PAYMENT METHODS

PRESENTATION

By Jackie Hall

http://www.commonwealthfund.org/Content/Publications/Fund-
Reports/2007/Apr/Evidence-Informed-Case-Rates--A-New-Health-Care-
Payment-Model.aspx
 INTRODUCTION

• Fee-for-service
• Capitation payment
cycles
• Relationship among
provider, patient, and
payer

Malaysian Family Physician, 2007)

FEE-FOR-SERVICE
• Patient
o Pays for services received
o Pays premium
• Provider
o Delivers medical services
o Records claim
• Health Plan
o Compensates provider on behalf of patient
o Compensates medical expenses
CAPITATION PAYMENT CYCLES
• Patient
o Pays premium
• Provider
o Delivers medical services
o Records encounter data
• Health plan
o Prepays capitation rate for medical expenses
CONCLUSION

• Fee-for-service
• Capitation
• Payer
• Patient
• Health plan
REFERENCE
• Malaysian Family Physician (2007) Review Article. Retrieved
---------from
http://ejournal.afpm.org.my/Assets/health_care_system.gif

http://www.commonwealthfund.org/Content/Publications/Fund-
Reports/2007/Apr/Evidence-Informed-Case-Rates--A-New-Health-
Care-Payment-Model.aspx