...Health Care Financing Gail M. Biggers Grand Canyon University: HCA 515 – O102 March 24, 2013 There are two broad approaches to financing health care: a market-based approach and a government-financed approach. For each approach, answer the following questions: 1. Who is provided access? Most government financed systems are inclined to make available for every person living in the nation with treatment which proposes access to some fundamental level of care. Majority of people pay for coverage through taxes and additional charges. In government financed health care the government may provide care itself such as the United Kingdom or they may contact other providers to do so ex: Germany and Japan or in the United States government financed programs Medicare and Medicaid. Under the market-based system it is employer based dependents other half or children may also be covered by the working spouses or parent’s employer. Access in the United States is restricted to those that health insurance through their employer under government plan and those those who can afford to buy insurance through their personal funds and those who can pay for services surreptitiously. 2. How much coverage is provided? Starting in January 2014 new individual plans and plans purchased in an Affordable Insurance Exchange will cover essential benefits like hospitalizations doctors’ services prescription drugs rehabilitation and mental health services. Under the government financed...
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...| |Market- Based Approach |Government- Financed Approach | | |(Private Insurance, self-insured employers, Managed Care |(Medicare, Medicaid, State Children’s Health Insurance Program [SCHIP]) | | |Organizations) | | |Access for who: |Private insurance provides access to employees whose employer,|Medicare is for individuals 65 years or older. Medicaid are for families | | |union or organization qualifies for group insurance. |with children in the Temporary Assistance for Needy, the elderly, blind, | | |Self-insured employers provide access to its employees and |and disabled with low incomes, and children and pregnant women whose income| | |managed care organizations provide access to its’ insured (Shi|is 133% below the Federal Poverty Level (Shi & Singh, 2008). SCHIP provides| | |& Singh, 2008). |access to children under the age of 19 whose family income exceeds Medicaid| | | |threshold levels (Shi & Singh, 2008). ...
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...Financing of Health Care Teonna Smalls HCS/440 Donna Lupinacci 05/12/2012 Introduction HMO’s and enrollees are two important players in the world of health care. Due to uncertainty on the supply and demand, moral hazard, and adverse selection, decision making for HMO’s more complex. The simulation provided me the decision making tools necessary, when making an economic decision for an HMO. Health care can be seen as a good that consumers demand and managed care firms are considered to be suppliers of both health insurance and health care. Economics tells us that rational firms make choices to maximize profits. Managed care firms incur cost when providing health care services to their enrollees and maximize their revenue by providing health insurance. Castor Collins Health Plans Castor Collins Health Plans was founded as a regional HMO in 1999. The HMO provides health insurance and health services to enrollees through its statewide network of physicians and hospitals using a capitation model to pay health care providers within the network. Currently the plan has 100,000 enrollees through the state. My responsibility as Vice President of Castor of financial planning and strategy requires me to interact with new clients and formulate health plan that will best suit their needs. In addition, I am responsible for pricing plans and setting insurance premiums. Collins has three plans to choose from, Castor Standard, which does not cover preexisting medical conditions, Castor...
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...HealthCare Financing Cathy Jones HCA 515 9/9/2015 Market Based Approach 1. Who is provided access? Market based approach provides access to consumers and employers including large, small, and individual employers. All subjects encompass different needs and preferences. 2. How much coverage is provided? The amount of coverage varies per the need of the customer. It can provide as much or as little as they need. The qualifiers include but are not limited to the breadth of the coverage, the techniques in managing the services and the sharing of beneficiary amounts fluctuate. 3. How are the services paid for? They are paid for by the employer and consumer through high deductable health plans and Health Savings Accounts. 4. How does reimbursement apply? Employees are reimbursed through premiums with a set annual limit. One way is through Health Reimbursement Arrangement (HRA). These plans are popular because it allows the employer to reimburse employees tax free for their personal insurance premium and out of pocket medical expenses up to a certain limit. 5. Are there limitations on care? This approach does not serve everyone equally. Premiums and access to health insurance varies across the nation. Premiums vary with differences in the cost of living, what medical providers are in the area, and the pattern in health care practices. 6. What guides care decisions for patients? 7. What is the quality of services? This plan provides a...
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...Name: Michelle Burke Score: 100% Instructor: KATHLEEN GALUSZKA Date: Mon Jan 23 19:36:01 GMT-0500 2012 A term that means the assigning of staff to fill scheduled positions. You selected: Staffing Correct answer: Staffing A budget that generally deals with actual short term revenues and expenses necessary to operate the facility. You selected: Operating budget Correct answer: Operating budget The proportion of revenues realized from different types of payers. A measure often included in the profile of a healthcare organization. You selected: Payer mix Correct answer: Payer mix Name: Michelle Burke Score: 100% Instructor: KATHLEEN GALUSZKA Date: Mon Jan 23 19:36:01 GMT-0500 2012 Making choices among available alternatives. You selected: Decision making Correct answer: Decision making Provide evidence that some event has occurred in the healthcare financial system. You selected: Original records Correct answer: Original records One of the four basic financial statements. Generally speaking, the balance sheet records what an organization owns, what it owes, and what it is worth at a particular point in time. You selected: Balance sheet Correct answer: Balance sheet Name: Michelle Burke Score: 100% Instructor: KATHLEEN GALUSZKA Date: Mon Jan 23 19:36:01 GMT-0500 2012 Makes a manager responsible for both the revenue/volume side and expense side of a department, division, unit or program. You selected: Responsibility center Correct answer: Responsibility center Information...
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...completion of my undergraduate degree in 2012. I know that in order for me to continue to build myself professionally a graduate degree is extremely necessary. A Master’s degree will not only qualify you for more advanced career opportunities and increase salaries but it will also allow one the opportunity to completely immerse one’s self in a specific area of study. After the completing of my master program I hope to continue to progress along the professional ladder in the Healthcare industry. My dream job would be to work in a position where I would be able to directly affect patient care and experience without having to be clinical. To me this position would best be suited in patient advocacy or even patient relations. In either of these departments I would have the ability to work directly the community that we serve by listening to concerns, answering questions, and providing the necessary help and care to anyone who enters the facility. These departments are also culturally and religiously sensitive to the growing populations and demographics that contribute to the community in which they serve. In a professional setting the process of earning a Master’s degree will aid me in acquiring skills such as cognitive reasoning and negotiation, gain experience in different career fields as well as open up doors of opportunity that would normally be more limited to females than our male counterparts. According to a report from GMAC Global Management Survey (2012), more than half of all...
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...Strayer University | Financing and Structuring Health Care | Health Services Organization Dr. Manuel Johnican | | Erica Horton | 1/29/2012 | | | Financing and Structuring Health Care 1. Identify and describe the three main types of health insurance in the U.S. The three main types of health insurance in the U. S. are Voluntary Health Insurance (VHI), Social Health Insurance, and Public Assistance or Welfare Medicine. VHI is consisted of private insurance that people can purchase themselves. Examples are Blue Cross and Blue Shield or Health maintenance organizations that offer different types of health care plans to consumers that are affordable. Social Health Insurance is where the policy holder is pushed to be insured by a third party. (2001) A good example of this is when a government may make all employees participate in a social security program, so employers may make it apart of the job requirements that they participate in the insurance program. (2001) Several employers in the United States make in mandatory that employees carry their insurance or some kind of insurance. The last of the three is Public Assistance or Welfare Medicine. This insurance mainly consists of Medicare and Medicaid in the United States. These programs are federally funded and provide health care coverage to millions of people in the U.S. The Medicaid program and the Children’s Health Insurance Plan provides to almost 60 million...
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...Obstructive sleep apnea is a very common form of apnea which affects an individual’s sleep pattern; this condition causes cessation of breath or shallow breathing while asleep. Obstructive sleep apnea (OSA) occurs when there are consecutive episodes of complete or partial blockage of the upper airway during sleep. This blockage in airway causes the diaphragm and chest muscles to work harder in order pull air into the lungs and can also reduce the flow of oxygen to vital organs and cause irregular heart rhythms. Patients diagnosed with this condition often experience an array of symptoms such as daytime sleepiness or fatigue, Sudden awakenings with a sensation of gasping or choking, Restlessness during sleep, arrhythmias and are at risk of developing ischemic heart disease and other vascular related problems (Hsu et al., 2007). Several treatment options have been identified for individuals with OSA including continuous positive airway pressure (CPAP), weight loss to reduce pressure on the diaphragm, dental appliances, and surgical procedures. This study assessed patients who have undergone the uvulopalatopharyngoplasty (UPPP) procedure to determine if their upper airways have improved after the procedure. To make this determination, researchers used quantitative video endoscopic computer-assisted measurement (CAM) to show improvement in the apnea-hypopnea index (AHI). The researchers who conducted this study indicated that its design is prospective. Patients who participated...
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...Financing and Structuring Health Care Assignment #2 Health Services Organization – HSA 500 1. Identify and describe the three main types of health insurances in the U. S. The three main types of are Voluntary Health Insurance (VHI), Social Health Insurance, and Public Assistance or Welfare medicine. Each type of health insurance provides medical benefits which provide payment for medical services rendered. Voluntary health insurance (VHI) can be divided into three categories: BCBS, private or commercial insurance companies and Health Maintenance Organizations (HMO). VHI began in 1929 when Baylor teachers in Dallas, Texas contracted with Blue Cross to provide hospital coverage for three cents a day. This was the beginning of hospital coverage provided by an insurance company. Other states began to provide this same type of coverage for their employees. Since this time health coverage has been extended to provide benefits for physicians, pharmacies and other medical providers. More than 70 years later over 70 percent of the US population under age 65 has some form of VHI, and more than 90 percent of these have health coverage linked through employment. The United States mandates two social health insurance (SHI) programs: Workers Compensation which covers the cost associated with job-related injuries, and Medicare which provides health insurance for the elderly, disabled and other special groups. Workers Compensation provides two basic benefits: cash replacement for...
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...Financing and Structuring Health Care Strayer University HSA 500 Health Services Organization Mr. David Tataw July 24, 2011 1. Identify and describe the three main types of health insurances in the U. S. The three main types of health insurance in the United States are the commercial health Insurance, Blue Cross and Blue Shield, and Health Maintenance Organization (HMO). The commercial Health Insurance is typically offered by agents or brokers. These insurance carriers’ objective is to make a profit. The commercial health companies are owned by their policyholders or stockholders. Commercial Health insurance is classified by their renewal provision and the benefits it offers to the insured. The coverage includes medical expenses and disability income, which could be long or short term needs. The category of commercial health Insurance companies offer insurance on other property such as home, auto, business etc. (Williams, & Torrens, 2010). Companies that offer a portfolio of services from insurance coverage to pension plan and other financial services are consider multiline carriers (Williams, & Torrens, 2010). Within the commercial health industries, there are companies that are considered single-line carriers that offer health insurance and related employee benefits only (Williams, & Torrens, 2010). Blue Cross and Blue Shield were closely affiliated with the American Hospital Association; their initial focus was on insuring hospitals...
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...head: FINANCING AND STRUCTURING HEALTH CARE Financing and Structuring Health Care Health Services Organization- HSA 500 December 15, 2011 Identify and describe the three main types of health insurance in the U.S. The three main types of health insurance are: * Voluntary Health Insurance * Social Health Insurance * Welfare Health Care According to the authors of our textbook (Williams & Torrens, 2010) “Voluntary or private health insurance in the United States can be subdivided into three distinct categories: (1) Blue Cross and Blue Shield, (2) private or commercial insurance companies, and (3) health maintenance organizations” (p. 82). Initially, Blue Cross and Blue Shield were two separate entities. Before merging in the early eighties, Blue Cross provided coverage for hospital services and Blue Shield covered physician services only. The companies under the Blue Cross and Blue Shield umbrella are licensees and operate independently of each other but all offer plans within specific areas of the country. Private or commercial insurance companies are those that provide health benefits to groups or individuals which are paid for by other parties (ex: employers, employees, unions, etc.) besides the United States government. This particular type of insurance can vary in cost and the benefits received; it all depends upon who is paying and what they are willing to cover. Health Maintenance Organizations (HMOs) are companies that manage the care between...
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...HealthCare Financing and Structuring Health Care Erroll Reese Instructor: HSA 500 – Health Services Organization January 23, 2010 Table of Contents Introduction ……………………………………………………………………………………. 3 Identify and describe the three main types of health insurance in the U.S ……………..…….... 3 Describe the three methods for categorizing health insurance in the U.S……………………….. 5 Identify the three types of managed care plans and provide the pros and cons of each for the health care provider, insurer, and patient……………………………………...............................5 Describe the impact of managed care on both the Medicare and Medicaid programs.…………. 8 Conclusion ……………………………………………….……………………………………… 8 References …………………………………………….………………………….……………… 9 Introduction Our stable outlook on the U.S. health insurance sector reflects our belief that industry risk is moderating, business conditions--including growth and retention opportunities and access to capital--have improved, and health insurers' financial fundamentals are now relatively strong. Offsetting these favorable factors are concerns about slowing economic growth, growing governmental fiscal pressures (particularly at the state and local levels), and health care reform issues. We believe these factors will affect each business and individuals differently and will likely keep the number of rating actions moderate for 2012. Identify and describe the three main types of health insurance in...
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...Financing Health Care in the U.S. Tim Johnson HCCUniversity NURS 3006 Section 02, The Context of Healthcare Delivery Nov 24, 2013 Financing Health Care in the U.S. Financing healthcare in the U. S. continues to be a major concern, and going forward it could become a monsoon. There are many methods available to finance healthcare in this country, and some people have access to several methods. However, a large percentage does not have access to any methods, and as a result they are uninsured. Among the methods used to finance healthcare are private insurance, Medicare, and Medicaid. We will discuss Medicare, and some of the issues the federal government is facing with rising health care cost. Money and how to pay for things are always at the forefront of the problems. Unlike other healthcare funding issues Medicaid is funded totally by the federal government. Private insurance is funded by employers, employees and private citizens. Medicaid is funded 2/3 by the federal government and 1/3 by the state government. Medicare is currently funded by tax payers and the federal income tax. The population is getting older, and many baby boomers are nearing 65 years of age and will be eligible for Medicare. If the current trend continues many experts believe the system will be bankrupt within 10 years. As a result, the government will have to increase the federal income tax, or find a way to reduce cost. One of the main issues is that curtailing cost normally means...
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...The Economic Impact on HMOs Katria Anderson HCS/440 ECONOMICS: THE FINANCING OF HEALTH CARE November 18, 2013 Jeanne Hutsberger Major The Economic Impact on HMOs Health care insurance has always been a hot commodity for people in the United States. Over the course of the past decade the demand has become even greater. Health care reform has implemented laws that state the employers must offer health insurance. Because of this companies are looking for ways they can offer insurance with the lowest possible impact on their administrative budget. This is no easy task, but there are insurance companies that offer plans that will work for all parties involved. In order to offer companies plans that will suit their employees and not break the bank close attention to detail must be paid to the company’s overall state of health. An in-depth analysis is conducted and health conditions are looked at with much scrutiny. Although it appears to be much to go through for health insurance coverage, it is an absolute necessity. “Insurers have to determine a premium price based on risk factors balanced over the entire group, using general information on members of the group, such as age or gender” (National Conference of State Legislatures, 2013). Castor Collins Health Plans has taken on the task of deciding on offering coverage to one of two businesses. The businesses are Constructit...
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...Provena Health – Ghost Image Log This Image was checked for viruses on: 8/25/09 |PC Make / Mod |HP dc7900 sff |Memory Size |2Gb | |PC serial no. | |Hard Drive Size |250Gb | |Image Name |dc7900v4 |System ROM Date |V1.16 | |Date Imaged |8/26/09 |System ROM SoftPaq | | |Operating Sys |XP |Video Card |Intel Q45/Q43 | |Your Name |Reese |NIC Card |Intel 82567LM-3 | |Version of Ghost used |11.5 |Wireless Card if installed | | | | |Local Admin Password |roo$t3r | |Note: Latest ROMPaq must be installed (dock must be updated |Note: After ghosting and before putting on the network, PC or laptop must have McAfee| |also for laptops). ...
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