New Payment Methods in Health System and Quality of Care :: Argumentative Persuasive Government Papers

New Payment Methods in Health System and Quality of Care Introduction For the purpose of this article I will make some generalizations and I will define some words to facilitate the reading and understanding. These definitions are not intended to be exhaustive and must be understood only in the context of this article. In America health has had its own evolution, passing from the personal relationship between a physician and a patient to a complex system with many actors. As technology developed, on one hand, the costs increased and patients or their families weren’t able to pay by themselves. As a consequence, new payers, such as Government and employers appeared in the health industry. But once again, one treatment could be so expensive, that the resources of a small employer wouldn’t be enough to cover it, and his business could get in financial risk. Consequently, the typical insurers began to play their own role: The affiliation of large number of people paying a fixed premium per person and period of time, regardless the cost of the treatments needed by each of their affiliates. A patient could choose the provider, pay the treatment by itself, and later the insurer reimbursed him the cost of it. If the number of affiliates is high, the probability of a high cost treatment becom es more standard or predictable and the excess of money the insurer earns with people who pay and don’t get sick can absorb its costs. This is known as the â€Å"big numbers† law. On the other hand, physicians became more specialized, and needed more technology not affordable on an individual basis. Now we have physicians, nurses, hospices, clinics, hospitals and complex systems joining all them in order to provide the care needed by patients. For the purpose of this article I’ll call all of them providers. Cost continued increasing, the relations between these actors continued changing, and the characteristics of each of them too. In the side of the insurers, in the 1980’s, the Health Maintenance Organizations or HMO’s appeared. Despite their differences, in the beginning most had similar characteristics: they were non-profit organizations providing care to their affiliates with a selected net of providers and special rules and procedures that patients and providers should follow in order to accept the service and pay the provider. Recently, in the search to achieve the key objective of cost containment, the