Assigment 515 (87)

Payments for Health Services Providers (110 points)

Insurance is based on pooling of losses, payment for random losses, risk transfer, and indemnification. As a result, insurers use several different approaches to mitigate their risk and set premium rates, including:

the fee-for-service method

the cost-plus approach

population health – capitation

• For your assignment, evaluate two global payment systems within healthcare and address each of the following items:
• Define the structure of the payment systems.
• Identify risk to loss of revenue in each system.

Describe advantages and disadvantages of each system.

Identify how pay for performance can be added to each payment system.