Profit: Reimbursement in Healthcare

There are various types of reimbursement that are currently applied in healthcare practices. Doctors and hospitals may be paid for the quality of care delivered (value-based reimbursement). Another way to gain profit is to determine the cost of an implemented procedure that will be paid (cost-based reimbursement). Finally, payment may be based on a previously established rate (prospective reimbursement). Various healthcare providers use systems which better fit their policy, while often combining them. Furthermore, the type of reimbursement system used by a healthcare provider may also determine the quality of services as well as their planning.

A study by Mylotte et al. (2013) concludes that the usage of the transcatheter aortic valve replacement practice in Europe is firmly connected to the reimbursement strategies functioning in various hospitals. Furthermore, some policies in particular may lead to underutilization of this practice that is sometimes crucial for the patient’s recovery. Although it is a study based on researching the application of only one medical practice, it is a good example of how reimbursement may impact the quality of healthcare services. Another study performed by Tolppanen et al. (2013) uses data on reimbursement systems in various hospitals to offer suggestions on improving the care provided to people with Alzheimer’s disease and planning the expenses that this practice demands.

Therefore, it is evident that studying and applying different reimbursement systems is crucial to improving the current health care practices. This would increase the benefits for both patients and providers which will lead to a healthier community as well as more profitable business for both sides. Moreover, implementing innovative reimbursement practices may also contribute to the economic state of any country in which the practice is applied. Different systems may provide less contribution needed for a more stable functioning of healthcare system.

References

Mylotte, D., Osnabrugge, R. L. J., Windecker, S., Lefèvre, T., Jaegere, P., Jeger, R., … Piazza, N. (2013) Transcatheter aortic valve replacement in Europe. Journal of the American College of Cardiology, 62(3), 210-219.

Tolppanen, A.-M., Taipale, H., Koponen, M., Lavikainen, P., Tanskanen, A., Tiihonen, J., & Hartikainen, S. (2013). Use of existing data sources in clinical epidemiology: Finnish health care registers in Alzheimer’s disease research – the medication use among persons with Alzheimer’s disease (MEDALZ-2005) study. Clinical Epidemiology, 5, 277–285.

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