Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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AppendixB : Research Issues Concerning Reimbursement for Childbirth Services
AppendixB : Research Issues Concerning Reimbursement for Childbirth Services
Pages 80-90
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From page 80... ...
The final section of this paper contains information on the costs of different birth settings. REIMBURSEMENT Reimbursement/Financing Issues There is one basic question pertaining to reimbursement for birth servicesa What third-party reimbursement methods would establish appropriate relative support for each of the major birth settings?
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From page 81... ...
Conditions of Participation When a third-party payer •purchases• health care facilities and services, it may make stipulations, called conditions of participation, that outline such items as quality standards and cost restraints. Conditions of participation may include decisions about whether a provider is qualified to receive reimbursement from a third party or whether facilities meet certain requirements pertaining to staffing, equipment, etc.
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From page 82... ...
Nor is there any provision in this plan for reimbursing costs for a nonhospital birth center, either as a basic benefit without coinsurance or as a supplemental benefit subject to coinsurance. If the nonconventional services are covered as supplemental benefits and conventional services as basic benefits, the patient's out-of-pocket costs would be greater if she chose the lower cost service.
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From page 83... ...
Charge reimbursements are made to all covered providers of health care by commercial health insurance companiesr they are also made on a cost basis to physicians and other independent practitioners and suppliers by most plans that pay hospitals and other institutions. There are a number of safeguards intended to ensure that excessive charge reimbursements are not made.
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From page 84... ...
There has been concern that cost reimbursement and fee-for-service reimbursement might stimulate excessive increases in services and, accordingly, in health expenditures. For this reason, there has been considerable effort to identify reimbursement approaches that provide incentives for cost controls.
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From page 85... ...
A technical issue that would need to be examined relates to what some critics of birth centers term •creaming.• It is correct that most birth centers and midwives do not treat high-risk patients whose records and symptoms suggest the likelihood of complications requiring hospitalization and physician intrapartum care. Critics argue that when simpler cases are treated by birth centers and midwives, the average case handled by a physician would become more complex and an upward adjustment in physician fees would be justified.
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From page 86... ...
Reimbursement of costs of home care or a lump sum allowance for the patient to use as desired might be considered in order to reduce or avoid some of the out-ofpocket costs for postpartum home care, thereby avoiding an incentive to obtain services through the more expensive hospital route. Transitional Issues If the decision is made to design reimbursement to encourage a shift from conventional hospital to nonconventional birth settings, careful attention should be given to potential problems.
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From page 87... ...
RBSBARCB POSSIBILITIES A wide range of research topics aay be explored to enhance the decisionaaking process in foraulating a policy for financing birth centers. However, aany of the research areas cannot yet be addressed adequately.
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From page 88... ...
Durations of hospital stays for labor and delivery vary substantially among and within areas. Both hospital coats and physician charges for maternity care vary as well.
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From page 89... ...
The birth center provides nurse midwife services as part of the care included in its $1,000 fee. The Maryland Health Services Cost Review Commission, through the courtesy of its staff director Harold Cohen, provided data on the vari ation among hospital delivery charges in Maryland during 1981.
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From page 90... ...
For normal births, the length of average stay varied among hospitals from a low of 2.35 days at Memorial Hospital in Easton to a high of 3.49 days at Maryland General Hospital in Baltimore. Charges varied from $565 in Garrett County Hospital to $1,350 at University Hospital in Baltimore.
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