Reimbursement
How are providers reimbursed for their services?
The main reimbursement method of healthcare providers within the framework of the GHS is Fee for Service while other reimbursement methods apply for specific categories of healthcare providers as explained below:
1. Fee for Service
Fee for Service applies for the following healthcare providers:
- outpatient specialist for healthcare services to outpatients
- pharmacy for providing pharmaceutical products to outpatients
- laboratory
- nurse, midwife and allied health professionals
- dentist
- ambulance services
- accident and emergency department
- medical rehabilitation centre (and/or per diem)
- palliative care centre (and/or per diem)
- hospital for inpatient healthcare services
The fees for the above providers, except hospitals for inpatient healthcare services and pharmacies for dispensing pharmaceutical products to outpatients, are paid in accordance with specific services catalogues that will be drawn up in cooperation with the competent bodies of the healthcare providers.
Hospital fees for inpatient healthcare services are paid per hospitalisation case in accordance with the Diagnosis Related Groups, (DRGs) system that codifies incidents with specific DRGs codes based on the diagnosis and procedures followed in each case.
Pharmacy fees for dispensing pharmaceutical products to outpatients are paid per package (box) provided by the pharmacists to beneficiaries.
In accordance with the above and for the purposes of implementing the Global Budget, the fee for each outpatient service provided/inpatient case, is readjusted on a monthly basis depending on the volume of services/cases, so that the actual cost does not exceed the budgeted cost for that specific group of services.
2. Other payment methods
The main payment method of a personal doctor is the per capita fee for each beneficiary enrolled in his/her list. Capitation differs depending on the age of each beneficiary.
After the introduction of the GHS and after collecting the necessary information as well as data through the Information Technology system, the application of additional healthcare providers’ payment methods depending on their performance in accordance with specific Key Performance Indicators (KPIs) will be considered in consultation with the competent bodies.
Upon receiving healthcare services, and where applicable, beneficiaries pay directly to the providers, a Co-payment, a Personal Contribution I and a Personal Contribution II as explained under Co-payments and Personal Contribution I and II.
Healthcare providers’ fees for all services provided are paid on a monthly basis