Pages:6 (1653 words)
HealthCare Insurance and Reimbursement
Medical Insurance Products and Services
Health and medical insurance represent an insurance coverage form that disburses operation and clinical treatment expenditure incurred by those insured. Such insurance may either reimburse insured individuals for the money they put into treatment for injuries or disease or may directly pay care practitioners. It is commonly a part of the compensation packages offered by organizations to their employees for attracting quality recruits (IMedPub, 2020). It constitutes one means by which individuals in different nations pay for their healthcare needs. When individuals hailing from poor backgrounds without any financial risk protection get sick or injured, they encounter the following difficulty: they may either make use of healthcare services, further impoverishing themselves by financing these services, or may forego treatment, stay sick/injured, and risk not being able to function properly or go to work. Regardless of the differences in funding and corporate structures in different nations, high-income nations currently witness an almost undisputed dedication to guaranteeing universal healthcare access to their citizens. Globally, healthcare insurance coverage attempts at improving health service utilization as well as safeguarding families against destitution due to out-of-pocket expenses (Ho, 2015).
Managed healthcare insurance plans represent a substitute for conventional healthcare plans, such as paid service plans. Over the last few decades, such schemes have grown into a widely-chosen health insurance form, with the growth of healthcare expenses. The kind of managed scheme of an individual determines how the individual acquires healthcare services. Some of the key kinds of network healthcare plans are:
· Health Maintenance Organization (HMO)
· Point of Service Plan (POS)
· Preferred Provider Organization (PPO)
· Exclusive Provider Organization (EPO)
The most flexible plans will, perhaps, be the costliest on account of the associated lack of previously agreed-upon network member contracts. While plans differ, HMOs are usually the cheapest alternative when it comes to managed care. Meanwhile, PPOs are moderately expensive; the POS is, perhaps, owing to its maximum flexibility, costlier as compared to HMOs; and the EPO, perhaps, entails out-of-pocket expenses if one gets services outside member organizations or network (Araujo, 2020).
Role of Health Care Providers, Insurers and Integrated Delivery Systems
Healthcare insurers’ market power is leveraged to obtain price discounts from healthcare organizations and systems or providers or for screening out costly providers from the networks. Insured individuals profit from such discounts even if they are paying out of their pockets for healthcare services (except for prescription drugs, as patients, even those who are insured, typically pay the list price). Policies concentrating on this health insurance function impact healthcare organizations’ and providers’ negotiating leverage about insurers. For instance, Medicare establishes payment rates using fee schedules, instead of enabling healthcare systems to utilize their leverage in the market for driving up charged rates. The ACA (Affordable Care Act) urged insurers to forge “narrow” healthcare organization and provider networks for aiding commercial plans in obtaining reduced rates using greater negotiating leverage. Further, the consolidation of insurance firms reinforces the negotiating position of the insurer (Dey & Bach, 2019).
The goal of offering improved catastrophic monetary protection that is dependent upon pooling the risks of several individuals who won’t be enduring such events is contrary to the goal of selling highly-personalized insurance to different clients based on their unique anticipated needs. Encouragement of narrow networks may help reduce prices, though at the expense of omitting quality practitioners. Governmental, as well as commercial insurers, have come up with measurement efforts aimed at monitoring and improving healthcare organization quality. Some examples are quality ratings that aid…
Operation Finance and Budgeting
The health sector is one of the sole global sectors, which will be imperative in the long run, unforeseeable. This domain has been undergoing constant growth and progress for several centuries, with no indication of ever slowing down. Day after day, technological advancements in some or other areas contributing to the health sector are witnessed. Right from drugs to clinical instruments, healthcare sector improvements have the potential to change, improve, and save lives worldwide. With the expansion in human knowledge of such matters is a simultaneous expansion of inpatient care. Ultimately, better patient results are the aim of all healthcare organizations and facilities, irrespective of any other differences that may exist between healthcare practitioners (Strata Decision Technology, 2020).
Decision-making represents a central factor when deciding small and large provider success in the long run, though it isn’t the sole factor to be considered by healthcare organizations. Healthcare organizations seeking both long life and heightened current patient outcomes must consider financial planning. Those bracing for the future are also better equipped to handle coming change. With the swift evolution of healthcare markets, it is sometimes difficult to ascertain where best to allocate funds and how to balance capital budgets. But organizations prepared for the numerous future possibilities may more effectively and strategically plan for the future in terms of finance. Financial security can be secured by organizations planning well in advance where to spend funds while seeking areas for cost improvements. Healthcare practitioners not constantly seeking areas for improving efficiency usually end up wasting considerable money. While there is a need to devote some funds to compulsory entities dutifully, other areas like substitute devices, several metrics, vendor negotiations and leverage, and contract analysis must be thoroughly studied before allotting funds. Here, funds are generally…
Araujo, M. (2020). Health and medical insurance differences: HMO, PPO, POS, EPO. Retrieved from https://www.thebalance.com/health-and-medical-insurance-2645378
Bertram, M. Y., Lauer, J. A., De Joncheere, K. D., Edejer, T., Hutubessy, R., Kieny, M. P., & Hill, S. R. (2016). Cost-effectiveness thresholds: pros and cons. Bull World Health Organ, 94, 925–930. http://dx.doi.org/10.2471/BLT.15.164418926
Dey, P., & Bach, P. B. (2019). The 6 functions of health insurance. The JAMA Forum, 321(13), 1242-1243. DOI:10.1001/jama.2019.2320
Ho, A. (2015). Health insurance. Encyclopedia of Global Bioethics. Retrieved from https://www.researchgate.net/publication/298022702_Health_Insurance
IMedPub. (2020). Health insurance. Retrieved from https://www.imedpub.com/scholarly/health-insurance-journals-articles-ppts-list.php
Maruthappu, M., Hasan, A., & Zeltner, T. (2016). Enablers and barriers in implementing integrated care. Health System & Reform, 1(4), 250-256. https://doi.org/10.1080/23288604.2015.1077301
Sekhri, N. (2000). Managed care: The US experience. Bulletin of the World Health Organization, 78(6), 830-844. Retrieved from https://www.who.int/bulletin/archives/78(6)830.pdf
Strata Decision Technology. (2020). Healthcare and hospital capital budget. Retrieved from https://www.stratadecision.com/healthcare-and-hospital-capital-budget/
Health Care Reimbursement and Billing Both Mrs. Zwick and Mr. Davis face significant issues in the presented scenarios. Mrs. Zwick has multiple considerations under Medicare Parts A, B and D, in addition to her hospital-acquired urinary tract infection. Meanwhile, Mr. Davis must address the severe time constraints and costs of COBRA in light of his job termination. These two scenarios underscore current difficulties and complexities of current health care in the
Health Care Economics In economics, cost-benefit analysis assists in evaluating the costs of an approach in terms of resources spent while cost-effective analysis evaluates the costs as achieving some sort of benefit which is not evaluated in monetary terms. Moreover, cost-benefit study examines several aspects including net-present value, present value of benefit, and present value of costs; in line with this, if a project indicates that the monetary outcome is greater
Health Care in the U.S. And Spain What Can the U.S. Learn About Health Care from Spain? In 2009, Spain's single-payer health care system was ranked the seventh best in the world by the World Health Organization (Socolovsky, 2009). By comparison, the U.S. health care system ranted at 37 (Satiroglou, 2009). The Spanish system offers coverage as a right of citizenship that is constitutionally guaranteed. Spanish residents pay no expenses out-of-pocket, with
For example, prior to 2007, there were approximately 1 million confirmed cases of hospital-acquired ("nosocomial") infections in American hospitals and other healthcare institutions (clinics, nursing homes, etc.), resulting in the premature and preventable deaths of nearly 100,000 patients who would otherwise have survived the illnesses or surgeries for which they originally received treatment in those institutions (Reid, 2009). Approaches to Reducing Healthcare Costs Because the problem of treating those nosocomial infections
Future of health care in the St. Louis area This paper presents a detailed examination of the future of health care in the St. Louis area. Included in the paper are discussions about economics and population issues as well as changes hat are coming. The writer addresses many economic issues including good and services and resources in the health care industry currently as well as the future projections. There were 12
Strategic Management of a Healthcare Facility in St. Louis In the late 1800's and early 1900's St. Louis was a major center for automotive and other heavy manufacturing but the industrial restructuring of the Midwest during the latter half of the century has resulted in consistent economic decline of the St. Louis region. Today however as the rest of the country faces a slowing economy this region is showing new signs