. What are some of the industries in the healthcare sector?
Some of the industries in the healthcare sector are health insurance, pharmaceuticals and biotechnology, medical equipment and supplies and health services. Others include education institutions, government and private research agencies.
b. What is meant by the term healthcare finance as used in this book?
Healthcare finance is a term used in this book to describe accounting and financial management principles and practices used to ensure the financial well-being of health care organizations.
c. What are the two broad areas of healthcare finance?
The two broad areas of healthcare finance are accounting and financial…show more content…
The role of finance is to make health service organizations maximize their resources to increase their efficiency and their value. Health Services Financial Essay
b. Has this role increased or decreased in importance in recent years?
This role has increased in importance over the recent years, because of health care reform changes and economic crises.
1.4.
a. Briefly describe the following health services settings:
* Hospitals- provides general, acute care, diagnostics, surgery, usually for patients who need several hours of care. Recent operations allow shorter lengths of stay, which results in excess capacity. Hospitals can vary in size from 25 beds to 1000’s of beds. The constant nursing to patients make them labor intensive. * Ambulatory care-outpatient service, not requiring overnight stay; walk-in clinics, surgery clinics, provide services at lower costs than hospitals such as medical practices or emergency care. * Home health care- brings many of the same services provided in ambulatory care settings into the patients’ homes. This can help with day-to-day activities. * Long-term care- this is provided for individuals who are unable to perform day-to-day activities (i.e bathing, walking, eating) due to the lack of functional ability. * Integrated delivery systems- has all the health settings mentioned above under one entity. Health Services Financial Essay
HEALTH CARE REIMBURSEMENT PROGRAMMES.
Health care professionals play an important role in society. As such, there is a need for these professionals to understand the various health care reimbursement systems and methodologies to discharge their duties. There exist various financial systems adopted to cater for the financing of healthcare with each plan posing its risks as well as the incentives these systems exists solely because most patients have an insurance plan. Health Services Financial Essay
Fees for service reimbursement program mean that a fee is paid dully to the healthcare provider for each specific service rendered. This system is widely used as it guarantees total independence of which services to sort from whichever healthcare provider. So the more service a provider renders the more reimbursement they get.
Managed care reimbursement methods are whereby the third party payers such as the patient or the insurance company manage the healthcare and the outcome without any input from the healthcare professional. This implies that the third party has set some measures to regulate the cost of health care without compromising the quality of care. The sole purpose of this system is to provide affordable but quality care. The forms of managed care include PPO (preferred provider organization), HMO (heath maintenance organization), and EPO (exclusive provider organization). Health Services Financial Essay
The cost-based reimbursement method is whereby health care providers are paid based on the cost that they incur during the provision of the service. The major incentive in this program is the fact that the health care professional can recover what they incurred in providing the service. However, the risk is most patients may fail to cover these costs as they are too expensive.
A charge based payment system is driven by the fees that the provider charges the patient. These fees are based on every single procedure and assessment carried out as pertains to that illness. An example of charge includes: in Nairobi Hospital: caesarian section is $80, herniography is $20, antenatal care and H.I.V testing is free. Health Services Financial Essay
Capitation and global payment are examples that fall into a health care reimbursement system called episode of care system. In this payment method, healthcare providers are paid a lump sum amount that covers all services rendered as per the disease. This effectively does away with individual fees and charges. Capitation is a form of healthcare payment method in which the third party payer (the insurance) reimburses a fixed sum to the provider after a fixed period. This is typical of health maintenance organizations. Capitation wo
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