The impact that policy formation places on direct patient care delivery.

The impact of FFS on direct patient care is tangible and often negative. It can lead to:

Overutilization of services: Providers may order unnecessary tests or procedures to increase revenue. This can expose patients to avoidable risks, increase healthcare costs, and waste valuable resources.

Fragmentation of care: The FFS model doesn't financially reward care coordination. This can result in a lack of communication between different specialists, leading to disjointed care, medication errors, and a poor patient experience.

Lack of focus on preventive care: Because payment is tied to treating illness, preventive services—which are crucial for long-term health—are often undervalued or not incentivized.

Proposed Improvement

To provide better care and patient outcomes, the reimbursement model should shift from fee-for-service to a value-based care model. This approach, also known as value-based payment (VBP), rewards providers for the quality of care they deliver and for improving patient health, not just for the quantity of services.

Here's how this shift would improve care:

Focus on Patient Outcomes: In a VBP system, hospitals and clinics are incentivized to keep patients healthy. This encourages a greater emphasis on preventive care, chronic disease management, and patient education.

Encourages Care Coordination: A VBP model rewards care teams for working together to achieve the best possible patient outcomes. This fosters better communication and collaboration between primary care providers, specialists, and other members of the care team, leading to more integrated and effective care. 🤝

Reduces Waste and Unnecessary Services: By linking payment to outcomes, VBP disincentivizes unnecessary testing and procedures, which reduces costs and minimizes the risk of patient harm. This allows healthcare resources to be reallocated to services that truly benefit patients.

Sample Answer

Health policy profoundly affects direct patient care delivery by establishing the framework for access, quality, and safety. It shapes everything from what services are covered by insurance to the protocols a nurse follows when administering medication. The most direct impact is on the staffing and scope of practice for healthcare professionals, which directly influences patient-to-provider ratios and the types of services available to patients.

Policy Area: Reimbursement Models

A key area of health policy that significantly impacts patient care is reimbursement models. This refers to the methods and payment structures used by insurance companies and government programs (like Medicare and Medicaid) to pay for healthcare services. The dominant model in the U.S. has been fee-for-service (FFS), where providers are paid for each individual service they provide (e.g., each test, procedure, or office visit). This model creates an incentive for providers to deliver more services, regardless of whether they improve patient outcomes.