Reimbursement system

The reimbursement system is a powerful instrument to ensure the quality, efficiency and equal access to care. The aim should be a uniform reimbursement system with market rates. There should be no difference in the conditions and amount of payments for the same care activities with different patients, as this will lead to unequal access to care to the detriment of the patients for whom is paid less. Furthermore, a financial balance is important to ensure that care remains affordable for the population and that on the other hand caregivers have sufficient income to ensure the quality and continuity of care. At the same time it is important to ensure that caregivers deliver best value for the right price.  There are several reimbursement systems, each of which are variants of three basic forms:

  • Activity based: pay for each activity, regardless of the reason for that activity
  • Value based: pay for care products (bundling of care activities related to a referral and/or discharge diagnosis)
  • Fixed fee: fixed remuneration which is not or little related to production

Each system has its advantages and disadvantages with respect to inhibiting or promoting production, quality, fraud and administrative burdens.

ACSION assists in the development of health care and reimbursement systems to suit the needs of the country and those involved.