Resources for Chapter 12

The relationship between health and healthcare

What the chapter is about

This chapter deals with provider payment models (PPM) in more detail. It considers the models of fee-for-service, capitation, global budget. pay-for-performance and diagnosis-related groups (DRGs) and outline the advantages and limitations of each.

It describes the roles of deductibles, coinsurance, and co-payments and finishes by considering the effects of financing methods on the equity, quality, and efficiency of health care.

Listen to an AI-generated discussion about the contents of the chapter

The case studies from this chapter are from:

  • England
  • Japan
  • Kenya
  • Vietnam

References with links to full text where available

Bredenkamp, C., Bales, S., & Kahur, K. (Eds.). (2019). Transition to Diagnosis-Related Group (DRG) payments for health: lessons from case studies. World Bank Publications.

Doran, E., & Robertson, J. (2009). Australia’s pharmaceutical cost sharing policy: reducing waste or affordability?. Australian Health Review, 33(2), 231-240.

Dzampe, A. K., & Takahashi, S. (2023). Financial incentives and health provider behaviour: Evidence from a capitation policy in Ghana. Health Economics.

Forbes, L. J., Marchand, C., Doran, T., & Peckham, S. (2017). The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners, 67(664), e775–e784.
https://doi.org/10.3399/bjgp17X693077

Fusco, N., Sils, B., Graff, J. S., Kistler, K., & Ruiz, K. (2023). Cost-sharing and adherence, clinical outcomes, health care utilisation, and costs: a systematic literature review. Journal of Managed Care & Specialty Pharmacy, 29(1), 4-16.

Gillies, A. C. (1998). Computers and the NHS: An analysis of their contribution to the past present and future delivery of the National Health Service. Journal of Information Technology, 13(3), 219–229. https://doi.org/10.1177/026839629801300307

Government of Vietnam, The (2005). Decree 63/2005/NĐ-CP on Health Insurance Principles (Nghị định số 63/2005/NĐ-CP. Ban hành điều lệ bảo hiểm y tế).

Gusmano, M., Laugesen, M., Rodwin, V., & Brown, L. (2020). Getting the price right: How some countries control spending in a fee-for-service system, Health Affairs, 39(11).
htt ps://doi.org/10.1377/hlthaff.2019.01804

Koohi Rostamkalaee, Z., Jafari, M., & Gorji, H. A. (2022). A systematic review of strategies used for controlling consumer moral hazard in health systems. BMC Health Services Research, 22(1), 1-12.

Liu, K. S., Yu, T. F., Wu, H. J., & Lin, C. Y. (2019). The impact of global budgeting in Taiwan on inpatients with unexplained fever. Medicine, 98(37), e17131. https://doi.org/10.1097/MD.0000000000017131

Majeed A & Molokhia M (2023) The future role of the GP Quality and Outcomes Framework in England BJGP Open 2023; 7 (3): BJGPO.2023.0054. DOI: 10.3399/BJGPO.2023.0054

Mathauer, I., & Wittenbecher, F. (2013). Hospital payment systems based on diagnosis-related groups: Experiences in low- and middle-income countries. Bulletin of the World Health Organisation, 91(10), 746–756A     
https://doi.org/10.2471/BLT.12.115931

Matsuda, R. (2020). The Japanese health care system. In R. Tikkanen, R. Osborn, E. Mossialos, A. Djordjevic, & G. Wharton (Eds.), 2020 international profiles of health care systems. The Commonwealth Fund. https://www.commonwealthfund.org/sites/default/fi les/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020.pdf

Mirian, I., Kabir, M. J., Barati, O., Keshavarz, K., & Bastani, P. (2020). Deductibles in Health Insurance, Beneficial or Detrimental: A Review Article. Iranian journal of public health, 49(5), 851–859.

Ochieng TB (2019) A Comparison of capitation and fee for service provider payment mechanisms and their effects on cost of healthcare: a case study of the Avenue Hospital, Nairobi, MBA Thesis, Strathmore University.

Pott, C., Stargardt, T., & Frey, S. (2023). Does prospective payment influence quality of care? A systematic review of the literature. Social Science & Medicine, 115812.

Truong, T. A., Le, L., & Pham, K. N. (2023) The Impact of Co-Payments on Self-Reported Health: Evidence from Rural Vietnam. Available at SSRN 4645329.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4645329

Yang, S. W., Chu, K. C., & Kreng, V. B. (2021). The impact of global budgeting on the efficiency of healthcare under a single-payer system in Taiwan. International Journal of Environmental Research and Public Health, 18(20), Article 10983. https://doi.org/10.3390/ijerph182010983

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