Reimbursement

In a healthcare context, reimbursement is the payment that a healthcare provider (such as a hospital, clinic, or pharmaceutical company) receives for the medical services or products they have provided to a patient. This payment is typically made by a third party, such as the payer or an employer. The amount and method of reimbursement are not fixed but are based on a variety of models, including: Fee-for-service: Where providers are paid for each individual service or procedure they perform, sometimes referred to as ‘tariffs‘. Capitation: Where a provider receives a fixed amount per patient or per resident per period, regardless of how many services are used. Bundled or block payments: Where a single, lump sum payment is made for an entire episode of care, such as a surgical procedure and the associated follow-up visits. In the English NHS, the NHS Payments scheme is used. The policies and decisions made by payers on what services to reimburse, and at what rate, are a major driver of how healthcare is delivered and which new technologies are adopted. The reimbursement/tariffs don’t necessarily equal costs incurred by providers”