How Money Flows in US Healthcare
Follow a dollar from the premium a member pays to the payment a provider receives, and see where fee-for-service and value-based payments differ.
How Money Flows in US Healthcare
Coming soon. This post is a placeholder in the US Healthcare learning path. The outline below is what it will cover.
What this post will cover
- Premiums, employer contributions and taxes: where the money comes from
- Fully insured vs self-funded employer plans
- Billed charges (chargemaster) vs allowed amount vs paid amount
- Payment models at a glance: fee-for-service, capitation and bundled payments
- Where the patient pays: cost sharing and balance billing
- A worked example tracing one office visit end to end
Further watching
From the HealthTech Decoded channel:
- Healthtech overview: PPO/HMO, in-network and out-of-network providers
- Healthcare bills truth that no one tells you
- How your $5,000 hospital bill becomes $900: claims repricing (short)
Where this fits
Level 1 · Foundations › The US healthcare ecosystem
This post is licensed under CC BY 4.0 by the author.