Discussion: Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement.
NUR 621 Topic 5 DQ 1 Retrospective Reimbursement Assessment Description
Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement. How has this affected value-based healthcare?
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NUR 621 Topic 5 DQ 1 Retrospective Reimbursement Sample
The payment for healthcare has shifted from retrospective reimbursement to prospective payment systems (PPS). Under the retroactive method, providers were reimbursed actual expenditures costs regardless of the level of inefficiency, thus contributing to an increase in wastage and overall healthcare costs (Pott et al., 2023). This system did not foster cost containment or efficient treatment delivery since providers were compensated for all charges.
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NUR 621 Topic 5 DQ 1 Retrospective Reimbursement The introduction of PPS, which pays providers a fixed amount for each diagnostic category, has brought new dynamics. According to Pott et al. (2023), this change effectively manages resources and costs since the providers have to control treatment within the limited payment system. In the current PPS model, providers are advised to cut out extraneous services and conduct care processes best aligned with payment constraints (Schumacher, 2022). NUR 621 Topic 5 DQ 1 Retrospective Reimbursement Nevertheless, since providers are responsible for covering additional expenses, this system also places a financial risk on them.
The shift to PPS has driven even more the change towards value-based healthcare. As Schumacher (2022) elaborates, linking reimbursement to the quality and efficiency of treatment helps the PPS model improve patient outcomes and cost-effective treatment. To maximize reimbursement under PPS, providers increasingly concentrate on improving care coordination, lowering hospital readmissions, and raising the general quality of treatment (Schumacher, 2022). NUR 621 Topic 5 DQ 1 Retrospective Reimbursement Preventive care, chronic disease management, and other approaches that enhance patient outcomes while underlining cost control have thus gained more importance in the PPS model.
NUR 621 Topic 5 DQ 1 Retrospective Reimbursement References
Pott, C., Stargardt, T., & Frey, S. (2023). Does prospective payment influence quality of care? A systematic review of the literature. Social Science & Medicine, 323(323), 115812. https://doi.org/10.1016/j.socscimed.2023.115812
Schumacher, C. (2022). Effectiveness of hospital transfer payments under a prospective payment system: An analysis of a policy change in New Zealand. Health Economics, 31(7), 1339–1346. https://doi.org/10.1002/hec.4508 NUR 621 Topic 5 DQ 1 Retrospective Reimbursement
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