====== Payment Model ====== A **payment model** is a structured method by which healthcare providers are reimbursed for delivering medical services. It determines **how, when, and how much** doctors, hospitals, or clinics are paid. ===== 📌 Common Types of Payment Models ===== | **Model** | **Description** | |---------------------------|---------------------------------------------------------------------------------| | *Fee-for-Service (FFS)* | Providers are paid for **each individual service** (e.g., test, surgery, consult). | | *Capitation* | Providers receive a **fixed amount per patient**, regardless of service volume. | | *Bundled Payment* | A **single payment** for all services tied to an episode of care (e.g., surgery + rehab). | | *DRG (Diagnosis-Related Group)* | Hospitals receive a **fixed payment per case**, based on diagnosis and expected resource use. | | *Value-Based Care* | Payment is linked to **patient outcomes and quality metrics**, not just volume. | ===== 🧠 In Context ===== > “China adopted a DRG-based payment model to control inpatient surgical costs.” This means hospitals are paid a **predefined amount** based on diagnosis (e.g., spinal tumor) rather than on each procedure, test, or implant used. ===== ⚠️ Why It Matters ===== The chosen payment model directly impacts: * Clinical decision-making * Length of stay * Access to complex procedures * Financial sustainability of high-risk specialties (like neurosurgery) A poorly designed payment model can lead to: * **Overtreatment** (in FFS) * **Undertreatment** or **early discharge** (in DRG) * **Avoidance of complex patients** (in capitation)