Sources of Reimbursement for Health-Care Service Delivery

In 1972, Medic be was amended to embarrass individuals who are disabled and receiving affectionate Security. The Medicare reimbursement program is divided into partition A and Part B. The former al commencements reimbursement of health-care services through hospitals, care for homes, and home health agencies, era the latter addresses out-patient physician and separate ambulatory services. Medicaid is for low-income and medically needed persons, with Title XIX of the 1965 Social Security Act amendments being the authorizing legislation.

For community/ verdant areas, the sources of reimbursement are the same as for metropolitan areas; however, the distribution of reimbursement between sequestered and public sources diverges dramatically. Note that, for example, during the 1975-1976 time-frame, the County of Multnoma in Oregon had reimbursements consisting of 71.9% from private sources; while 13.5% were from Medicare; 7.2% were from welfare (i.e., categorically needy) patients; and 7.4% was from other sources for non-welfare but poor patients. In contrast, for the City of Portland, Oregon during 1976-1977, 22.5% of reimbursements were from Blue Cross; 13.3% were from Blue harbour; 4.2% were from Aetna; and 18.0% were from other private sources. For health maintenance organizations, Kaiser accounted for 16.7%; while Portland pipe Health Cascade

tour there is clearly pressing demand for the increased consumption of financing in health, there is even more stress to curb health-care spending. Boland (1991) reports that, regarding reimbursement, there are several concerns as regards the impartial provision of health-care delivery for rural individuals, as is the case with those persons residing in larger city areas. The alleged blank check that is of import to the cost-based retrospective reimbursement system utilized by indemnity companies and employers, as well as the reimbursement for usual and customary fees confronting these entities, allows for negligible incentive for health-care providers to contain be. This, in turn, results in increased pressure on all health-care providers to cut costs where possible.

For community/rural hospitals, this terminate proves highly damaging given their low and declining operating margins, low admission rates, and ever declining occupancy rates. Further, given that unnecessary costs are incurred because no price competition exists between providers, insurance companies and employers are often powerless to influence rate decreases.

beyond these factors, The Institute of Medicine (1989, pp. 225-229) reports that, while rural versus non-rural hospital-bed-to-population rates are similar, there exists a problem relative to the number of health professionals in relation to the total population in rural areas. Note that, of 5,732 community hospitals in 1986, 47% were rural and, of these, 17% had less than 50 beds. Moreover, of the 214 community hospitals that closed between 1980 and 1985, 75% had less than 50 beds, which indicates that community hospitals are more possible to close than their larger counterparts. In support of this, the American infirmary Association indicates that smaller hospitals are more vulnerable to shutdown due to the indicators of inadequate and declining operating margins, commence and declining rates of admissions, lower and declining occupa
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