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“The complexity of financing in health care

“The complexity of financing in health care is one of the primary characteristics of medical care delivery in the United States” (Shi & Singh, 2012, p. 129). There are numerous reimbursement methods (e.g., capitation, fee-for-service, package pricing, etc.) that are used by health care organizations and providers to get paid for the health care services that they provide. Building upon your Individual Project from Unit 1, write a 3-5 page paper not including a title page and reference page that contains the following:

Summarize 3 different reimbursement methods that are used by health care providers and organizations.
Choose which method(s) will work best for the health care facility that you have proposed to be developed, and explain why you chose that method(s).
Discuss the pros and cons of the reimbursement method(s) that you chose.
Discuss the impact that the method(s) may have on the financial operations of the facility that you chose

Full Answer Section

Common Reimbursement Methods

Fee-for-Service (FFS): This traditional method reimburses providers based on the volume of services rendered. Each service has a predetermined fee, and providers bill payers for each test, procedure, or consultation performed.
Capitation: Under capitation, providers receive a fixed sum of money per patient enrolled for a defined period. This method incentivizes preventive care and efficient resource utilization as providers aim to keep patients healthy within the allotted budget.
Bundled Payments: This method reimburses providers a set amount for a specific episode of care, regardless of the services utilized. This encourages collaboration between providers and reduces unnecessary procedures.

Choosing the Right Method for Our Community Health Center

Sample Answer

The intricate web of healthcare financing in the United States presents a challenge for organizations striving to deliver quality care while maintaining financial stability. This paper explores three common reimbursement methods – fee-for-service (FFS), capitation, and bundled payments – analyzing their suitability for a proposed community health center focused on preventative care and chronic disease management for an underserved population.