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IntroductionFragmentation of health care services remains widespread, resulting in adverse effects such as inefficient and inequal care. Networks have the potential to address those ‘wicked’ problems. However, current ways of paying seem to impede coordination and collaboration. Health-care providers are predominantly reimbursed through traditional payments models that reward volume rather than value, such as fee-for-service or diagnosis-related groups. It is believed that moving from separate provider reimbursement to joint reimbursement of networks stimulates coordination between providers and encourages flexible use of resources. Ultimately, jointly reimbursing networks through network-level payment models is assumed to lead to improved performance. Aims Objectives Theory or MethodsOur aim was to study how network-level payment models affect the performance of health-care networks. Due to the broad nature of this aim, a scoping review was conducted. Six bibliographical databases were searched, combining various terms that reflected ‘payment model’ and ‘interorganizational network’. Articles were eligible for inclusion if they described networks, payment (models), performance indicators and if it was a peer-reviewed, empirical study set in an OECD country. Network performance was defined as the ability of the network to satisfy the payment model’s objectives. We distinguish four categories of performance: spending, utilization, quality of care, and other consequences.Highlights or Results or Key Findings63 studies were included with the majority of studies stemming from the USA (N=58). Payment flows to the network were more common than payment flows in the network (N=57 vs. N=6). Global payment with add-ons (N=49) was the most common model, followed by pay-for-performance (N=7), capitation (N=4) and bundled payment (N=3). In general, the results show that payment models have mixed effects on performance. No single payment model proved able to consistently improve on all four categories of performance. However, in the majority of studies performance in terms of quality and utilization remained stable or improved. Spending was not curbed under the disease-based bundled payment model. Our results also show that the relation between payment models and performance is not necessarily stable, with several factors of importance: timing of the performance assessment, cohort entry year, and scope of services offered by the networks explain differences in performance.ConclusionsAlthough network-level payment models are still in their infancy, this review shows that these models have the potential to improve performance of networks. Given the increasing omnipresence of health-care networks, it is fruitful to keep experimenting with joint reimbursement of those networks.Implications for applicability/transferability sustainability and limitationsIt might prove worthwhile to develop more theory-based understanding on the contexts and mechanisms under which payment models lead to certain performance. As alternative payment models gain momentum, this understanding can enhance transferability of knowledge and subsequently support providers in preparing for future (mandatory) payment reform.

Clinical coding systems play a crucial role in transforming medical concepts into a structured format suitable for computational analysis. However, the development of an ideal coding system remains a challenge due to the diverse requirements and benefits sought by the medical community. This paper explores the design principles and attributes of an effective clinical coding system, drawing on the foundational framework proposed by James Cimino. Key features include non-ambiguity, non-vagueness, non-redundancy, inviolability, evolvability, consistency, and polyhierarchy. The concept of polyhierarchy is examined in depth, highlighting its ability to accurately represent the complex relationships between medical concepts. The paper also discusses the benefits of implementing a well-designed clinical coding system at local, national, and international levels, such as enhanced auditing capabilities, improved communication among healthcare teams, and the ability to identify global health inequalities. Furthermore, the paper delves into the intricacies of surgical reimbursement, explaining the concept of global surgery packages and the appropriate use of modifiers and add-on codes. Understanding these concepts is crucial for ensuring accurate billing and compliance with reimbursement policies. The paper emphasizes the importance of precise documentation and coding practices in reflecting the complexity and value of surgical services provided.

During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.