Ways of medical fee-paying
Keywords:
HEALTH ECONOMICS, COST BENEFIT ANALYSIS, ORGANIZATION AND ADMINISTRATION, HEALTH CARE COSTS, HEALTH CARE REFORMAbstract
The ways that medical fee-paying take place, play an important role in any reform process of the health sector and are closely related to the main characteristics of the organization and its objectives. Relations between users, financiers, providers are determined by the existing differences or agreements with the objectives they aim at, they are reflected in a predominant way of stating medical-fees. The model chosen is both an effect of the health sector organization and a determinant factor of some of its predominant characteristics. The design of medical fee-paying models that include cost-effectiveness relations depends on a balanced distribution of financial risks considering advantages and disadvantages for each way.
References
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13) Kronick R, Dreyfus T, Lee L, Zhou Z. Diagnostic risk adjustment for Medicaid: the disability payment system. Health Care Financ Rev 1996; 17(3): 7-33.
14) Hornbrook MC, Goodman MJ. Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment. Health Serv Res 1996; 31(3): 283-307.
15) Newhouse JP, Sloss EM, Manning WG (Jr), Keeler EB. Risk adjustment for a children´s capitation rate. Health Care Financ Rev 1993; 15(1): 39-54.
16) Rice N, Dixon P, Lloyd DC, Roberts D. Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis. BMJ 2000; 320(7230): 284-8.
17) Buglioli M, Ortún V. Sistemas de ajuste por riesgo. Rev Med Uruguay 2000; 16: 123-32.
18) Newhouse JP. Risk adjustment: where are we now? Inquiry 1998; 35(2): 122-31.
19) Robinson JC. Blended payment methods in physician organizations under managed care. JAMA, 1999; 282(13): 1258-63.
20) Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Effective Practice and Organization of Care Group. Oxford: Cochrane Database of Systematic Reviews. Essue 4, 2002.
21) Gray B. Do Medicaid physician fees for prenatal services affect birth outcomes? J Health Econ 2001; 20(4): 571-90.
22) Silverman EM, Skinner JS, Fisher ES. The association between for-profit hospital ownership and increased Medicare spending. N Engl J Med 1999; 341(6): 420-6.
23) Sloan FA, Picone GA, Taylor DH, Chou SY. Hospital ownership and cost and quality of care: is there a dime's worth of difference? J Health Econ 2001; 20(1): 1-21.
2) Sonis A, Neri A, Feld S. Medicina Sanitaria y Administración de Salud. 2ª ed. Buenos Aires: El Ateneo, 1985: 418p, v.2.
3) Ferrara F, Acebal E, Paganini J. Medicina de la Comunidad. 2ª ed. Buenos Aires: Intermédica, 1976: 362p.
4) Mintzberg H. Diseño de Organizaciones Eficientes. Buenos Aires: El Ateneo, 1994: 160-2.
5) Maceira D. Mecanismos de pago a prestadores en el sistema de salud: incentivos, resultados e impacto organizacional en países en desarrollo. Bethesda: Partnerships for Health Reform, 1998: 12-13. (Mimeo).
6) Contandriopoulos AP, Champagne F, Baris E. Le rémunération des prossionnels de santé. J Economie Médicale 1993; 11(7/8): 405-42.
7) Pellisé L. Sistema de pago óptimo en el sector sanitario. In: Del Llano J, Ortún V, Martín JM, ed. Gestión Sanitaria: innovaciones y desafíos. Barcelona: Masson, 1998: 49-64.
8) Chalkley M, Malcomson JM. Contratos en el National Health Service. In: Ibern P, ed. Incentivos y contratos en los servicios de salud. Barcelona: Springer, 1999: 49-62.
9) Peiró S, Meneu R, Roselló M. Pago prospectivo por caso y duración de la estancia en hospitales privados concertados. Med Clín (Barc) 1993; 100: 372-4.
10) Donaldson C, Gerard K. Countering doctor moral hazard. In: Economics of health care financing: the visible hand. London: Mac Millan, 1993: 101-15.
11) Barnum H, Kutzin J, Saxenian H. Incentives and provider payment methods. Int J Health Plann Manage 1995; 10(1): 23-45.
12) Newhouse J. Sistema de pago a planes de salud y proveedores: eficiencia en la producción versus selección. In: Ibern P, ed. Incentivos y contratos en los servicios de salud. Barcelona: Springer, 1999: 87-125.
13) Kronick R, Dreyfus T, Lee L, Zhou Z. Diagnostic risk adjustment for Medicaid: the disability payment system. Health Care Financ Rev 1996; 17(3): 7-33.
14) Hornbrook MC, Goodman MJ. Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment. Health Serv Res 1996; 31(3): 283-307.
15) Newhouse JP, Sloss EM, Manning WG (Jr), Keeler EB. Risk adjustment for a children´s capitation rate. Health Care Financ Rev 1993; 15(1): 39-54.
16) Rice N, Dixon P, Lloyd DC, Roberts D. Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis. BMJ 2000; 320(7230): 284-8.
17) Buglioli M, Ortún V. Sistemas de ajuste por riesgo. Rev Med Uruguay 2000; 16: 123-32.
18) Newhouse JP. Risk adjustment: where are we now? Inquiry 1998; 35(2): 122-31.
19) Robinson JC. Blended payment methods in physician organizations under managed care. JAMA, 1999; 282(13): 1258-63.
20) Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Effective Practice and Organization of Care Group. Oxford: Cochrane Database of Systematic Reviews. Essue 4, 2002.
21) Gray B. Do Medicaid physician fees for prenatal services affect birth outcomes? J Health Econ 2001; 20(4): 571-90.
22) Silverman EM, Skinner JS, Fisher ES. The association between for-profit hospital ownership and increased Medicare spending. N Engl J Med 1999; 341(6): 420-6.
23) Sloan FA, Picone GA, Taylor DH, Chou SY. Hospital ownership and cost and quality of care: is there a dime's worth of difference? J Health Econ 2001; 20(1): 1-21.
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Published
2002-12-31
How to Cite
1.
Buglioli M, Gianneo O, Mieres G. Ways of medical fee-paying. Rev. Méd. Urug. [Internet]. 2002 Dec. 31 [cited 2024 Nov. 25];18(3):198-210. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/962
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Opinion articles
