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How participation contracts represent financial opportunities for providers. What are positive and negative ramifications of discounted fee-for-service arrangements?

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Abi Ainscough Profile
Abi Ainscough answered
The answer to this question must be explained in a number of steps, so this entire answer must be read in order for it to be properly understood.

  • What is a participation contract?

In the sense of this question, a participation contract is a contract signed by a doctor or medical practitioner and a body such as an insurance agency. The contract states that the doctor can carry out procedures and practice medicine, and that the other body (for example, an insurance agency) will cover the doctor's bills and expenses should anything go wrong. Therefore, each party in the contract has legally agreed to "participate" and play their role in the professional medical relationship.

  • How would a participation contract benefit providers?

If the doctor is considered as the provider (because she/he is providing a medical service to the public and her/his customers), then the doctor would benefit from a participation contract because they would be free to practice medicine without the fear of economic collapse if something were to go wrong, as their insurance company would cover the costs. Also, if potential customers are aware that their doctor has insurance, they may be more likely to choose that doctor as their healthcare professional.

If the insurance company is seen as the provider (because they provide the doctor or healthcare body with insurance) then they would benefit because they would receive steady payments and consistent business from their client.

  • What are positive ramifications of discounted fee-for-service arrangements?

A positive ramification of a discounted fee-for-service arrangement is that physicians or doctors are paid in order to provide you with a treatment, and so may be more likely to offer you a treatment than if they were paid a standard monthly wage.

  • What are negative ramifications of discounted fee-for-service arrangements?

A negative ramification of a discounted fee-for-service arrangement is that the physician on doctor may prescribe you the wrong type of treatment or service in order to crank up the numbers of services she/he provides - as long as a treatment is prescribed, whether it is the right treatment or not, the physician will get paid.
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