Types of Financial Reimbursement Systems

Types of Financial Reimbursement Systems

There are three types of financial reimbursement systems in the U.S. First, there are Medicare reimbursements through which hospitals are paid in a government arrangement. Second, Medicaid reimbursements are paid to hospitals based on cost reimbursement as influenced by state governments. Third, there is a private insurance reimbursement system through which private insurers pay hospitals per diem as agreed by the hospital and its insurers. Notably, Medicaid and Medicare reimbursement systems are public, while private insurance is private. Notably, this system of reimbursement is compared to that of Canada. Canada is selected as a neighboring country that shares a common background with the U.S. regarding weather and policies. Canada’s reimbursement system entails payments made through public health insurance, private health insurance, and out-of-pocket payments as agreed between doctors and patients. Canada’s reimbursement system is more complex than that of the United States because 15% of payments are made through agreements between doctors and patients (Tikkanen et al., 2020). The systems are similar in many aspects, but they are different.

The patient-provider relationship to generate a patient bill differs from Canada to the United States, whereby in Canada, providers are not allowed to bill their patients using private insurance for services that would be covered under public insurance. Further, the billing is guided by the negotiated fee schedule. The United States, on the other hand, does not restrict patient-provider billing to a negotiated schedule, which has increased out-of-pocket spending for some services, such as dental care, to 40% of total spending (Dieleman et al., 2020). Also, providers can choose which insurance to accept for specialist services offered. Based on personal opinion, the relationship between cost and quality of patient care in the U.S. is positively associated. With a higher cost, a patient can access better quality using private insurance and out-of-pocket spending.

References

Dieleman, J. L., Cao, J., Chapin, A., Chen, C., Li, Z., Liu, A., & Murray, C. J. (2020). US health care spending by payer and health condition, 1996-2016. Jama, 323(9), 863-884.

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). United States. Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states

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After you have read chapters two and four of your textbook, research another country’s different types of reimbursement/payment systems using this site: https://international.commonwealthfund.org/ and compare it with the US reimbursement systems.

Answer the following in paragraph/essay form:
1Describe the various types of financial reimbursement systems in the US and cite accordingly.
2. What country did you choose to compare and why? Is that country’s system of reimbursement for care more or less complex? (Explain the overall views of the country’s health care system. If there were no statistics for the country you chose, describe the stats from another country.) Please cite accordingly.
3. How does the patient-provider relationship to generate a patient bill differ from the country of your choice to the US? Please cite accordingly.
4. In your opinion, describe the relationship between cost and quality of patient care in the US.
Criteria for success:
•
Complete your 100-150-word original post by 11:59 p.m. EST Thursday. See the course snapshot for details on the due date.
Complete the 50-75-word peer reply by 11:59 p.m. EST Sunday. See the course snapshot for details on the due date.