
Designing and Implementing Health Care Provider Payment Systems How-To Manuals
by Langenbrunner, John C.; Cashin, Cheryl; O'Dougherty, SheilaBuy New
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Summary
Table of Contents
Preface | p. xi |
Acknowledgments | p. xiii |
List of Contributors | p. xv |
Abbreviations | p. xviii |
Glossary | p. xix |
Overview: What, How, and Who: An Introduction to Provider Payment Systems | p. 1 |
Aims and Readership of This Volume | p. 1 |
Provider Payment Systems and Methods: An Overview | p. 3 |
Main Characteristics of Provider Payment Methods | p. 12 |
The Way Forward | p. 19 |
Organization of This Volume | p. 20 |
Notes | p. 24 |
References | p. 24 |
Primary Health Care Per Capita Payment Systems | p. 27 |
Overview of PHC Provider Payment Systems | p. 27 |
Defining the Health Policy Context | p. 27 |
Methodology for Developing a Per Capita PHC Payment System | p. 33 |
Defining a PHC Package of Services | p. 35 |
Setting the PHC Pool and Calculating the Base Per Capita Rate | p. 37 |
Calculating Risk Adjustment Coefficients | p. 40 |
Developing an Enrollment Database | p. 52 |
Calculating Each Provider's Per Capita Budget | p. 61 |
Designing a Finance and Management System | p. 62 |
Designing a Monitoring and Quality Assurance System | p. 75 |
Expanding the Base Per Capita Rate and Package of Services | p. 87 |
Implementation Issues | p. 89 |
The Link between PHC Per Capita Payment and the Health System Axes: Experience from Four Central Asian Republics | p. 97 |
Note | p. 120 |
References | p. 120 |
Case-Based Hospital Payment Systems | p. 125 |
Overview of Case-Based Hospital Payment Systems | p. 125 |
Defining Case Grouping Criteria | p. 134 |
Completing Cost-Accounting Analysis | p. 148 |
Calculating Case Group Weights | p. 159 |
Calculating the Base Rate | p. 161 |
Designing an Information and Billing System | p. 170 |
Refining Case Grouping | p. 190 |
Implementation Issues | p. 192 |
Case Studies from Kazakhstan and the Kyrgyz Republic | p. 196 |
Notes | p. 211 |
References | p. 212 |
Hospital Global Budgeting | p. 215 |
Overview | p. 215 |
Setting the Hospital Global Budget | p. 218 |
Performance Incentives | p. 229 |
Nonbudget Funding | p. 232 |
An Overview of Costing | p. 241 |
Managing the New Global Budget | p. 248 |
Annual Adjustments | p. 248 |
References | p. 253 |
A Primer on Contracting | p. 255 |
Introduction | p. 255 |
Which Contract? | p. 256 |
Volumes | p. 257 |
Which Contract When? | p. 259 |
Consortia | p. 261 |
Duration of Contract | p. 262 |
Note | p. 262 |
Health Management Information Systems: Linking Purchasers and Providers | p. 263 |
Background | p. 263 |
Implementing Appropriate Provider Systems | p. 268 |
Implementing Appropriate Purchaser Systems | p. 283 |
Implementing an Appropriate Link between Purchaser and Provider Systems | p. 291 |
Concluding Remarks | p. 297 |
Annex 5.1: A Primer on Health Management Information Systems | p. 300 |
Notes | p. 304 |
References | p. 304 |
Index | p. 307 |
Boxes | |
Incentives | p. 2 |
Balance of Decision Rights in Costa Rica | p. 33 |
Top-Down Estimation of the PHC Pool as a Health Policy Tool | p. 39 |
Open Enrollment in Zhezkazgan, Kazakhstan | p. 56 |
Budget Overruns and the Unadjusted Base Per Capita Rate | p. 63 |
Budget Neutrality and a Per Capita Rate Adjusted Using Age/Sex Adjustors | p. 64 |
Budget Neutrality and a Per Capita Rate Adjusted Using Both Geographic and Age/Sex Adjustors | p. 65 |
Introductory Training for Finance Managers in Uzbekistan | p. 68 |
Basic Health Management for General Practitioners in Uzbekistan | p. 70 |
Issues and Solutions in a Fully Automated System in the Kyrgyz Republic | p. 74 |
Benchmarking, Not Targets, in Karaganda, Kazakhstan | p. 84 |
PHC Monitoring System in Karaganda, Kazakhstan | p. 86 |
Provider Satisfaction | p. 93 |
Results of Increased Provider Autonomy in Karaganda, Kazakhstan | p. 96 |
Karaganda Achievements | p. 110 |
Possible Adjustment Coefficients to the Payment Per Case Formula | p. 132 |
Initial Case Groups and Weights in the Kyrgyz Republic | p. 135 |
Major Diagnostic Categories in the Australian Refined Diagnosis-Related Groups Classification | p. 141 |
Serial Example: Calculating Average Cost per Case | p. 144 |
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