...Private Payer and Consumer-Driven Health Plans PPOs will pay participating contributors established on a discount from their physician fee schedules, called discounted fee-for-service. Under the PPO’s, the patient has to pay an annual premium and frequently a deductible. A PPO plan may propose either a lower deductible with a higher insurance payment or a high deductible with a lower premium. Covered members remit a copayment at the time of each medical service. Each individual may also have a per annual deductible to pay out-of-pocket. A patient may see an out-of-network doctor requiring a referral or preauthorization, but the deductible for out-of-network services may be higher, and the percentage plan will pay may be lower (Valerius, Bayes, Newby, Seggern, 2008). Healthcare organizations were initially intended to protect all basic services for an annual premium and visit copayments. This contract is called “first-dollar coverage” considering that no deductible is needed and patients do not make out-of-pocket payments. On account of expenses, still, HMOs may at the present time assign deductibles to family coverage, and employer-sponsored HMOs are also starting to restore copayment with coinsurance for some services (Valerius, Bayes, Newby, Seggern, 2008). HCR 230 Week 1 Assignment Features of Private Payers and Consumer Driven Health Plans Get Tutorial by Clicking on the...
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...In contrast, Germans who need medical care often pay very little for copays as well as very little for out-of-pocket expenses. In the United States there are usually several choices of which doctor you wish to see and a complicated system of in and out of network providers, but you can choose to see the doctor you want to see within this system. In Germany, if you are using the government-regulated health care plan you need to see whichever doctor is available at your nearest hospital and you have fewer choices. However you do have more choices over your provider if you use the more expensive private insurance. In conclusion, I think the best feature of the United States insurance is the choices to available to consumers, while the best of the German system is less out-of-pocket expense at the time you need medical treatment. Both systems have their positives and negatives and can be very confusing to try to figure out. Overall, I think I would prefer to be covered under the German system at this point due to its lack of cost at the time when I would need it most. Within this system I would prefer to use the government-regulated system and supplement it with some private insurance so I could have more choices while...
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...little bit of Beveridge, Bismarck, National Health Insurance, and Out of Pocket models. The working class is considered to be generally in the Beveridge model. Americans who receive Medicare or Medicaid are considered to be on the National insurance model. Americans with no health insurance are on the Out of Pocket model, (Reid, 2008). Germany has the Bismarck model. This model is to ensure that all people have comprehensive coverage. Germany has what they call a sickness fund that both the employer and the employee fund through withholding. Features are quality care, low cost, claims paid without question, fixed prices, private healthcare providers, and strict governance of insurance sold on a nonprofit basis. Physicians acquire a costless education, have essentially no departmental obligations, and are hardly ever brought into litigation, (Reid, 2008). 1b. In four sentences total describe the Beveridge, Bismarck, National Insurance, and Out of Pocket models. Beveridge model is not based on whether or not a person can pay but based on medical necessity. (The Beveridge Model, 2010) Bismarck model has a sickness fund which is paid by both employer and employee through withholdings, (Kevin M.D.com, 2011). National Insurance consists of Medicare and Medicaid put in place by the government, (The National Health Insurance Model, 2011). Out of Pocket model is based on a patient’s ability to pay out of pocket for services rendered. (Personal, Experience) 2a. What types...
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...assignment will also show how the medical market differs from other markets and how this contributes to the rise in health care costs. Finally, the assignment will show how a small business owner whose group insurance policy costs continue to rise may make decisions to halt increases to his insurance cost. I would not get the laser surgery at the cost of $500.00 per eye. The procedure is considered to be cosmetic and not a medical need or emergency. This would make the surgery elective and a choice. Since my nearsightedness does not interfere with my job performance and also is not a detrimental factor in getting a job, I would not see a need to spend that amount of money. Even though odds of the surgery correcting my vision are very high, due to the surgery not being covered by my health insurance, I could not afford the out of pocket expense for the procedure. Such a response also reflects the reality that the moral hazard is low or non-existent. This is due to the fact that the procedures would not protect me from a disease or debilitating health condition (Folland, Goodman & Stano, 2010, pp. 155-156). If my health insurance covers 80% of the cost of surgery, I would have the surgery. This would mean that I would only have to pay a total of $200.00, as my out of pocket costs would be $100.00 per eye. The insurance company would pay $800.00. Coinsurance allows for the insurance company and the person insured to share the costs of the medical procedure. The insurance...
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...the contribution and the benefits are limited for a period of one year. Why Health Insurance? Medical expenses are sky high these days. An appointment with a doctor might churn out big bucks. The elaborate medical treatment medical expenses could eat into your savings meant for the future. Health insurance policy kicks in to ensure that you get the required treatment and your pocket is still under control. Having health insurance is important because the coverage helps people get timely medical care and improve lives and health. It covers the risk of financial difficulties in the event of long illness. The awareness has been enormous in the last couple of years. This must have been in response to the series of uncertainties people have observed in recent times like the terror attacks. BENEFITS: Benefit depends on the policy you choose and the coverage it provides. Here is a list of basic coverage provided by most of the health policies. 1. It helps securing a better future by paying a fraction as an expense today called the premium. 2. It reduces saving huge amount of financial losses, risk of financial breakdown in case of expensive medical and post-illness care. 3. It definitely induces a sense of security to the insured. 4. It provides financial security to the family members. 5. It covers your hospitalization and medical bills. 6. It also covers disability and custodial bills. 7. You can avail tax benefits on the premium paid under...
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...These facilities offer the amenities to socialize with one another and do activities that can strengthen their minds and increase mobility on their motor skills. During my college years, I had to participate in one of these facilities for an assignment and it was a great experience. Members would play dominoes, sew, and do plenty of arts of crafts. Another form of Long-Term Care is an Assisted Living Facility, this consist of a facility that can be mostly associated with an apartment complex. It can offer services as a regular living community with medical attention for those who require it. When comfortable with your living settings and are able to be fully independent, residents are able to upgrade their living arrangements. Only those who are able to independent with their ADL’s are able to living in this type of facility. Also, Nursing homes are facilities that patients are admitted when not independent or require medical attention that cannot be given at their primary residence or if they don’t have a caretaker. There is also Hospice Care which entails to make the patient as comfortable as possible on their last days of living. It prepares the family mentally, emotionally, and physically for the loss of...
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...HEALTH Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners. HEALTH CARE SCENARIO Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line. Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country. CG: Central Government PH: Primary Health MCH: Maternal and Child Health. • Access to health care service providers and availability of physicians is one part of the...
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...way I can give back to a community. I have chosen to work with the elderly because I have seen firsthand the helplessness and unknowing that comes along with getting older. The elderly community has many troubles. Some of the troubles are: getting good nutrition, affordable housing, medical care, loss of driving capabilities, loneliness, and lack of family support. I plan to be a very diligent advocate for the elderly on any issue or problem they are facing. Many elderly are lacking nutritional care. This is usually caused by not having enough money for food. Many elderly have to choose between good nutritional food and medications. Most people opt for the medications and live with little to no food. How I would aviate on behalf of the elderly community regarding nutrition care is to lobby government to raise the limit of how much money can be made to be eligible for food stamps. In Ohio the monthly cash limit allowed is $1,174 of monthly income for a single individual. For a family of two, it‘s $1,579 (White, 2011). If a person or family makes over these amounts they are not eligible for food stamps. Once a person pays their rent, water, electric, gas, phone, insurance, and medication expenses there is not much left, if there is any money left at all for food. Another issue facing the elderly is affordable housing. Most of the cheaper housing is in bad neighborhoods where drug sales and crime are a part of everyday life. Getting the government to give poorer communities to...
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...however, the health care industries growth has stayed low. Federal actuary analysis has shown that in 2011 there was $2.7 trillion spent nationally; the averages per person consisted of $8,680 spent on health care. These figures show a 3.9% of growth rates in both 2010 and 2011. Not exactly what individuals want to see concerning their health and getting the proper medical care they need (NCSL. 2013). Expenses are paid out to multiple different areas, the major areas consisting of physician and clinical services, Medicare spending, private health insurance, retail prescription drugs, and out-of-pocket spending; it was these areas that percentages rose. Major areas that slowed down in the spending rate were Medicaid and Hospital spending (NCSL. 2013). The graphs below show the area percentages in which accelerated and what slowed. Health care spending has recently proven to be too much, thinking about that $2.7 trillion spent nationally in 2011, is a big part of why the United States is in debt, and cannot pull itself out. With 2014 quickly upon Americans, the United States needs to be careful with its expenses; health care spending is to rise by 7.4%. This rise will be after the Affordable Care Act (ACA), Medicaid, and health insurance exchange have their expansions, allowing roughly 30 million more individuals to have health care benefits (Adams. 2013). Reasoning behind the expected rise also has to do with the 22 million that are going to...
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...University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. | |Origin: When was the |What kind of payment |Who pays for care? |What is the access |How does the model affect patients? |How does the model affect providers? | | |model first used? |system is used, such | |structure, such as |Include pros and cons. |Include pros and cons. | | | |as prospective, | |gatekeeper, open-access, | | | | | |retrospective, or | |and so forth? | | ...
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...to be very popular with the people enrolled in these programs. These are also known as health reimbursement accounts, health savings account and the like, are components of ways for individuals to allocated funds (Wikipedia, 2011). Funds are deducted from your weekly paycheck and may be used to pay for out-of-the pocket expenses. These funds are tax deductible and “pre-tax” dollars are a benefit to people. Flexible Benefit Program What is a flexible benefit program? A flexible benefit program is a program that allows eligible employees to choose and pay for benefits such as medical insurance, life insurance, short and long term disability, out-of-pocket medical expenses, child care or even adult day care. These benefits are paid for out of their pre-taxed income. One benefit for an employee who takes advantage of a flexible benefit program is that the insurance and other benefits that they contribute to are usually of a better quality than what they could purchase on their own. This is because the company that is going to supply these can get a better price and better benefits for a larger group, such as the company they are working for. If a person were to go out and try to get the same benefits on their own they would be so expensive that the average person more than likely would not be able to afford them. When an employee pays for these benefits with their pre-taxed income they actually end up paying less in taxes. According...
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...relies heavily on private health insurance, which is the main source of coverage for most Americans. According to the Center of Disease Control, approximately 58% of Americans have private health insurance. The primary public programs are Medicare, a federal social insurance program for seniors and certain disabled individuals and Medicaid, also referred to as Medical. These two are funded jointly by the federal government and states but managed at the state level, which covers certain very low income children and their families. Health advocacy companies initiated to become visible to assist patients muddle through the complexities of the healthcare system (Wikipedia, 2014). In 2010 President Obama signed into law the Patient Protection and Affordable Care Act. This Act includes individual mandate that every American must have medical insurance or pay a fine at tax time (Obama Care Facts, 2014). Before the enhancement of medical expense insurance, patients were presumed to pay health care costs out of their own pockets, which is known as the fee-for-service professional standard. Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid base, eventually leading to the development of Blue Cross organizations. The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World...
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...Income, Risk, and Consumer Demand for Healthcare Why is the depreciation of capital good a cost of society? In what ways does a person’s health depreciate? Depreciation is the way to track the wear and tear of assets over time. Now, only those assets which are defined as being capital goods can depreciate. The capital goods will provide value or generate income for the company over a period of time normally greater than one year. The depreciation of capital goods requires knowing three different variables: the original cost of the asset, the salvage value of the asset and the life expectancy of the asset. All three of these variables help the organizations or companies to determine the amount to write policies off against income on an annual basis. Based on that, the cost for the society for the use or availability of this service or technology will be established. So the investment for example on a new instrument or new technology will be recuperated thru the years of use as income, and this income would be obtained from the users (customers). At the end, the company will obtain the total investment plus some income from that investment if used by customers to obtain good health. The health is treated as a stock which degrades over time in the absence of "investments" in health, so that health is viewed as a sort of capital. Unfortunately the depreciation rate increases with age similar to any instrument or technology. It is more difficult to achieve or...
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...understanding how they affect healthcare economics can be challenging to say the least. Although, there are many factors that contributed to these changes perhaps the biggest factor was the technological advances and changes in the quality of medical care. To be able to prosper now, and plan the future one must study the past. Healthcare mangers must fully understand the history and flow of funds in healthcare economics to be effective in their positions. Although, it seems obvious it is important to remember that the driving force behind any organization including healthcare is money. Money is vital because without it the organization would have to close. “Formalized medicine in America began in the 1800’s and continued until the 1930’s. This helped to establish the medical profession through both expanded duties and formal education” (Wasley, 2011para4). When doctors or physicians first began some would barter with their less fortunate patients to ensure payment for services rendered. Doctors that would have taken food, livestock or even just a partial payment when the medical profession began are now highly paid physicians or technicians. “In 1929 81% of expenditures came directly from the individuals out of pocket payments and 11% came from other sources the government and third party payers” (Getzen & Moore, 2007 chapter1 para22). Today...
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...Health Care Spending By: Davida McKnight HCS/440 Pranab Root February 16, 2015 Health Care Spending In today’s society the purpose of our nation’s health care practices has shifted from supplying and meeting the medical needs of patients to the supply and demand of fee-for-service care. Our growing health care crisis is the results of medical organizations working with third party payers and private insurance sectors focusing more on the assets of funding instead of the quality of care for patients. As a result the rising cost of health care is continuously huge issue affecting our economy making it difficult for many Americans to live comfortably within our economy less known afford insurance services. The quality of care is not a priority of many health care professionals but the necessity of meeting quantity over volume is the mission of many health care groups. Health care organizations has lost their dedication for healing and helping patients to avoiding and profiting patient volumes. The trending rates of inflation, increased health insurance coverage, demographics, provider merging, technology and the lack of health provider-patient care ratios are enormous contributors as well affecting our nation’s health care spending. The National Health Care Expenditure The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health...
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