Discussion: Reimbursement for Services

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There are a number of different options for determining how to charge for services provided at a health care organization. In the case-based service approach, one set fee covers an entire procedure. For example, if you needed knee replacement surgery, the fee would include preliminary visits, the surgery, and follow-up visits. However, in a fee-for-service approach, every different step would incur a separate cost. The reimbursement approach taken has significant ramifications for how care is provided.

To prepare:

  • Review the information focusing on reimbursement for services. How are these approaches the same or different in your own setting?
  • Identify an example of a fee-for-service approach and a case-based service approach.
  • Reflect on the benefits and limitations of each approach.
  • Review the article, “Which Health care Payment System is Best?” and examine the additional reimbursement strategies described. Consider the viability of these alternative strategies within your own organization (or one with which you are familiar).
  • Examine how the nurse-to-patient ratio is affected by the payment approach used and consider how this can impact quality of service.

Post an example that illustrates the difference between a fee-for-service payment and a case-based service payment. Explain the benefits and limitations of each approach. Assess the viability of utilizing, within your own organization (or one with which you are familiar), the two alternative reimbursement strategies described in “Which Health care Payment System is Best?” Analyze how the nurse-to-patient ratio is affected by the payment approach selected and how these impact quality of service.

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