After 5-years working for Corpus Christi Medical Center, Sara gets married and is expecting her first child.
After 5-years working for Corpus Christi Medical Center, Sara gets married and is expecting her first child. Sara begins seeing an OB-GYN for regular prenatal visits where she receives prenatal lab tests, a physical examination, a review of vital signs, a check of the baby’s heartbeat, a genetic screening, and a series of ultrasounds. The OB-GYN submits a bill to Sara’s health plan for all activities performed at each visit, according to a schedule of rates agreed upon by the OB-GYN and the insurance plan. Sara has some (preventable) complications immediately before giving birth and must spend 4-days in the hospital, eventually giving birth to a healthy baby boy. The health plan pays the hospital treating Sara $1,400 per day for the four days she is admitted. What are the two reimbursement mechanisms illustrated here and what incentives do they create for the providers? What would be an alternative reimbursement strategy that would lead to reduced healthcare costs and would incentivize those treating Sara to provide quality care? Explain
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