MPV_HFAR Healthcare Finance and Reimbursement

Faculty of Economics and Administration
Spring 2025

The course is not taught in Spring 2025

Extent and Intensity
0/2/0. 5 credit(s). Type of Completion: z (credit).
In-person direct teaching
Teacher(s)
doc. JUDr. Ivan Malý, CSc. (seminar tutor)
Guaranteed by
doc. JUDr. Ivan Malý, CSc.
Department of Public Economics – Faculty of Economics and Administration
Contact Person: Jana Biskupová
Supplier department: Department of Public Economics – Faculty of Economics and Administration
Course Enrolment Limitations
The course is only offered to the students of the study fields the course is directly associated with.
fields of study / plans the course is directly associated with
Course objectives
The course builds on the mainly theoretical knowledge of the functioning of quasi-markets in healthcare acquired in the course Introduction to Healthcare Economics. It focuses on the institutional design of financial flows in health systems. The aim of the course is:
(a) to present current insurance systems as a mix of public and private institutions working together to ensure access to a universal health care;
(b) using a logical-historical method to introduce students to a wide range of payment mechanisms and explain the logic of their operation in relation to the resolution of the main dilemmas of contemporary health systems; and
(c) to lead students to understand how different payment mechanisms influence provider behaviour and what role key features of payment mechanisms play in this, such as how the performance base is defined, whether and how the price of performance or total reimbursement is predetermined and/or regulated, etc.
Learning outcomes
Upon completing the course, the student will be able to:
- identify and describe the ways in which the quantity, structure and price of health services are determined in current public health insurance systems;
- explain how different reimbursement mechanisms and regulations influence the behaviour of health service providers;
- identify and describe trends in health care financing;
Syllabus
  • 1. Financial flows in the healthcare system. Funding.
  • 2. Health insurance funds - main dilemmas (solidarity, stability, fiscal context).
  • 3. Co-payments. Forms, amounts, impacts.
  • 4. Redistribution of funds. Instruments for minimising adverse selection and cream skimming.
  • 5. Health insurance companies as administrators of funds, contractors, and guarantors of access to care. Health insurance plans. Creating a network of contractors.
  • 6. Payer competition vs. single payer. Resource allocation mechanisms between care segments and regions.
  • 7. Reimbursement mechanisms. Typologies. Performance payments. Alternatives to defining performance.
  • 8-9. Specifics of the most commonly used reimbursement in each service segment (capitation, fee-for-service, DRG).
  • 10. Price setting, reimbursement amounts. Market, contractual, administrative prices. Price regulation.
  • 11. Prepaid care. Regulation of total reimbursement.
  • 12. Case study - reflection of changes in the reimbursement mechanism in health care provider decision-making.
Literature
    recommended literature
  • Raulinajtys-Grzybek, M. (2015). Pricing health services: Transaction cost approach. Anchor Academic Publishing (aap_verlag).
  • Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement (p. 371). American Health Information Management Association.
  • Mossialos, E., & Le Grand, J. (Eds.). (2019). Health care and cost containment in the European Union. Routledge.
  • Good practice in health financinglessons from reforms in low and middle-income countries. Edited by Pablo E. Gottret - George Schieber - Hugh Waters. Washington, DC: World Bank, 2008, xxiv, 504. ISBN 9780821375121. info
    not specified
  • Shi, L., & Singh, D. A. (2022). Essentials of the US health care system. Jones & Bartlett Learning. chapt.6th
Teaching methods
lectures, class discussion, group projects, presentations by professionals in the sectors, homework, readings.
Assessment methods
final essay & group project
Language of instruction
English
Further Comments
The course is taught annually.
The course is taught: every week.
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