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Designing and implementing health care provider payment systems [electronic resource] : how-to manuals /
edited by John C. Langenbrunner, Cheryl Cashin, and Sheila O'Dougherty.
imprint
Washington, D.C. : World Bank, c2009.
description
xxii, 321 p. : ill. ; 26 cm.
ISBN
0821378155 (alk. paper), 9780821378151 (alk. paper)
format(s)
Book
More Details
added author
imprint
Washington, D.C. : World Bank, c2009.
isbn
0821378155 (alk. paper)
9780821378151 (alk. paper)
restrictions
Licensed for access by U. of T. users.
contents note
Overview : what, how, and who : an introduction to provider payment systems -- Primary health care per capita payment systems -- Case-based hospital payment systems -- Hospital global budgeting -- A primer on contracting -- Health management information systems : linking purchasers and providers.
catalogue key
9824028
 
Includes bibliographical references and index.
A Look Inside
Reviews
This item was reviewed in:
SciTech Book News, June 2010
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Summaries
Main Description
A set of manuals to help low- and middle-income countries design and implement performance-based health care provider payment systems.
Main Description
Strategic purchasing of health services involves a continuous search for the best ways to maximise health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, The passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns. Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need. The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. it also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, As well as the necessary infrastructure for strategic purchasing.
Main Description
Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.
Main Description
Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.
Table of Contents
Prefacep. xi
Acknowledgmentsp. xiii
List of Contributorsp. xv
Abbreviationsp. xviii
Glossaryp. xix
Overview: What, How, and Who: An Introduction to Provider Payment Systemsp. 1
Aims and Readership of This Volumep. 1
Provider Payment Systems and Methods: An Overviewp. 3
Main Characteristics of Provider Payment Methodsp. 12
The Way Forwardp. 19
Organization of This Volumep. 20
Notesp. 24
Referencesp. 24
Primary Health Care Per Capita Payment Systemsp. 27
Overview of PHC Provider Payment Systemsp. 27
Defining the Health Policy Contextp. 27
Methodology for Developing a Per Capita PHC Payment Systemp. 33
Defining a PHC Package of Servicesp. 35
Setting the PHC Pool and Calculating the Base Per Capita Ratep. 37
Calculating Risk Adjustment Coefficientsp. 40
Developing an Enrollment Databasep. 52
Calculating Each Provider's Per Capita Budgetp. 61
Designing a Finance and Management Systemp. 62
Designing a Monitoring and Quality Assurance Systemp. 75
Expanding the Base Per Capita Rate and Package of Servicesp. 87
Implementation Issuesp. 89
The Link between PHC Per Capita Payment and the Health System Axes: Experience from Four Central Asian Republicsp. 97
Notep. 120
Referencesp. 120
Case-Based Hospital Payment Systemsp. 125
Overview of Case-Based Hospital Payment Systemsp. 125
Defining Case Grouping Criteriap. 134
Completing Cost-Accounting Analysisp. 148
Calculating Case Group Weightsp. 159
Calculating the Base Ratep. 161
Designing an Information and Billing Systemp. 170
Refining Case Groupingp. 190
Implementation Issuesp. 192
Case Studies from Kazakhstan and the Kyrgyz Republicp. 196
Notesp. 211
Referencesp. 212
Hospital Global Budgetingp. 215
Overviewp. 215
Setting the Hospital Global Budgetp. 218
Performance Incentivesp. 229
Nonbudget Fundingp. 232
An Overview of Costingp. 241
Managing the New Global Budgetp. 248
Annual Adjustmentsp. 248
Referencesp. 253
A Primer on Contractingp. 255
Introductionp. 255
Which Contract?p. 256
Volumesp. 257
Which Contract When?p. 259
Consortiap. 261
Duration of Contractp. 262
Notep. 262
Health Management Information Systems: Linking Purchasers and Providersp. 263
Backgroundp. 263
Implementing Appropriate Provider Systemsp. 268
Implementing Appropriate Purchaser Systemsp. 283
Implementing an Appropriate Link between Purchaser and Provider Systemsp. 291
Concluding Remarksp. 297
Annex 5.1: A Primer on Health Management Information Systemsp. 300
Notesp. 304
Referencesp. 304
Indexp. 307
Boxes
Incentivesp. 2
Balance of Decision Rights in Costa Ricap. 33
Top-Down Estimation of the PHC Pool as a Health Policy Toolp. 39
Open Enrollment in Zhezkazgan, Kazakhstanp. 56
Budget Overruns and the Unadjusted Base Per Capita Ratep. 63
Budget Neutrality and a Per Capita Rate Adjusted Using Age/Sex Adjustorsp. 64
Budget Neutrality and a Per Capita Rate Adjusted Using Both Geographic and Age/Sex Adjustorsp. 65
Introductory Training for Finance Managers in Uzbekistanp. 68
Basic Health Management for General Practitioners in Uzbekistanp. 70
Issues and Solutions in a Fully Automated System in the Kyrgyz Republicp. 74
Benchmarking, Not Targets, in Karaganda, Kazakhstanp. 84
PHC Monitoring System in Karaganda, Kazakhstanp. 86
Provider Satisfactionp. 93
Results of Increased Provider Autonomy in Karaganda, Kazakhstanp. 96
Karaganda Achievementsp. 110
Possible Adjustment Coefficients to the Payment Per Case Formulap. 132
Initial Case Groups and Weights in the Kyrgyz Republicp. 135
Major Diagnostic Categories in the Australian Refined Diagnosis-Related Groups Classificationp. 141
Serial Example: Calculating Average Cost per Casep. 144
Table of Contents provided by Ingram. All Rights Reserved.

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