Healthcare Management: News. Views. Education

4 . 2023

Analyzing payment methods for medical care: in search of the best

Abstract

The relevance of the search for new methods of payment for medical care is due to significant shortcomings of the approaches used today - both methods of payment for medical services and methods of financing the activities of medical organizations. The authors propose a new combined method of payment for medical care based on the two-component tariff technology: prospective (prepaid) coverage of fixed costs of medical organizations by line-item budget and retrospective reimbursement of actually incurred clinically justified variable costs, including additional payments for efficiency/quality P4P (Pay-for-Performance). In addition, for public health care organizations, the authors consider it advisable to abandon the idea of market relations between providers and payer in favor of a non-market integrated model of administrative subordination and economic accountability of the provider to the payer (The Payvider model).

Keywords:payment for medical services; financing the activities of medical organizations; two-part tariff; separate coverage of fixed and variable costs; integrative model of payer-provider relations

Funding. The article was prepared based on the results of research carried out at the expense of budgetary funds under the state assignment of the Financial University under the Government of the Russian Federation.

Conflict of interest. The authors declare that there is no conflict of interest.

Contribution. Concept and design of the study, writing the text; statistical processing of data, editing – Ragozin A.V.; concept and design of the study, writing the text, collection and processing of material, compilation of the list of references, editing – Kudinov A.A.; collection of statistical data, tabular and graphical presentation of results, analysis of the obtained results – Chirkova T.A.; collection and processing of statistical data, compilation of the list of references – Sivodedov A.A.

For citation: Ragozin A.V., Kudinov A.A., Chirkova T.A., Sivodedov A.A. Analyzing payment methods for medical care: in search of the best. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2023; 9 (4): 77–86. DOI: https://doi.org/10.33029/2411-8621-2023-9-4-77-86 (in Russian)

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