HLT 205 Week 4 Topic 4 Discussion 2

Define retrospective and prospective reimbursement methods. In what way did retrospective reimbursement contain perverse financial incentives? Cite reference to support your response.

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Retrospective and prospective reimbursement methods

Introduction

Retrospective and prospective reimbursement methods are two different ways to pay for healthcare services. They both have their benefits and drawbacks, so you’ll need to assess whether one works better than the other for your organization before deciding which one is best for you.

Retrospective reimbursement

Retrospective reimbursement is the traditional method of reimbursement. It’s based on a provider’s past services and not their future intentions or capabilities. In this model, providers are reimbursed for the services they have provided to patients.

The biggest problem with retrospective systems is that it doesn’t account for all aspects of health care delivery: it fails to take into account things like patient perceptions or other factors that can affect outcomes (see below).

Prospective reimbursement (Capitation)

A method of reimbursement that pays a provider a fixed amount per member per month, capitation is used to cover the costs of medical services provided to a group of members. Capitated plans can be for both inpatient and outpatient services.

Global payments

Global payments are a type of prospective reimbursement method that is used in some countries, but not all. The global payment system is based on a fee schedule and can be used for any procedure or service that has been approved by the government. Generally speaking, it’s more common to see global payments made at hospitals where they’re often paid by insurers rather than patients directly.

How do you know if your hospital uses global payments? If you visit a hospital that has implemented this type of payment model, you’ll likely notice something different about its billing process: You may be asked to fill out an online form with your insurance information before receiving any bills from them—and those forms will probably ask for information about how much money you’ve already spent at other facilities (such as emergency rooms).

Global payments aren’t always ideal because they don’t account for inflation over time; however, they do make up part of many health care systems around the world today so we’ll cover them here anyway!

Takeaway:

Retrospective reimbursement is a type of payment that reimburses for services that were already provided. Prospective reimbursement is a type of payment that reimburses for services that will be provided.

Conclusion

Retrospective reimbursement is the most common method used by hospitals today. It involves setting a price for each service at the time of delivery and then reimbursing that amount to the provider. Prospective reimbursement, also known as capitation, is often seen as an alternative to retro in which providers receive a fixed payment for each patient over a specified period of time. Global payments are another approach that allows hospitals to pay per procedure or service without considering any cost factors such as location or facility size (for example, rural versus urban).