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ECO: Capitation - Assignment Example
Pages 3 (753 words)
Capitation Capitation can be defined as monthly repayments of a permanent value of health cover evidently stated services for a given populace on a per-member per-month basis. The health care provider who accepts the use of capitation takes the financial risk of ensuring that individuals are provided with efficient and defined services…
In distinction with a DFS, capitation reimbursement gives a chance to the Managed Care Organization (MCO) to shift almost all the risks and cost of health care to the provider. In most cases, the provider is not allowed to request the MCO or any individual for extra reimbursement even if the amount used is far beyond the projected amount (Niles, 2010). Diagnosis Related Groups (DRGs) In the Diagnosis Related Groups health care program, DRGs pays health care providers are paid on prospective terms while factoring in diagnoses and procedures. These are determined and classified to give them codes referred to as diagnosis related groups (DRGs). The allocated codes show a monetary value to show what the services rendered to the patient should cost. The government pays health care providers a flat charge for each DRG. This charge doe not depend on the number of days an individual spend in the health care facility or the actual cost of care. The health care provider is obliged to administer its costs within the DRG charge (Niles, 2010). Future of Health Care Reimbursement One area where changes are taking place is in the business of health insurance and health care delivery. Increasing health care costs have become a major national issue. ...
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