Reimbursement
Published on Nov 18, 2015
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PRESENTATION OUTLINE
REIMBURSEMENT
WHAT IS IT & HOW DOES IT WORK?
SWEDEN
- National reimbursement decison
- Regional healthcare system
- TLV - Dentist & Pharmaceutical Benefit Agency
- County Councils & Municipals
TLV - DENTAL AND PHARMACEUTICAL BENEFIT AGENCY
WHICH PRODUCTS?
TLV - DENTAL AND PHARMACEUTICAL BENEFIT AGENCY
WHO MAKES THE DECISION?
TLV - DENTAL AND PHARMACEUTICAL BENEFIT AGENCY
HOW IS THE DECISION MADE?
COUNTY COUNCILS & MUNICIPALS
HOW IS THE DECISION MADE?
THE U.S
- Public & private insurance companies
- Reimbursement codes for physicians and facilities
- Reimbursement codes for different diagnoses
- Local Weights
PUBLIC INSURANCE COMPANIES
- Ex. Medicare - care for elderly & disabled
- Advanced code system for different reimbursment:
PRIVATE INSURANCE COMPANIES
- Used to follow Medicare's model
- "Pay for what is medically necessary"
- HMO - Health Maintenance Organizations
- PPO - Preferred Provider Organizations
