Payment systems accountability

The Accounts system keeps a record of payments against accounts (see Figure 10.25). The reference attribute of an account enables it to be cross-referenced to external records. 

Two mid-term objectives are closely related to the principal goal of RP. The first of them has to do with encouraging price competition, as it provides an incentive for companies to bring their prices close to the reference level. This is precisely one of the reasons why the European Commission5 recommends RP. The second mid-term objective concerns incentives, as it takes into account the cost-effectiveness ratio of prescription drags by increasing the financial responsibility of patients, which in turn may influence prescriber decisions. It is important to note that, unlike in traditional co-payment, under this system the patient s share of the cost of the product is avoidable if the patient and/or doctor select a product with a price that does not exceed the reference price. 

For the purpose of analysing incentives of a financial nature in a European context, it is advisable to attach more emphasis to the formula of budgets than to the various physician payment mechanisms. From our point of view, these mechanisms are taken into account indirectly as regards the impact that the articulation of budgets might have on prescriber fees (as in the German case). There are two reasons for this approach first, in most of Europe s public health systems the salary is the predominant form of payment for physicians,... 

The basic concept of the CGO within CREST remains the same—that is, the provision of secure settlement for gilt-edged securities through an efficient and reliable system of electronic book-entry transfers in real time against an assured payment. The CGO is a real-time, communication-based system. Settlement on the specified business day (T + 1 for normal gilt trades) is dependent on the matching by CGO of correctly input and authenticated instructions by both of the parties and the successful completion of presettlement checks on the parties stock account balances and credit headroom. 

The third user is a new virtual Bank set up recently by one of the major Banks in Northern Italy with the widest country-wide reach. The web-based system has been adopted as part of their core-business and is an integral part of the services offered by this virtual bank. The Bank is completely independent from the Northern Italian bank and is, in a sense, competitor to the parent company. The view adopted by the new bank is that virtual banking should not focus only on the electronic provision of traditional banking services — deposits, credit cards, account payments etc.— but must offer new services in a seamless environment. The web-based personal asset allocation system provides a service not offered by most retail Banks which integrates naturally with the core business of electronic banking. The Bank uses the web-based system at the basic level offering one more service to its clients. In doing so it must be noted that it competes with the parent company. 

The system selected for delivering cash and in-kind transfers to beneficiaries should consist of the appropriate combination of delivery agencies and means of payments and should be well integrated with other operational processes. In addition, the system will need to be feasible enough to be improved over time, while taking current implementation constraints into account. 

As the healthcare system is extensive and complex, it presents opportunities for different business models to emerge. The possibilities include, emergence of niche providers, patient activation, innovations enabling process automation, shift from resource utilization to final outcomes, reconfiguration for accountability, new technologies such as electronic medical records, bundled payments, new medical devices that necessitate process reengineering, and government vs. private ownership of services and/or payments. 

In a hybrid model, the ACO receives a single payment to cover all costs associated with ambulatory care services for the patients in its care. It also receives a bonus payment based on shared savings (or penalty) in costs of inpatient care services. The ACO is not fully at risk for inpatient care, as it would be under a comprehensive care payment. The ACO is far more accountable for inpatient care than that under a fee-for-service system. It also gives the ACO the flexibility to try different treatments than that under a shared savings approach. 

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