Publication:
Pricing Health Services for Purchasers : A Review of Methods and Experiences

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dc.contributor.authorWaters, Hugh
dc.contributor.authorHussey, Peter
dc.date.accessioned2013-06-05T14:39:52Z
dc.date.available2013-06-05T14:39:52Z
dc.date.issued2004-09
dc.description.abstractThis paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment; the availability of information on costs, volumes, outcomes, and patient and provider characteristics; methods used to calculate providers' costs; and characteristics of purchasers and providers-including the regulatory environment, provider autonomy, negotiating power, and the degree of competition. The paper focuses on methods for setting levels of payment under different provider payment mechanisms. Line item and global budgets remain the most common reimbursement methods in developing countries. However, many of these countries are implementing mixed payment systems that have greater information demands. The principal payment types used in high-income countries-capitation, payments per case or diagnosis, and fee-for-service-are reviewed here, and implications for low- and middle-income countries discussed. To minimize incentives for under- or over-utilization, prices that purchasers pay for health care services should be related to the unit costs of services. However, establishing the true unit cost of health services is complicated, and detailed data needed to correctly allocate indirect costs to the units of services are not generally available in developing countries. The organizational characteristics of health care providers and their relationships with purchasers strongly influence the way prices for health services are determined. Pertinent characteristics include provider autonomy, provider negotiating power, and the degree of competition. The principal constraint on the development of provider payments systems in developing countries is the limited availability of information on costs, volumes, and patient characteristics. However, international experiences reveal a variety of options for setting prices for health care purchasers in developing countries that are reforming their payment systems.en
dc.identifierhttp://documents.worldbank.org/curated/en/2004/09/5635196/pricing-health-services-purchasers-review-methods-experiences
dc.identifier.doi10.1596/13764
dc.identifier.urihttps://hdl.handle.net/10986/13764
dc.languageEnglish
dc.language.isoen_US
dc.publisherWorld Bank, Washington, DC
dc.relation.ispartofseriesHealth, Nutrition and Population (HNP) discussion paper;
dc.rightsCC BY 3.0 IGO
dc.rights.holderWorld Bank
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/igo/
dc.subjectACCOUNTABILITY
dc.subjectACCOUNTING
dc.subjectACCOUNTING SYSTEMS
dc.subjectBANK PUBLICATIONS
dc.subjectBUDGETING
dc.subjectCAPITATION
dc.subjectCHILD SURVIVAL
dc.subjectCURRENCY
dc.subjectDENTAL CARE
dc.subjectDIABETES
dc.subjectDIARRHEAL DISEASES
dc.subjectDISCHARGE
dc.subjectDRAFTS
dc.subjectEMPLOYERS
dc.subjectEXPENDITURE
dc.subjectEXPENDITURES
dc.subjectEXTERNALITIES
dc.subjectEXTERNALITY
dc.subjectFEE FOR SERVICE
dc.subjectFINANCIAL DATA
dc.subjectFINANCIAL RESOURCES
dc.subjectFINANCIAL RISK
dc.subjectGENERAL PRACTITIONERS
dc.subjectGLOBAL BUDGETS
dc.subjectHEALTH CARE
dc.subjectHEALTH CARE COSTS
dc.subjectHEALTH CARE FINANCING
dc.subjectHEALTH CARE PROVIDER
dc.subjectHEALTH CARE PROVIDERS
dc.subjectHEALTH CARE SERVICES
dc.subjectHEALTH CARE SYSTEMS
dc.subjectHEALTH CENTERS
dc.subjectHEALTH EXPENDITURES
dc.subjectHEALTH FACILITIES
dc.subjectHEALTH INSURANCE
dc.subjectHEALTH OUTCOMES
dc.subjectHEALTH POLICY
dc.subjectHEALTH SECTOR
dc.subjectHEALTH SERVICES
dc.subjectHEALTH SYSTEM
dc.subjectHEALTH SYSTEMS
dc.subjectHOSPITAL ADMISSIONS
dc.subjectHOSPITAL CARE
dc.subjectHOSPITAL DISCHARGE
dc.subjectHOSPITALIZATION
dc.subjectHOSPITALS
dc.subjectHUMAN DEVELOPMENT
dc.subjectHUMAN RESOURCES
dc.subjectIMMUNIZATION
dc.subjectIMMUNIZATIONS
dc.subjectINCOME
dc.subjectINFLATION
dc.subjectINFORMATION NEEDS
dc.subjectINFORMATION SYSTEMS
dc.subjectINPATIENT CARE
dc.subjectINSURANCE
dc.subjectINSURERS
dc.subjectINTERVENTION
dc.subjectLAWS
dc.subjectLESSONS LEARNED
dc.subjectLIABILITY
dc.subjectMEDICAL EQUIPMENT
dc.subjectMORBIDITY
dc.subjectNATIONAL HEALTH INSURANCE
dc.subjectNURSING
dc.subjectNUTRITION
dc.subjectOFFICE SPACE
dc.subjectORGANIZATIONAL STRUCTURE
dc.subjectOUTPATIENT CARE
dc.subjectOUTPATIENT SERVICES
dc.subjectPATIENT CHOICE
dc.subjectPATIENTS
dc.subjectPAYMENT SYSTEMS
dc.subjectPHYSICIANS
dc.subjectPRIMARY CARE
dc.subjectPRIVATE SECTOR
dc.subjectPROMOTING HEALTH
dc.subjectPUBLIC HEALTH
dc.subjectPUBLIC HEALTH INSURANCE
dc.subjectPUBLIC HOSPITALS
dc.subjectPUBLIC SECTOR
dc.subjectREFORMS
dc.subjectREINSURANCE
dc.subjectSERVICE DELIVERY
dc.subjectTRUSTS
dc.subjectUNIVERSAL HEALTH INSURANCE COVERAGE
dc.subjectVACCINATION
dc.subjectWORKERS
dc.titlePricing Health Services for Purchasers : A Review of Methods and Experiencesen
dspace.entity.typePublication
okr.date.doiregistration2025-05-05T11:39:31.989425Z
okr.doctypePublications & Research::Working Paper
okr.doctypePublications & Research
okr.docurlhttp://documents.worldbank.org/curated/en/2004/09/5635196/pricing-health-services-purchasers-review-methods-experiences
okr.guid133261468779433086
okr.identifier.externaldocumentum000090341_20050302144436
okr.identifier.internaldocumentum5635196
okr.identifier.report31590
okr.language.supporteden
okr.pdfurlhttp://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2005/03/02/000090341_20050302144436/Rendered/PDF/315900HNP0Chap1gHealthServicesFinal.pdfen
okr.topicEconomic Theory and Research
okr.topicHealth Monitoring and Evaluation
okr.topicBanks and Banking Reform
okr.topicHealth Economics and Finance
okr.topicPayment Systems and Infrastructure
okr.unitHealth, Nutrition, and Population (HDNHE)
okr.volume1 of 1
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