Financing System for Healthcare Services: Background
The current healthcare system requires substantial financing. Because of the necessity to meet the increasingly high-quality standards, healthcare organizations must purchase necessary equipment, train their staff, etc. Therefore, exploring the opportunities for financing healthcare organizations is crucial to the further improvement of patient outcomes. At present, the concept of health insurance is used as the foundation for financing healthcare services and providing people with an opportunity to access the latter. Medicare offers extensive opportunities for covering the expenses for public care. Similarly, Medicaid provides extensive opportunities for financing healthcare organizations so that U.S. citizens could use available healthcare services. At this point, one must mention that the identified system allows reimbursing hospitals and other health organizations for the expenses that they take to meet the needs of patients (Duston, 2016).
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Reimbursement for Providers’ Services: Three Options
As stressed above, the reimbursement for services offered by healthcare organizations is a crucial part of the U.S. health system. At present, three primary types of reimbursement are used in the context of the American healthcare system. These are the value-based reimbursement, the fee-for-service framework, and the pay-for-coordination approach. The value-based reimbursement implies that payment should be provided for the quality of care as opposed to paying for the volume thereof. The fee-for-service approach, in turn, suggests that patients should provide payment for each healthcare service that they were provided. Finally, the pay-for-coordination concept implies that the reimbursement should be offered to not only the primary care provider but also other health services that offer other options for maintaining health. As a result, one can design a unified healthcare plan that will be used by both an individual and their family members (Maurer & Smith, 2013).
Reducing Healthcare Costs: Three Approaches
The ability to control costs is a crucial skill for a healthcare provider; otherwise, one will fail to control the available resources and use them so that the services of the finest quality could be delivered to patients. Therefore, it is crucial to introduce the mechanisms that will help reduce healthcare costs significantly. At present, several tools for controlling costs in the context of a healthcare organization can be identified. First and most obvious, alternatives to the existing fee-for-service framework need to be sought. Thus, the available financial resources will be allocated more efficiently. Furthermore, the adoption of competitive bidding as the means of setting higher prices for the suggested commodities and, therefore, receiving greater profits, needs to be listed among the primary strategies for reducing the costs spent on healthcare. Finally, one must bring up the phenomenon of sustainable use of resources (Raulinajtys-Grzybek, 2015).
Conclusion: Implications for Savvy Nurse Managers
The challenges that the contemporary economic environment poses to healthcare providers can and should be managed so that the quality of the corresponding services could rise regularly. As a result, the opportunities for increasing the competitiveness of health organizations will be built. At present, it is crucial to make sure that health providers are capable of allocating available resources efficiently. As long as expenses are reduced to their logical minimum and opportunities of the target market are explored fully, a steep rise in the quality of healthcare services and, therefore, the loyalty levels among customers are expected to rise.
Duston, P. S. (2016). Analyzing form, function, and financing of the U.S. health care system. Chicago, IL: CRC Press.
Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. New York, NY: Elsevier Health Sciences.
Raulinajtys-Grzybek, M. (2015). Pricing health services: Transaction cost approach. New York, NY: Anchor Academic Publishing.