Designing and Implementing Health Care Provider Payment Systems : How-To Manuals

This volume grows out of an initiative in the World Bank on resource allocation and purchasing ('RAP'), which started in 2000, and continues to publish articles and books related to strategic purchasing. The initiative emerged from such questions in developing economies as: why do individuals need help in purchasing health services from providers? Is the 'middleman' really necessary? Can people not just buy health services in the same way they would go to the local market to buy bread, milk, or fruit, especially since, throughout most of history that is what most people did? When sick, they contacted local healers directly. Public policy historically was limited largely to protecting the sick against charlatans and was enforced through ethical codes such as the Hippocratic Oath. There was no expensive technology, and most serious conditions led to death. Loss of employment and burial costs were the most expensive parts of illness. With industrialization and the scientific revolution, all this changed. As understanding about the causes, prevention, and treatment of illness expanded, interventions become more complex and expensive. Health care was no longer the exclusive domain of traditional healers. Partly because of the complexities involved, the World Bank's new health, nutrition, and population strategy has noted that 'countries increasingly not only want to know what to do (with health systems) but also how to do it, particularly how to design and manage the transition from current to reformed systems.' This volume is a step in that direction, to help countries design, manage, and implement reforms related to strategic purchasing with an emphasis on changing their provider payment systems.

Bibliographic Details

Main Authors:	Langenbrunner, John C., Cashin, Cheryl, O’Dougherty, Sheila
Format:	Publication biblioteca
Language:	en_US
Published:	Washington, DC: World Bank 2009
Subjects:	accountability mechanisms, Accounting, administrative costs, aggregate costs, allergies, allocation of funds, allocative efficiency, automated teller machines, basic health care, beds, budget cap, Capitation, Capitation Fee, capitation payment, Capitation Payments, Claim, clinical outcomes, clinics, collection of revenues, conflicts of interest, Cost per Case, cost reductions, cost sharing, Cost shifting, costs of care, degree of competition, direct patient, Direct payment, doctors, employment, equilibrium, equity in access, Essential health care, expenditures, families, Fee for service, fee schedule, fee schedules, Fee-for-Service, fee-for-service method, fee-for-service methods, fee-for-service payment, financial incentives, Financial management, financial protection, financial risk, financial transactions, Fixed budgets, fractures, global budgets, Hard budget, Health Care, health care financing, Health Care Markets, Health Care Per Capita, Health Care Provider, health care providers, health care Research, Health Care Resources, health care services, health care system, health care systems, Health Delivery, Health Delivery System, health expenditure, health financing, health financing reform, Health information, Health information system, Health Insurance, Health Insurance Fund, Health Insurance Schemes, health interventions, Health Management, health needs, Health Organization, Health Planning, health plans, Health Policy, Health Programs, health promotion, health providers, Health Purchaser, health purchasers, Health Reform, Health Reforms, health sector, Health Service, health services, health status, Health System, health system performance, health systems, health workers, home care, hospital admissions, hospital budgets, hospital care, hospital costs, Hospital Discharge, hospital sector, hospital services, Hospitalization, Hospitals, illness, Incentives for providers, income, income countries, indirect costs, Informatics, information asymmetry, Information Systems, inpatient care, insurance systems, insurers, judgement, level of payment, low income, managed care, market incentives, Medical economics, Medical fees, Medicare, medicines, moral hazard, multiple purchasers, National Health, National Health Service, negotiation, nurses, nursing, nursing home care, Nutrition, outpatient care, outpatient services, Overruns, Patient, patient cost, Patient information, patient outcomes, patients, payment arrangements, Payment System, Payment Systems, pharmacists, physician, Physicians, primary care, Primary Health Care, Private Finance Initiative, private insurers, private sectors, Provider Payment, providers of health care, provision of services, public funds, public health, public hospitals, public sector, recurrent costs, rehabilitation, rehabilitation services, reimbursement rates, Risk Adjustment, risk factors, risk sharing, salaries, Salary, social security, surgery, transition economies, workers,
Online Access:	http://hdl.handle.net/10986/13806
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