Sign Up Now
Get instant access to over 1 million+ study documents
OR
Already registered? click here to login
By creating your account, you agree to our terms of service, privacy policy and student honor code.
Health Insurance Plans
There seem to be three basic health insurance categories. They are generally called Fee-for-Service, Managed Care or Health Saving plans, though some call them by other names. The fee-for-service plan is what many people consider the traditional type of insurance. Like automobile insurance, people choose the cover they want and pay the price for those services. Often health care providers just take this insurance and the company pays after a deductible or co-pay, which are amounts to be paid at the time of service (usually a relatively small amount).
Managed Care is a newer type that essentially relies on the insurance companies having some type of agreement with doctors, hospitals and other care providers. Those who join a managed care program have choices from these services and negotiated amounts are paid to the provider for very specific services or types of treatment. In some cases, there are restrictions on what types of care will be paid for. Again, sometimes deductibles have to be met first...
Some of these services have preferred higher levels of quality or specialties that are appealing to some who may be willing to pay more.
The final type is something like a Health Savings Account. This was an effort to give individuals more control over their money and is often offered by employers. Basically money is set aside in a bank account that can be used for certain purposes over the course of a year. There are incentives for how to use the money related to health care. Until it is spent the funds can be invested or can earn interest. Most of the time individuals with these services also have another type of health insurance to cover certain costs.
MANAGED CARE TYPES: There are three kinds of Managed Care plans: HMOs, PPOs and POSs. Health Maintenance Organizations are popular because they save money by having large numbers of people who share costs. Their focus is often on preventive care, trying to keep health problems from developing or getting worse. Doctors and…
MANAGED CARE TYPES: There are three kinds of Managed Care plans: HMOs, PPOs and POSs. Health Maintenance Organizations are popular because they save money by having large numbers of people who share costs. Their focus is often on preventive care, trying to keep health problems from developing or getting worse. Doctors and hospitals agree to accept certain fees and co-pays. They often restrict the procedures. Cost savings is very important with HMOs.
Preferred Provider Organizations are similar to HMOs but usually cost more but offer more flexibility, at least within the network of doctors and hospitals they arrange. These types of programs usually allow people to go outside of the network if needed but it can cost higher service fees to do this. Sometimes specialist services can be included if someone needs a particular type of care. Point of Sale options are a final type. They are a hybrid of HMOs and PPOs. A primary doctor has to be identified and he or she determines what care can be received and where. With his or her authorization, the patient can go to other caregivers as needed though fees may again be higher. It seems that this option was a way to confirm that medical treatment, not just cost management was still important.
MEDICARE AND MEDICAID: Medicare and Medicaid are government options for care for poor and elderly people. They have care that is offered like regular insurance and some managed care options. The managed care elements were added with the growth of this option for others. Though it is hard to tell yet as to whether care is better, early results suggest people like this option. A Kaiser (2010) study shows that interest in this element has been great. The number of Medicaid users in a managed care program doubled to 33 million by 2008. However, the costs rose dramatically too so it isn't clear if this is good for savings. Other studies indicate that beneficiaries had better access to services and liked the care they received more. Some research shows that the type of care a patient gets is different too. In a study on heart procedures, patients received more sophisticated treatments and had less need for repeat procedures. In-patient procedures seem to be reduced as more people get less intensive care. Pharmacy costs seem to have been reduced as well.
Health Insurance Consumer Knowledge Do most people know everything about their health insurance plans? The two plans investigated for this assignment are Blue Cross Blue Shield and Humana, two of the most widely used and recognized health insurance companies in the United States. Do you think that in general most people know everything about their health insurance plans? The healthcare reform act of 2009 sought to make the healthcare system in the United States
" (National Conference of State Legislatures Forum for State Health Policy Leadership, 2007). However, regardless of state, the applicants have to meet certain qualifications. First, applicants have to be both uninsured and not eligible for Medicaid for other forms of state sponsored insurance. In addition, not all S-CHIP recipients have to be children; states can get waivers to use S-CHIP funds to cover adults. These other recipients are generally adults
High Insurance Portability Health Insurance Portability & Accountability Act Some hope was given for the current legal environment to become better defined for health-care providers when Health Insurance Portability & Accountability Act (HIPAA) was passed by the in 1996. As previously mentioned, HIPAA is a monumental act that attempts to address and incorporate all three issues-- privacy, confidentiality, and security within one law. When HIPAA was passed, many applauded the portability aspects
Each of these was included in the initial Senate bill, but was struck from the final Senate version. Despite the victories, the group isn't ready to pledge support for health reform bills. The AMA will not endorse any legislation unless Congress gets rid of the mandated payment cuts of more than $200 billion over 10 years in the government's Medicare program for the elderly. The cuts are part of
Even though the overall life expectancy in the U.S. has increased to the age of 78, the relative ranking has fallen in relation to the rest of the world, with the U.S. now 38th out of 195 countries, behind most of Western Europe. These rankings may reflect the combination of a shortage of public health education, lack of daily exercise, poor nutrition, and the uninsured not seeking medical help. The results seem
A recent article touted the 6.1% growth of spending on medical care in 2007. The same article cautioned however that, "most experts know that no matter what the numbers say, there is still a great deal of work ahead to reform a healthcare system that is still fundamentally broken -- and is facing one of the worst economic recessions in decades" (Lubell, 2009, pg. 6). Government and industry officials have been