Text: Create a case study from the interview with Dr. Steven Safyer, President & CEO Montefiore Health System.
• How does financing and reimbursement affect the delivery of care? Health insurance affects healthcare delivery in the US in that it makes providers less aware of the actual cost of healthcare. It creates provider-induced demand. This financing greatly influences how much healthcare is delivered.
• How does reimbursement differ in the delivery of outpatient vs inpatient care? Reimbursement varies most significantly by insurance company. More insurance companies do reimburse inpatient and outpatient services very differently, but some smaller insurance companies may reimburse according to simple criteria. Medicare's inpatient prospective payment system reimburses a weighted fee schedule of rates by diagnosis-related group based upon the average cost of care across the nation's providers for that particular set of health issues. Medicare outpatient reimbursement fits into one of two scenarios: clinic (a freestanding primary) and hospital (procedures performed either at the hospital or at a clinic located within 35 miles of the hospital that owns and operates the clinic). They are reimbursed accordingly to the ambulatory payment classification.
• How do Managed Care and Integrated Systems impact the cost, access, and quality of healthcare delivery? Managed care and integrated systems have a positive impact on the cost, access, and quality of healthcare delivery.
• How has Legislative Health Policy impacted the delivery of care? Legislative health policy has impacted the delivery of care. The healthcare delivery system continues to evolve by the market forces, and so do legal and regulatory changes resulting from health reform legislation.
• What is the future of health services delivery? The future of health service delivery: insurances drop individual plans because they do not comply with some of the mandates, and employers cope by reducing worker hours and negotiating new health plans. The US healthcare system will continue to evolve, but no one knows the destiny.