinary teams.     

The mental health care context and patient characteristics: implications for provider job satisfaction

This research examines job satisfaction among 282 staff providing mental health care to 574 patients with serious mental illness. The mental health staff worked in 18 Department of Veterans Affairs inpatient and outpatient mental health care units at 12 Veterans Affairs Medical Centers located across the contiguous 48 states. The purpose was to identify (1) aspects of the health care context that were associated with provider job satisfaction and (2) administrative and organizational procedures/interventions that might sustain or improve provider job satisfaction. The association of provider job satisfaction with patients' functional status and symptom severity was tested in multilevel statistical models that accounted for provider and unit characteristics. Provider job satisfaction was found to be greater on smaller units and units with higher patient functioning and lower illness severity. Implications of these results are discussed.     

Knowledge systems,health care teams,and clinical practice: a study of successful change

Clinical teams are of growing importance to healthcare delivery, but little is known about how teams learn and change their clinical practice. We examined how teams in three US hospitals succeeded in making significant practice improvements in the area of antimicrobial resistance. This was a qualitative cross-case study employing Soft Knowledge Systems as a conceptual framework. The purpose was to describe how teams produced, obtained, and used knowledge and information to bring about successful change. A purposeful sampling strategy was used to maximize variation between cases. Data were collected through interviews, archival document review, and direct observation. Individual case data were analyzed through a two-phase coding process followed by the cross-case analysis. Project teams varied in size and were multidisciplinary. Each project had more than one champion, only some of whom were physicians. Team members obtained relevant knowledge and information from multiple sources including the scientific literature, experts, external organizations, and their own experience. The success of these projects hinged on the teams' ability to blend scientific evidence, practical knowledge, and clinical data. Practice change was a longitudinal, iterative learning process during which teams continued to acquire, produce, and synthesize relevant knowledge and information and test different strategies until they found a workable solution to their problem. This study adds to our understanding of how teams learn and change, showing that innovation can take the form of an iterative, ongoing process in which bits of K&I are assembled from multiple sources into potential solutions that are then tested. It suggests that existing approaches to assessing the impact of continuing education activities may overlook significant contributions and more attention should be given to the role that practical knowledge plays in the change process in addition to scientific knowledge.     

Managed behavioral health care provider practice patterns: a new item for the public policy agenda

Managed care is a dominating issue on the public policy agenda. Difficulties in defining and operationalizing it continue to have ramifications for the nation. It is often assumed that the care being reimbursed by managed care organizations is for clients whose psychiatric conditions have been appropriately diagnosed and treated. Based on the responses of a randomly-selected group from the major behavioral health care disciplines, not all care reimbursed is for care which has been appropriately diagnosed and treated. The cost implications of managed care and the ramifications for public health policy are discussed.