Financing and Structuring Health Care
Health of a person is very vital. All people would do anything to maintain a good health. This explains the reason why people invest in health insurance. Basically the health insurances in the U. S. takes three forms are three. They include; Health Maintenance Organizations, Point-of-Service plans and Preferred Provider Organizations (Health insurance Overview, 2009). The Health Maintenance Organizations (HMOs) can be described as prepaid health policies.
The holders of these policies are required to pay fixed premiums each month which covers the holder together with his or her family by offering physicians visit, emergency care and laboratory checks along with other therapeutic services. It entails a wide infirmary exposure, has a huge association of pharmaceutical stores. HMOs involve contractual agreement between the covered parties through doctors to access treatment services. It is not mandatory that one pays co-insurable. The only payment required is a small co-payment every time you visit the healthcare center.
An example is $10 physician’s appointment fee and $25 emergency section cure fee. Any of the mentioned services in the contract does not require the procedures of filling forms. All that is required to access any service in the hospital is a HMO card. The insurance policy offers preventive measures like immunizations, mammograms, check ups and so on. The only disadvantage it has is the long bureaucratic procedures before accessing the service (Health insurance Overview, 2009). Point-Of-Service plans (POS) calls for the holder to identify personal doctor from an association of sources.
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The holder can outsource from the association but in such a case the benefits will be reduced. Selecting a personal doctor of Personal Care Physician from the network saves the company some money. The third type of health insurance is the Preferred Provider organization (PPOs). It is a blend of Health Maintenance Organizations and Fee-for service. They resemble HMO on the limitation of health centers and doctors choice in the approved list. The figure must fall within the agreed range. For your bills to be paid all you need is to hand in your card. It is mandatory to pay co-insurance as well as selecting a personal doctor.
A vast majority of them offer preventive care services such as immunizations, doctor appointments besides mammograms. In case you consult a doctor outside the plan, one has to fill a form and the coverage is partial leaving the lager portion on you. The filling of forms involves only the cases that were handled by doctors outside the plan (Health insurance Overview, 2009). 2. Describe the three methods for categorizing health insurance in the U. S. One of the major methods of categorizing health insurance is through the Indemnity plans or reimbursement plans.
In this category the plan compensates the health expenses no matter the provider used. Though there are restrictions on the amount to be compensated, they do vary with the type of policy. To settle on the amount to be compensated, three common methods are used in the Indemnity plan. These include Indemnity, repayment of definite charges and repayment of a certain percentage of genuine charges. Another method is through the Managed Care Plan. Unlike the indemnity plan, this involves the three major kinds of managed care plans mentioned earlier.
These are Health-Maintenance-Organization, Preferred-Provider-Organization and Point-Of-Service Plans. All of the above mentioned plans involve an agreement amid the insurer and a wellbeing provider’s network. Economic incentives are given to the insured to persuade them utilize the networks of providers who are selected in a formal process. 3. Identify the three types of managed care plans and give the pros and cons of each for the health care provider, insurer, and patient. Managed care plan is a wellbeing liberation scheme that combine the economic and deliverance of health-care.
It is applicable to different kinds of health-care insurance policies. The majority widespread managed care plans are; Preferred-Provider-Organizations, Health-Maintenance-Organizations and Point-of-Service plans. PPOs try to settle the therapeutic costs by involving provider networks that contract at low reimbursement charges. They are required to have utilization analysis among other necessities. Clients have the freedom to choose the medical provider they wish to but incur extra cost if their choice falls outside the network. HMOs encompass provider network and PCP as caretakers.
PCP handles the hospital admission of the client as well as appointments with medical practitioners. Some though use open policy that allows the client the choice of a personal doctor in the provider network without a recommendation. A vast majority of HMOs use the compensation to persuade providers economize on the cost. The policies may involve contractual agreements between doctors within the society or from the provider networks. The last but not least is the POS that provides members the chance to opt providers beyond the network. Clients who choose providers within the HMO network incur reduced cost that those with external providers.
The policy may also give a chance to provide a PCP to handle the intra-network examinations but with no recommendation for the exterior services. 4. Describe the impact of managed care on both the Medicare and Medicaid programs. The 2003 Medicare Modernization Act initiated a most important revolution to hold and transform personal health plans. It is very important that managers should consider the reason behind these routes because the programs have deviated and evaluate forecast for accomplishment in the Medicare Advantage commencement.
The wavering that face the Medicare managed care promotion designated a large discrepancy amid the relative harmony of controlled Medicaid programs within a similar period of time. The two managed care were discovered about two decades ago to improve the declining public programs. Since their initial implementation, there has been significant improvement in the field of interest. References Health Insurance Overview. (2009) Types of Health Insurance. Retrieved July 24, 2010,from http://www. healthinsuranceoverview. com/types-of-health- insurance. html
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Financing and Structuring Health Care. (2016, Jul 15). Retrieved from https://phdessay.com/financing-and-structuring-health-care/
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