The Health Policy Plus project assessed the strengths and weaknesses of CANAM’s current provider payment system in light of the opportunities presented by the introduction of RAMU to harmonize the various health insurance schemes consolidated under this insurance scheme.
Langenbrunner, Cashin and O’Daugherty (2009) state that three characteristics help define and differentiate providers’ payment methods:
- The amount to be paid to providers is decided either prospectively (in advance) or retrospectively (after the services have been rendered);
- Providers are paid either prospectively or retrospectively;
- Payment to providers is linked to inputs used (e.g. provider salaries or pharmaceutical costs) or outputs produced (e.g. health services).
Prospective provider payment methods are budget lines, global budget, and capitation while retrospective methods are fee-for-service, case-by-case, and per diem (Mathauer and Dkhimi, 2018).