Third-party reimbursements


Discuss the following:

There are two principles that health care providers rely on when set the rates for their services.
 
The first principle is cost, and the second is based on third-party reimbursements, especially from Medicare.
 
As the chief operations officer of your hospital, you have been asked by the board to make a presentation on how the hospital sets the price for the services that it provides.
 
Prepare a PowerPoint presentation of 6–8 slides with speaker notes that analyzes the different services provided by the hospital and the rationale for charging patients for them. In your presentation, consider the following:
 
Who are the stakeholders in this scenario, and what are their roles?
 
Describe the practice of price discrimination and its objectives.
 
What role does the cost of the doctor’s education and malpractice insurance play in costing health care services?
 
What is the role of third-party payers such as Medicare and Medicaid in pricing health care services?
 
How does the uninsured population impact pricing?
 
How does the use of emergency services for nonemergency situations impact pricing?
 
Document recommendations for improvement based on your economic analysis.

Ensure that you integrate economic terms, frameworks, and models throughout the review.

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