PROVIDER PAYMENT SYSTEMS
• Identify the history, theory, and characteristics of the major types of payment systems
• Identify the tactics payors and providers use to reduce their financial risk
• Determine the cost per member per month for specific procedures
• Understand the new wave of innovations in health care payment systems
This chapter provides an introduction to the development of the health care payment system
in the United States and some of the basic methods used to determine health care payments. The evolution of the payment system will be emphasized in light of the ongoing public policy debate about the roles, responsibilities, and effects of the payment system on various stakeholders, including:
• Providers—including ...