Many of the methods used in the strategies for reimbursement is a downside for the patients and health care providers.
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Ling throughly explains the process of DRGs. She notes, " In the DRG form of reimbursement, hospitals are paid a flat rate for each patient based on the diagnosis". In this method hospitals are responsible for managing the length of stay. A large number of staff is hired to make sure tests for patients are done on time, resulting in patient to go home quickly. The problem with this is the workload for nurses" increases because the patient length of stay decreases. Nurses work rapidly with each patient, to try and get as many patients seen. Getting the patient home quicker does not benefit the health care providers because in the long run, the patient will have to come back to the hospital to be seen again since not enough time is given for patient's recovery.
Another, method Ling points out is, Per diem payments. According to her, in this particular method the provider is paid a set daily rate. She clarifies that this method is suppose to reward health care providers who are efficient and effective, yet sadly some facilities are reluctant to take patients who requires more care than others. This method is a disadvantage to patients because they might not receive the quality care they are entitled to. .
A third method Ling reviews is Capitation. This is also a method of reimbursement that controls how health care is delivered. A lump sum payment is made to the provider for a specific service for a group of members they are responsible for. In this method, the provider is paid regardless if any people in the group come into the office for that month. Capitation method usually balances itself out, because one month the provider might see many patients but in another month very little. But on the other hand, the providers do benefit, since they are given a set amount each month.
