Financial Reimbursement Strategies
Various reimbursement strategies aim to compensate physicians for their work and decrease patient costs. There are at least four parties involved in the process: a patient, a service provider, an insurer who provide money for the provider, and a government that regulates the process (Picecchi et al., 2020). Various reimbursement models are discussed, as they make healthcare more cost-efficient. Modern reinforcement models are based on disease prevention and well-being maintenance rather than on episodes of care. An example of a model based on an episode of care is a pay-for-performance model, with the set of predefined treatment outcomes and paying for the desired ones. In that way, a physician is reimbursed after successfully finishing the episode of care. In my opinion, however, this model has drawbacks: a comprehensive set of predefined outcomes cannot be formulated, as each case is unique, and there are many risks. There are almost no direct mentions of reimbursement models based on health promotion, but in Picecchi’s article, the performance-based shared risk model is close to it. It means that the physician is reimbursed for maintaining the well-being of a patient and taking responsibility for their health.
The Triple Aim framework is a tool to address three dimensions of healthcare: costs, population health, and patient experience, introduced by the Institute for Healthcare Improvement (IHI). IHI wrote a guide to it, emphasizing the need to find detailed healthcare data that is changing over time. To implement the framework, one first needs to formulate uniform and quantitative metrics for every three aims. Cost monitoring is the work of accountants, population health should be measured by sociological research, and patient experience may be evaluated by surveys and non-intrusive observing of their behavior. The article of Obucina and colleagues discusses the implementation cases of the framework, which I find helpful for analyzing roles and functions necessary for the implementation (Obucina et al., 2018). One needs to select an optimal model for physician reimbursement to reach cost optimization. Then, patients may obtain accessible medical aid, and the physician will still be paid well for it. To maintain patient satisfaction, they should be treated with respect, consider their preferences, and survey after the treatment for feedback. Lastly, to improve population health, as many health determinants as possible should be learned and analyzed. Each of them should be addressed separately, for example, low immunization rate or high smoking rate: by planning specific actions to promote healthy lifestyle and free immunization.
Patient Experience as a Strategic Priority
Patient experience is an essential element of healthcare, highlighted in the Triple Aim framework as one of the three healthcare aims. In her article, Elysia Larson with colleagues describes possible metrics to measure patient experience and satisfaction from the treatment (Larson et al., 2019). I selected this article because it aims to develop quantitative person-centered metrics based on different variables: the patient’s background, needs, expectations, and values. Experience’s elements are communication efficiency, emotional support, and the level of respect: three categories of the patient’s feelings. I think it is an excellent base to analyze patient well-being and how the healthcare facility personnel may maintain it. I have learned that patient experience may be quite simple and calculated when appropriate variables are chosen. In this way, one may measure patients’ needs, cultural background elements, and mutual respect between them and the personnel. As a leader, I would encourage using these metrics to allow clearer evaluation of a patient’s state and experience from the healthcare facility.
The Physical Environment and Patient Experience
The physical environment is important for healthcare facilities, as patients are often hospitalized and spend a lot of time there, and the surroundings have a direct influence on their well-being. Facilities often have a similar structure: a long corridor with artificial light, nursing stations on each side, and several single- or multi-bed rooms on both sides of the corridor (Anåker et al., 2018). In the stroke unit described in the article, colors are mostly white and gray, and the clinic has a patient lounge and helipad on the roof. According to the survey, patients were unhappy with a lack of colors, loneliness, and the space to communicate together. However, they were happy with the ability to be alone, see via the window of their rooms, and reflect. Colorful walls and furniture, more room for talking together and communal dinners, and the possibility to do some art, such as painting, are planned changes for the facility. I agree that this will be helpful, as patients will improve their satisfaction by being less lonely and more inspired. Considering other healthcare facilities, I think each organization should conduct surveys first, and only they decide what to change.
Supplier-induced demand is a supplier’s persuasion that the customer should pay for their good: sometimes, the value of this good is exaggerated or even fabricated. It exists in healthcare, usually in the form of overdiagnoses and overtreatments: physicians persuade patients that they have various diseases and propose treatments for them, usually to earn more money (Hensher et al., 2017). Along with the desire to earn more from their patients, the reason is that physicians try to avoid uncertainty and make definitive diagnoses. In addition, such a situation results from overconsumption, when people tend to consume more and more medical services, fearing to be ill (Hensher et al., 2017). Supplier-induced demand is unethical and ineffective: it leads to excessive spending and possible dangers for patients, and a physician who induces excessive treatment is responsible for those problems. Insurance companies may help patients to avoid supplier-induced demand by covering risks connected with all diagnoses or treatments that may harm the patient. Lastly, the patient will more likely be protected from overconsumption by increasing their health literacy and knowledge about various medical diagnoses: thus, they will not be confused by demand induced by physicians.
Cost shifting occurs when some group of people pays more than another for the same service. The scale and prevalence of cost shifting in healthcare are debatable. However, according to the data, each $1.00 increase in Medicare’s fee in the field of surgery increases private fees by $1.16 (Clemens & Gottlieb, 2017). It means that when a government increases its healthcare spending, prices of private health insurance grow as well: thus, people who use private healthcare providers will be required to pay more. If the United States moved to a national health insurance plan, however, I think it would become even more prevailing, as the government’s money is formed from the people’s taxes. Thus, to create such an insurance plan, special taxes for it should be applied, and everyone should pay more for the ability to pay less for healthcare. I think that cost-shifting in medicine is appropriate, as it allows to help those people who are in trouble and require medical help, and I feel comfortable with the current model.
Anåker, A., von Koch, L., Heylighen, A., & Elf, M. (2018). “It’s lonely”: Patients’ experiences of the physical environment at a newly built stroke unit. HERD: Health Environments Research & Design Journal, 12(3), 141–152.
Clemens, J., & Gottlieb, J. D. (2017). In the shadow of a giant: Medicare’s influence on private physician payments. Journal of Political Economy, 125(1), 1–39.
Hensher, M., Tisdell, J., & Zimitat, C. (2017). “Too much medicine”: Insights and explanations from economic theory and research. Social Science & Medicine, 176, 77–84.
Larson, E., Sharma, J., Bohren, M. A., & Tunçalp, Ö. (2019). When the patient is the expert: Measuring patient experience and satisfaction with care. Bulletin of the World Health Organization, 97(8), 563–569.
Obucina, M., Harris, N., Fitzgerald, J. A., Chai, A., Radford, K., Ross, A., Carr, L., & Vecchio, N. (2018). The application of triple aim framework in the context of primary healthcare: A systematic literature review. Health Policy, 122(8), 900–907.
Picecchi, D., Bertram, K., Brcher, D., & Bauer, M. (2020). Towards novel reimbursement models for expensive advanced therapy medicinal products (ATMPs). Swiss Medical Weekly.