What is "4P"?
The concept of “4P†in the field of medical health has many different opinions. The four majors consist of Patient, Physician, Provider (Health Care provider) and Payer (Payer). The element is one of them. Because doctors belong to the category of medical service providers, the traditional medical ecosystem consists of three main subjects: Patients, Providers, and Payers.
Patients:
In the US medical system:
1. The patient can choose a medical insurance program;
2. Citizens over the age of 65 are covered by medical insurance;
3. Residents below the specific poverty standard are eligible for Medicaid;
4. Registered annually, except in special circumstances;
5. 15% of the population still do not have access to health insurance
What should I do if I am sick? There are two situations -
Not insured: see an emergency or participate in a Medicaid program
Insured:
1. Choose a family doctor
2. Family doctor becomes care manager
3. Family doctors must recommend hospitals for patients
4. Track payment status and bear part of the cost
Providers, not only family doctors, but also those who provide professional services to patients are called Providers. They include the following subjects:
Doctor
2. Hospital
3. Laboratory
4. Pharmacy
5. Pharmaceutical company
6. Home care and other professional care
What are the main responsibilities of Providers?
1. Family doctor: one-on-one medical service
2. Medical experts: professional services
3. Hospital: hospitalization and emergency treatment
4. Pharmacy: drug prescription
5. Pharmaceutical companies: Producing drugs as planned
Payers: The payer includes the following subjects -
1. Medicare or Medicaid policies implemented by national governments and local state governments
2. The medical insurance plan is HMO
3. Private insurance company
Patient individual
What does the Payers do?
Pay for medical services
2. Develop reasonable fees
3. Bargaining with Providers on price and quality of service
4. Manage medical affairs in terms of pre-authorization, referral, case management, preventive care, etc.
Among the reasons why insurance companies are willing to pay for medical expenses are:
1. The insured will remain healthy overall
2. Disease risk is detected early in the control
3. Minimize complications of various diseases
This kind of third-party insurance company payment method is the key to restricting the balance of the US medical system, that is, the introduction of competition mechanism through privatization, which is embodied in:
1. The medical service provider competes to seize the resources of the payer
2. The payer competes for patient resources
3. There are multiple payers in each level of market
4. There are also a number of health care providers in each level of market.
5. Participate in the fierce competition for price and quality of medical services
In addition, the federal government is by far the largest payer, and its main benefits are health care for people over the age of 65. It is estimated that the cost of medical insurance will reach 792 billion US dollars by 2015. In the same period, Medicaid costs will reach $670 billion. It is expected that the number of new registrations to enjoy US medical insurance will increase year by year:
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