Health Care Payment System: Impact on Nursing Practice

The development of the healthcare system is one of the priorities of the U.S. government. It also applies to the financial sphere: costs continue to grow, so the government is trying to find reliable and effective ways to reduce them. One of these reforms was the introduction of bundled payments. This type of payment for health care is one of the critical changes in this area.

Bundled payments are one of the main alternatives to paying for care. Using such fees consists of monetary reimbursement to doctors, hospitals, nurses, and other health care providers for a particular episode of care (Hardin et al., 2017). This approach has a substantial impact on the industry as a whole and its participants. In the interaction between bundled payment systems and nursing practice, several points can be identified that have both positive and negative implications:

  • Increased accountability on the part of the medical staff
  • Improved quality of service delivery
  • Increased client-nurse interaction
  • Risk of unnecessary treatment being prescribed
  • Difficulty in assigning financial responsibility
  • Transparency of services, prices, and data
  • Availability of share in savings
  • Improved organization of work

With bundled payments, doctors and nurses take more responsibility, as treatments are assigned for a specific span of treatment, which may include several procedures. This responsibility covers both the financial component as well as the outcome in the care (Althausen & Mead, 2016). Accordingly, this approach also leads to improved quality of care, as providers, particularly nurses and physicians, are interested in the long-term relationship with clients and understand their level of involvement. It guides to increased productivity of the medical staff, their professionalism, and their initiative in learning. A nurse who is involved in work will always make the patient feel comfortable. Thus, all the above aspects are fundamental in establishing a connection between the client and the caregiver.

Despite the effectiveness of this system, it may not always prevent unnecessary procedures from being scheduled. It can occur either unintentionally or vice versa: when the billing rates are very high, the nurse may take on unnecessary responsibilities and, along with the physician, prescribe procedures that the client does not require. It is done in the first place for dishonest financial gain. The opposite example is when the rates are low, and the medical staff member performs poorly and inadequately prescribes treatments. Another negative nuance is some of the difficulty in paying providers. Since a nurse may delegate a portion of a patient’s care to other health care workers, there may be difficulty assigning financial responsibility for that episode of service. Accordingly, a bundled payment system requires careful oversight and awareness by everyone involved.

Another critical factor in this type of payment is its transparency. It has a positive impact on patients, nursing practices, and healthcare professionals in general. All participants in the system have full access to data: prices, services rendered, patient history. The positive thing for nursing practice is that healthcare providers share the savings (Catalyst, 2018). It works if they keep costs below target and quality standards at the same time. In addition, the bundled payment system improves nursing organizations and eliminates inefficiencies in client care. It increases staff productivity and saves time for other responsibilities.

Care coordination is encouraged through bundled payment methods. Bundled fees are an example of combining techniques and prices to create the desired incentives for staff and clients. Monitoring provider behavior through analysis of service consumption can give vital information for payment strategies, and administrative regulators can help prevent overprovisioning. With quality controls and the responsible attitude of each participant, this payment approach can positively impact nursing practice and the health care system as a whole.


Althausen, P. L., & Mead, L. (2016). Bundled payments for care improvement: lessons learned in the first year. Journal of orthopaedic trauma, 30, 50-53.

Catalyst, N. E. J. M. (2018). What Are Bundled Payments? NEJM Catalyst, 4(1).

Hardin, L., Kilian, A., & Murphy, E. (2017). Bundled payments for care improvement: preparing for the medical diagnosis-related groups. The Journal of nursing administration, 47(6), 313.

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1. NursingBird. "Health Care Payment System: Impact on Nursing Practice." September 20, 2022.


NursingBird. "Health Care Payment System: Impact on Nursing Practice." September 20, 2022.