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What Is Primary Care Reimbursement?

Primary care doctors serve as the first point of contact and may refer patients to specialists.
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  • Written By: A. Leverkuhn
  • Edited By: Andrew Jones
  • Last Modified Date: 04 August 2014
  • Copyright Protected:
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    Conjecture Corporation
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In general, primary care reimbursement is the reimbursement of money to parties providing or facilitating primary care for patients. Primary care is the term for initial consultation, and those who are called primary care physicians are general practitioners or family doctors who see patients in a community on a regular basis. These first-line doctors will refer more serious health problems to specialists. This type of care is called primary care partially because it is the general front-line care for all of a wide range of physical conditions; it is also a vehicle for many kinds of preventative care that is so important in curbing serious chronic conditions.

There are two main definitions for primary care reimbursement. One is reimbursement to a patient by a health insurance company after that patient has received primary care. If the patient has a health insurance plan that includes a reimbursement policy, they may pay up front for services from their primary care physician or family doctor, and then expect reimbursement from their health insurance company.

A second definition for primary care reimbursement is extremely important in the context of today’s medical industry. Essentially, this kind of primary care reimbursement is called physician reimbursement. This is what happens when a doctor’s office or other primary care provider seeks to get payment for services from a health insurance company or government entitlement program.

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Physician reimbursement for primary care differs according to the country where the physician operates. In some countries, it has become difficult for primary care providers to get the reimbursement they require to cover the administrative costs. In these cases, doctors complain about some of the inferior systems for assessing reimbursement rates. It can become necessary for primary care practices to hire their own staffers just to pursue primary care reimbursement. In other cases, doctors simply change practices and leave the primary care field, which can lead to a shortage of primary care doctors and a crisis for a country’s medical system.

A look at physician reimbursement for primary care can provide much insight into how a nation’s medical industry values various kinds of health care. In cases where primary care is not reimbursed sufficiently, many patients struggle to afford this basic health care from their doctors. In countries where primary care is provided by the government, citizens may recognize less of a struggle over day-to-day health care costs, although other complications may arise because of bureaucratic hang-ups or the quality of care. There are many variables, and no system is perfect.

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