Episode-based payment recommandation - Research Paper Example

The U.S healthcare system is characterized of high level mechanization and technological advancement. High medical specialization is evident though at the primary level, resources are poorly supplied and the overall coordination pathetic. High spending in the sector has been a major concern to healthcare policy making over time. Inefficiencies in healthcare administration and poor or total lack of incentives to consumers to be prudent in their spending on health care services are the fundamental areas of failure of the whole system.

Studies in the past has shown that much of the bulk in costs in this sector are a resultant of offering unnecessary services while at the same time enduring high levels of waste. Recommendations have been the adoption of better means to offer the only necessary services and reducing on the wastes. However, this is far from being a reality and in the contrary, the costs and inefficiencies are continued phenomena in the sector. Accompanying advantages to the consumers when the system is well coordinated are numerous.

I find it more advantageous to have the services offered in a ‘bundle’ form of payment for the financial responsibility on the side of consumers (Keckley, Underwood and Frink 5-6). Funding in the health care sector in 2005 stood in the ration of 54.5% for the private funding compared to 45.5% for the public funding. The system in common use is the ‘fee for service’ system which relies on payment for the volume of services received. Nevertheless critics have cited this to be the main hindrance to the effective service delivery in health care system.

They reason that from this system, coordination in service delivery and resource utilization is interfered with hence resulting to the en-mass wastages and the rise in insurance premiums and other related charges. Many models of service provision and payments have been devised over years. Key in these models is the FFS (Fee For Service), capitation as well as the bundles/episode type of payments. However, each has had its own short comings in terms of overall efficiency in costs and quality service provision (Keckley, Underwood and Frink 7-10).

The bundle or episode based payment stands analytically promising than the previous systems. It entails summation of all costs in treatment of a certain condition through a defined time period and through direct and indirect service provision. This incorporates the costs incured through the service provision by various providers at the varying levels of health care provision. I support this system because it takes recognition of services offered at all levels within the care system. It incorporates expenses incurred at office consultation, rehabilitation, hospital out and inpatient, pharmacy and homecare among others.

It is based on evidence on the service offered other than who does it. This system also encourages low cost service delivery by incentives as opposed to high cost of servicing which the system penalizes. To encourage the episode system of payment, incentives to further research by the care providers and educational institutions should be adopted. Equally, the EBP method provides policy makers with options of strategically aligning the service delivery in the perspective of quality as against volumes offered.

Strategic handling of patient information and the sharing of the same from one