Purchasing Inpatient and Outpatient Care through Hospitals
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World Bank, Washington, DC
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After considering the fulfillment of
some basic criteria making purchasing a tool for
effectiveness, a framework allows to review how to best buy
hospital services. Who should benefit most from hospital
care financing ? The answer to this question will rely on an
investigation of hospital services utilization, and on a
better understanding of patients profiles. This type of
investigation is a baseline for further decisions on what to
buy. A purchaser should wonder: to what public health
priorities hospital responds best and how efficient and
equitable is hospital care? But hospitals have also a unique
role in helping people facing major hazards, in providing
some essential public health services and in enabling
training: these services should be considered when
purchasing. Hospitals represent a large diversity of
organizations. Having that in mind makes it easier to figure
out from whom to buy. The potential provision of care
depends on the level of the provider but is also related to
hospitals status taking into consideration productivity. It
is also worthwhile to investigate insurance's role in
the provision of care. Payment mechanisms have a strong
influence on performance, for that reason the major
alternative schemes have to be considered, each of them
having advantages and limits. But hospital cash flow is also
a specific issue that should not be ignored. The price paid
has to be determined before making an agreement. This should
lead to cautious estimates of cost of services as the
information systems are often weak. Moreover it might be
worthwhile to play with margin to favor internal cross
subsidies. The co-payments as well as the opportunity cost
have to be included to understand how to get best from
pricing. Dealing with subsidies is a cornerstone when
seeking better performance while purchasing hospital
services. How subsidies are going to be channeled and for
what kind of services will determine if purchasing is really effective.
Palabras clave
ACCESS TO HEALTH SERVICES, ACCOUNTABILITY, ACCOUNTING, BASIC HEALTH, BEDS, CAPITATION, CASH FLOW, CHILD HEALTH, CHRONIC DISEASES, CLINICS, COMMUNICABLE DISEASES, COUNTRYSIDE, CRITICAL CARE, DAY CARE, DEATHS, DEVELOPMENT GOALS, DRUGS, ECONOMIC STATUS, EPIDEMIOLOGICAL TRANSITION, EQUITY IN HEALTH, EXPENDITURES, FEE FOR SERVICE, FEES FOR SERVICE, FIXED COSTS, GENDER, HEALTH CARE, HEALTH CARE DELIVERY, HEALTH CARE EXPENDITURES, HEALTH CARE FACILITIES, HEALTH CARE FINANCING, HEALTH CARE PROFESSIONALS, HEALTH FINANCING, HEALTH HAZARDS, HEALTH INFORMATION, HEALTH MAINTENANCE ORGANIZATIONS, HEALTH NEEDS, HEALTH POLICY, HEALTH SECTOR, HEALTH STATUS, HEALTH SURVEYS, HEALTH SYSTEM, HEALTH SYSTEMS, HOSPITAL ADMISSIONS, HOSPITAL CARE, HOSPITAL COSTS, HOSPITAL MANAGEMENT, HOSPITAL OUTPATIENT SERVICES, HOSPITAL SERVICES, HOSPITAL UTILIZATION, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, IMMUNIZATIONS, IMMUNODEFICIENCY, INCOME, INFANT MORTALITY, INFORMATION SYSTEMS, INPATIENT CARE, LESSONS LEARNED, MAJOR HAZARDS, MALARIA, MEDICAL EQUIPMENT, MEDICAL RECORDS, NUTRITION, OBSTETRICAL CARE, OCCUPANCY, OCCUPANCY RATES, OPERATING COSTS, OUTPATIENT CARE, OUTPATIENT SERVICES, PATIENT SATISFACTION, PATIENTS, PHYSICIANS, POPULATION GROUPS, POSTNATAL CARE, PREGNANT WOMEN, PRESCRIPTIONS, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE SECTOR, PROMOTING HEALTH, PUBLIC, PUBLIC HEALTH, PUBLIC HEALTH AUTHORITIES, PUBLIC HEALTH NEEDS, PUBLIC HEALTH SERVICES, PUBLIC HOSPITALS, PUBLIC SECTOR, PURCHASING, QUALITY OF CARE, RURAL AREAS, SERVICE DELIVERY, SURGERY, TEACHING HOSPITALS, TOWNS, TRADITIONAL MEDICINE, TRAFFIC, URBAN AREAS, URBAN POPULATION, WORKERS, WORLD HEALTH ORGANIZATION