Designing and Implementing Health Care Provider Payment Systems: How-to Manuals
Jack Langenbrunner, Cheryl Cashin, Sheila O'Dougherty
World Bank Publications, Jan 1, 2009 - Medical - 321 pages
Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.
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adjustment coefficients administrative age/sex aggregated Almaty average cost base per capita base rate Bishkek capita payment system capita PHC payment capita rate Cardiology case-based hospital payment Central Asia changes clinical department clinical practice guidelines contract copayments cost-accounting countries database diagnosis disease drugs efficiency example expenditures financial incentives funds global budget group weights health care system health financing health insurance health policy health purchaser health reform health sector health services health system HMIS hospital payment system hospital pool implementation improve increase individual information systems inputs Issyk-Kul Karaganda Kazakhstan Kyrgyz Republic length of stay line-item budget ment MHIF Ministry of Health oblast open enrollment outpatient overall patients payment method PHC payment system PHC pool PHC providers PHC services population primary health provider payment systems purchaser and provider region reimbursement service delivery standards Tajikistan tion Uzbekistan volume World Bank ZdravPlus