Payment Systems in the Public
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Modern health care system exploits information technologies rather substantially these days. Computers are used everywhere, from registration services to health monitoring and controlling various micro devices implanted into the body. However, physicians do not use all the advantages of IT in their work in full. More to say, physicians avoid using widely available and inexpensive IT tools in their practice like e-mails and others. The problem is in the lack of desire to use IT stuff within medical practices (HRSA, 2012).
This issue is rather concerning due to the following reason – IT is everywhere these days, so the gap between areas that do not implement IT in full and those, where IT plays a significant role and facilitates operations will only increase. Physicians do not use information technologies in their work because either they do not want to learn how to use them properly or they do not see the need to do something that is not extra paid. The problem is hidden in the computer-based system as well (HRSA, 2012). They are either too complicated to master for a considerable amount of time, or overwhelmed with functions that are not used. Therefore, physicians do not want to spend extra time to learn the capabilities, master decision support systems, etc. (Miller, 2007).
On the other hand, the implementation of keeping health records in electronic form, electronic prescription practice, and computer-based decision support systems are the future of the health-care industry. Therefore there is an obvious need in creating such electronic systems that would be easy-to-use and if not free but inexpensive at least. It is the only possible way to promote the use of IT within medical practices these days. Otherwise, the issues will grow and become deeper from year to year. The thing is that health-care industry is rather conservative so the approach should be careful and considering all the peculiarities in order to change something.
Current payment systems in various areas are not as efficient as they should be. Such state of things raises the cost of services in these areas. This issue can be addressed to health care system as well. More and more providers of health care services are affected by the inefficient health care PS (payment systems) (Miller, 2007). HCPS (health care payment systems) may not reward efforts aimed to improve the quality of health care and even penalize health care specialists financially. It leads to the inevitable dissatisfaction of patients and the overall decline of health care system in terms of providing quality and efficient services (such as lower-cost operations, care of higher quality, etc.), instead of providing inefficient treatments that cost more (various invasive procedures, extensive use of technological advances, etc.).
Current PS is based on a fee-for-service (sometimes, on a fee-for-performance) basis, therefore, it usually cannot pay appropriately for various items of preventive care. The fee-for-service PS also encourages physicians to enter specialty care, when primary care can be applied. Preventive care is not interesting for the payers since the benefits can occur in distant future. In addition, pay-for-service PS presupposes limited time that might not be enough to perform appropriate diagnostic procedures and create a particular care plan suitable for both the patient and the physician. However, health care providers are often encouraged to order various tests that can be unnecessary, since there is no penalty for extra tests (Miller, 2007).
The use of the electronic prescribing system is the step in the right direction for health-care system. Such system mitigates the possibility of prescribing errors due to the inability to simply “decode” doctor’s handwriting and thus, decreases the number of deaths caused by a human error. It is possible to keep the database regarding prescribed medications for each patient and remind automatically regarding the need in refill (Miller, 2007). It reduces the number of unnecessary calls from pharmacies asking for clarification (about 150 million calls is a substantial number of minutes to be used more efficiently) (Miller, 2007). Finally, ePrescribing provides the opportunity to keep prescriptions in one place, available online etc. (HRSA, 2012).
Such approach would benefit for HCPS. Overall changes in health care system can decrease the amount of indirect expenses. Health care system should become more flexible in terms of payments for the services and related activities in order to become more efficient. Additionally, more money should be spent for preventive care but not for actual treatment. Such approach would provide people with an opportunity to use health insurance directly – ensure health but not treatment of various diseases that come with inappropriate way of living (Miller, 2007).
Health care payment system should be value-based to be effective for patients. PS must provide physicians with enough reasons to assign only necessary procedures that are effective, of high quality, and adequate cost. Providers of health care services should be interested in innovations and improvements supported by the value-based HCPS. Under(over)-treated cases must not be rewarded by payment system in order not to encourage such practices in health care institutions (HRSA, 2012).
In general, HCPS must be focused on the provision of quality services and delivery of good and timely treatment to patients. Current PS is based on the principles of higher income for hospitals, regardless of the quality of services in most cases. Patients may suffer from being not treated properly but health care provider will still obtain the full cost of procedures, sometimes, unnecessary ones. Therefore, value-based system must change the situation and provide patients with the new level of services – patient-focused. Physicians will be encouraged to order procedures that are necessary and enough in each particular case.