Provider payment schemes

A payment scheme is a mechanism used to transfer funds from the payers to the providers. It can have a significant effect on how health care resources are allocated and services delivered. A well designed scheme facilitates access to health services and ensures high quality care, while promoting efficient use of resources at low cost. Therefore, it accomplishes far more than just funds transfer. As outlined in Langenbrunner et al. (2009), the methods of payment include fee-for-service (FFS), capitation, per diem, case based as in bundled payment, and pay-for-performance (P4P). 

Dirkey Mostly private providers who apply payment per act (FFS) schemes in their bills Social health insurance covers the totality of costs, although specific rates are applied to uninsured groups All social health insurance schemes apply percentage rates of user participation for medicines (in out-patient visits)... 

The experiment conducted by the Rand Corporation in the late 1970s, designed as a large-scale experiment in order to overcome this methodological difficulty, is already a classic in the field of health economics.22 It consisted in allocating 16 different 3-5-year health insurance schemes at random to a broad sample of people distributed geographically in six different areas of the USA. The co-payment rates varied from 0 per cent to 95 per cent, depending on the scheme and the services provided. The data supplied by the... 

The new process started its operation in 2006. The Mexican Cleaner Production Centre evaluated the actual performance in order to check the economic and environmental benefits (reduction in the nickel consumption) and the functionality of the scheme of payment that forms the basis for the service of the chemical agents (brighteners) that was provided. 

Who are the likely winners and losers from the proposed subsidies Can their support for the scheme be achieved In the process of gathering information on the roles and interests of various stakeholders in the health problem, opportunities may arise to identify potential partnerships and to float the idea of a voucher scheme with potential partners. How open is the ministry of health to a scheme that effectively breaks its provider monopoly over the use of subsidies How willing would private providers be to entering into a partnership with the public sector, to bid for a contract, to accept vouchers as payment, to sign contracts for services, to follow a strict patient management protocol, to participate in an accreditation scheme Assessing different stakeholders reactions can provide a valuable input to the next phase, the feasibility assessment. 

Some countries prohibit private medical practice. Lack of private doctors would severely constrain a competitive voucher scheme (although it might still be possible to promote competition among public sector providers). Other countries prohibit public sector providers from receiving cash, which limits the use of monetary incentives. In these cases, public providers cannot receive extra payment from outside or private funding sources, which becomes an issue if, for example, a private foundation were trying to fund the subsidies. 

Value policies can affect effectiveness of a voucher scheme if they are used as incentives for providing additional services (if, for example, extra payments are made for referring patients for voluntary counseling and testing for HIV). 

Has a set of rules been drawn up to define who receives the vouchers, what the voucher entitles its bearer to, what the bearer must pay to the provider to use the voucher (if anything), who can participate in the scheme as service providers (and under what conditions), and what each provider will receive in payment from the voucher agency (and how payment is to be determined) ... 

The welfare of the workmen was a particular concern of Major Minnis, whose wife was appointed as the first full-time welfare officer. Central to the welfare scheme were the numerous workmen s canteens established with money advanced personally by Major Minnis. The canteens, which provided wholesome, inexpensive food for the workers, were a huge financial success. All the profits were directed into the welfare fund, enabling the payment of a wide range of benefits at a level previously unknown in British industry. 

Defined-benefit pension plans. If, in retirement, you receive from your former employer a fixed monthly payment, your pension exemplifies the defined-benefit type. The structure of such a plan makes your employer legally responsible for implementing all of it. It requires the company but not the employee to make a minimum annual contribution, which comes from investments. The employer must make up any investment losses to maintain its annual contribution. It may not end the plan without sufficient assets to provide the promised benefits, and its obligation to continue payments to employees survives bankruptcy. The Pension Benefit Guarantee Corporation, which is wholly owned by the U.S. government, secures payments to employees who participate in defined-benefit schemes. Consequently, participants can never exhaust their benefits while they live, and their spouses may continue to receive pension payments after the participants die. Regular lifetime payments are important features of defined-benefit pension plans, about two-thirds of which disallow lump-sum distributions at retirement (Kehrer, 1995). 

Given the variety of schemes it is not possible to provide any generally apphcable conclusions as regards the impact of different forms on the burden of costs borne by the patient. In a study assessing the cost burden in a sample of European countries using typical prescription scenarios, the dehcate interplay between drug price, co-payment system and exemptions is illustrated [7]. 

All regulations regarding working hours, employee s payment, welfare schemes, provident funds and retirement benefits, health check-ups and benefits, prevention of child labour, and special rules for women employees are to be complied as per applicable laws in the country. 

Currently in the EU, all states provide some form of support for organic farming through their rural development programmes. The amount of support varies widely between Members States. In England, payments are received if farmers enter the Organic Entry Level Stewardship scheme (OELS). Payments are highest for the first two years in-conversion. Wales, Scotland and Northern Ireland have broadly similar schemes. 

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