Pricing Health Services for Purchasers : A Review of Methods and Experiences

This paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment;...

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Main Authors:	Waters, Hugh, Hussey, Peter
Format:	Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2013
Subjects:	ACCOUNTABILITY ACCOUNTING ACCOUNTING SYSTEMS BANK PUBLICATIONS BUDGETING CAPITATION CHILD SURVIVAL CURRENCY DENTAL CARE DIABETES DIARRHEAL DISEASES DISCHARGE DRAFTS EMPLOYERS EXPENDITURE EXPENDITURES EXTERNALITIES EXTERNALITY FEE FOR SERVICE FINANCIAL DATA FINANCIAL RESOURCES FINANCIAL RISK GENERAL PRACTITIONERS GLOBAL BUDGETS HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CENTERS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH INSURANCE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSIONS HOSPITAL CARE HOSPITAL DISCHARGE HOSPITALIZATION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMMUNIZATION IMMUNIZATIONS INCOME INFLATION INFORMATION NEEDS INFORMATION SYSTEMS INPATIENT CARE INSURANCE INSURERS INTERVENTION LAWS LESSONS LEARNED LIABILITY MEDICAL EQUIPMENT MORBIDITY NATIONAL HEALTH INSURANCE NURSING NUTRITION OFFICE SPACE ORGANIZATIONAL STRUCTURE OUTPATIENT CARE OUTPATIENT SERVICES PATIENT CHOICE PATIENTS PAYMENT SYSTEMS PHYSICIANS PRIMARY CARE PRIVATE SECTOR PROMOTING HEALTH PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC HOSPITALS PUBLIC SECTOR REFORMS REINSURANCE SERVICE DELIVERY TRUSTS UNIVERSAL HEALTH INSURANCE COVERAGE VACCINATION WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2004/09/5635196/pricing-health-services-purchasers-review-methods-experiences http://hdl.handle.net/10986/13764

id	okr-10986-13764
recordtype	oai_dc
spelling	okr-10986-137642021-04-23T14:03:09Z Pricing Health Services for Purchasers : A Review of Methods and Experiences Waters, Hugh Hussey, Peter ACCOUNTABILITY ACCOUNTING ACCOUNTING SYSTEMS BANK PUBLICATIONS BUDGETING CAPITATION CHILD SURVIVAL CURRENCY DENTAL CARE DIABETES DIARRHEAL DISEASES DISCHARGE DRAFTS EMPLOYERS EXPENDITURE EXPENDITURES EXTERNALITIES EXTERNALITY FEE FOR SERVICE FINANCIAL DATA FINANCIAL RESOURCES FINANCIAL RISK GENERAL PRACTITIONERS GLOBAL BUDGETS HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CENTERS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH INSURANCE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSIONS HOSPITAL CARE HOSPITAL DISCHARGE HOSPITALIZATION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMMUNIZATION IMMUNIZATIONS INCOME INFLATION INFORMATION NEEDS INFORMATION SYSTEMS INPATIENT CARE INSURANCE INSURERS INTERVENTION LAWS LESSONS LEARNED LIABILITY MEDICAL EQUIPMENT MORBIDITY NATIONAL HEALTH INSURANCE NURSING NUTRITION OFFICE SPACE ORGANIZATIONAL STRUCTURE OUTPATIENT CARE OUTPATIENT SERVICES PATIENT CHOICE PATIENTS PAYMENT SYSTEMS PHYSICIANS PRIMARY CARE PRIVATE SECTOR PROMOTING HEALTH PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC HOSPITALS PUBLIC SECTOR REFORMS REINSURANCE SERVICE DELIVERY TRUSTS UNIVERSAL HEALTH INSURANCE COVERAGE VACCINATION WORKERS This paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment; the availability of information on costs, volumes, outcomes, and patient and provider characteristics; methods used to calculate providers' costs; and characteristics of purchasers and providers-including the regulatory environment, provider autonomy, negotiating power, and the degree of competition. The paper focuses on methods for setting levels of payment under different provider payment mechanisms. Line item and global budgets remain the most common reimbursement methods in developing countries. However, many of these countries are implementing mixed payment systems that have greater information demands. The principal payment types used in high-income countries-capitation, payments per case or diagnosis, and fee-for-service-are reviewed here, and implications for low- and middle-income countries discussed. To minimize incentives for under- or over-utilization, prices that purchasers pay for health care services should be related to the unit costs of services. However, establishing the true unit cost of health services is complicated, and detailed data needed to correctly allocate indirect costs to the units of services are not generally available in developing countries. The organizational characteristics of health care providers and their relationships with purchasers strongly influence the way prices for health services are determined. Pertinent characteristics include provider autonomy, provider negotiating power, and the degree of competition. The principal constraint on the development of provider payments systems in developing countries is the limited availability of information on costs, volumes, and patient characteristics. However, international experiences reveal a variety of options for setting prices for health care purchasers in developing countries that are reforming their payment systems. 2013-06-05T14:39:52Z 2013-06-05T14:39:52Z 2004-09 http://documents.worldbank.org/curated/en/2004/09/5635196/pricing-health-services-purchasers-review-methods-experiences http://hdl.handle.net/10986/13764 English en_US Health, Nutrition and Population (HNP) discussion paper; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Working Paper Publications & Research
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	ACCOUNTABILITY ACCOUNTING ACCOUNTING SYSTEMS BANK PUBLICATIONS BUDGETING CAPITATION CHILD SURVIVAL CURRENCY DENTAL CARE DIABETES DIARRHEAL DISEASES DISCHARGE DRAFTS EMPLOYERS EXPENDITURE EXPENDITURES EXTERNALITIES EXTERNALITY FEE FOR SERVICE FINANCIAL DATA FINANCIAL RESOURCES FINANCIAL RISK GENERAL PRACTITIONERS GLOBAL BUDGETS HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CENTERS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH INSURANCE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSIONS HOSPITAL CARE HOSPITAL DISCHARGE HOSPITALIZATION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMMUNIZATION IMMUNIZATIONS INCOME INFLATION INFORMATION NEEDS INFORMATION SYSTEMS INPATIENT CARE INSURANCE INSURERS INTERVENTION LAWS LESSONS LEARNED LIABILITY MEDICAL EQUIPMENT MORBIDITY NATIONAL HEALTH INSURANCE NURSING NUTRITION OFFICE SPACE ORGANIZATIONAL STRUCTURE OUTPATIENT CARE OUTPATIENT SERVICES PATIENT CHOICE PATIENTS PAYMENT SYSTEMS PHYSICIANS PRIMARY CARE PRIVATE SECTOR PROMOTING HEALTH PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC HOSPITALS PUBLIC SECTOR REFORMS REINSURANCE SERVICE DELIVERY TRUSTS UNIVERSAL HEALTH INSURANCE COVERAGE VACCINATION WORKERS
spellingShingle	ACCOUNTABILITY ACCOUNTING ACCOUNTING SYSTEMS BANK PUBLICATIONS BUDGETING CAPITATION CHILD SURVIVAL CURRENCY DENTAL CARE DIABETES DIARRHEAL DISEASES DISCHARGE DRAFTS EMPLOYERS EXPENDITURE EXPENDITURES EXTERNALITIES EXTERNALITY FEE FOR SERVICE FINANCIAL DATA FINANCIAL RESOURCES FINANCIAL RISK GENERAL PRACTITIONERS GLOBAL BUDGETS HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CENTERS HEALTH EXPENDITURES HEALTH FACILITIES HEALTH INSURANCE HEALTH OUTCOMES HEALTH POLICY HEALTH SECTOR HEALTH SERVICES HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSIONS HOSPITAL CARE HOSPITAL DISCHARGE HOSPITALIZATION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES IMMUNIZATION IMMUNIZATIONS INCOME INFLATION INFORMATION NEEDS INFORMATION SYSTEMS INPATIENT CARE INSURANCE INSURERS INTERVENTION LAWS LESSONS LEARNED LIABILITY MEDICAL EQUIPMENT MORBIDITY NATIONAL HEALTH INSURANCE NURSING NUTRITION OFFICE SPACE ORGANIZATIONAL STRUCTURE OUTPATIENT CARE OUTPATIENT SERVICES PATIENT CHOICE PATIENTS PAYMENT SYSTEMS PHYSICIANS PRIMARY CARE PRIVATE SECTOR PROMOTING HEALTH PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC HOSPITALS PUBLIC SECTOR REFORMS REINSURANCE SERVICE DELIVERY TRUSTS UNIVERSAL HEALTH INSURANCE COVERAGE VACCINATION WORKERS Waters, Hugh Hussey, Peter Pricing Health Services for Purchasers : A Review of Methods and Experiences
relation	Health, Nutrition and Population (HNP) discussion paper;
description	This paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment; the availability of information on costs, volumes, outcomes, and patient and provider characteristics; methods used to calculate providers' costs; and characteristics of purchasers and providers-including the regulatory environment, provider autonomy, negotiating power, and the degree of competition. The paper focuses on methods for setting levels of payment under different provider payment mechanisms. Line item and global budgets remain the most common reimbursement methods in developing countries. However, many of these countries are implementing mixed payment systems that have greater information demands. The principal payment types used in high-income countries-capitation, payments per case or diagnosis, and fee-for-service-are reviewed here, and implications for low- and middle-income countries discussed. To minimize incentives for under- or over-utilization, prices that purchasers pay for health care services should be related to the unit costs of services. However, establishing the true unit cost of health services is complicated, and detailed data needed to correctly allocate indirect costs to the units of services are not generally available in developing countries. The organizational characteristics of health care providers and their relationships with purchasers strongly influence the way prices for health services are determined. Pertinent characteristics include provider autonomy, provider negotiating power, and the degree of competition. The principal constraint on the development of provider payments systems in developing countries is the limited availability of information on costs, volumes, and patient characteristics. However, international experiences reveal a variety of options for setting prices for health care purchasers in developing countries that are reforming their payment systems.
format	Publications & Research :: Working Paper
author	Waters, Hugh Hussey, Peter
author_facet	Waters, Hugh Hussey, Peter
author_sort	Waters, Hugh
title	Pricing Health Services for Purchasers : A Review of Methods and Experiences
title_short	Pricing Health Services for Purchasers : A Review of Methods and Experiences
title_full	Pricing Health Services for Purchasers : A Review of Methods and Experiences
title_fullStr	Pricing Health Services for Purchasers : A Review of Methods and Experiences
title_full_unstemmed	Pricing Health Services for Purchasers : A Review of Methods and Experiences
title_sort	pricing health services for purchasers : a review of methods and experiences
publisher	World Bank, Washington, DC
publishDate	2013
url	http://documents.worldbank.org/curated/en/2004/09/5635196/pricing-health-services-purchasers-review-methods-experiences http://hdl.handle.net/10986/13764
_version_	1764424242860916736

Pricing Health Services for Purchasers : A Review of Methods and Experiences

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