Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many features in terms of medication coverage, coverage of surgery expenses and hospital care services. Most plans provide coverage no drugs given where as other plans offer a range of coverage for dentist services and other providers. Lets examine the two Medicare health plans and determine how they in one part ease the accessibility of patients to health care services and on the other hand how they limit the accessibility of Medicare services to patients. Indemnity insurance coverage is the type that allows the patient to make a choice of doctors and hospitals. In this case, this Medicare plan makes it easy for the patient to access health care service since one does not require a referral to visit a specialist or obtain other services like carrying out x-ray tests and other lab services. Availability of paper work, for instance, medical records that one initially acquired from primary physician is enough for presentation. For a patient to get quality service based on the diagnosis, one should not forget t... ... middle of paper ... ...ntives to improve hospital effectiveness. Basing on referrals and payment of services, if the operating expense shoots up, the hospital maintains the disparities between the costs of cheap hospitalizations and the standard price of the DRG, but will acquire losses if hospitalization costs are elevated. The DRG is used as the result inconsistent because it a strong compilation with rate cost. Charity cares are non profit health facilities that bases on provision of financial assistance services to communities and individuals who are urgently in need and lacks financial alternatives. These facilities are required to access the community health needs, determine the finance to be spent, and ensure for limitations on charges billing and collection practices. To conclude, health care is a very crucial sector, it should be managed well for it to deliver quality services
Describe the differences between nonprofit and for-profit hospitals. William & Torres provided a table to reflect hospital ownership, and noted that some hospitals, while owned by one type of entity, may be operating under a contract by another entity, such as a hospital management company (Williams & Torres, page 185). Some of the largest groups of hospitals in the nation are nonprofit community hospitals (Williams & Torrens, page 185). Nonprofit entities, including hospitals, function under special provisions of corporation law in each state, and under federal and state tax provisions that recognize their community service function (Williams & Torrens, page 185).
Medical malpractice has become a controversial social issue. From a doctor’s standpoint, decisions and preventative actions can alter the medical malpractice lawsuits filed against them. In order to protect their career and professional life medical malpractice insurance is available. Medical professional liability insurance, sometimes known as medical malpractice insurance, is one type of professional liability insurance. “Professional liability refers to liability that arises from a failure to use due care and the standard of care expected from a person in a particular profession, in this case a doctor, dentist, nurse, hospital or other health-related organization” (Brandenburg, 2014).
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Cost of medical care continues to increase and reimbursement is declining, therefore it is vital for the organization to consider types of payers that the service will attract. Knowledge of the types of insurance provided and the percentage of patients with Medicare, Medicai...
Health insurance is currently an important issue in the United States. Everyday more and more Americans become uninsured due to job loss and an increase in premiums. These Americans add to the ever growing population of 45.7 million people who are currently uninsured (Bialik). Moreover only 27% of those uninsured are under the age of 65 (NCHC). This is staggering considering most of those who are uninsured have, or soon will, suffer from some sort of illness or injury. As a result they will not be able to afford proper treatment. Insurance premiums can range in cost from fifty dollars per month, to fifteen hundred dollars per month (Kreidler). An individual’s premium is determined by factors they choose as well as other factors looked at by their provider. The cost of health insurance in America varies depending on the controllable factors, like particular insurance policies, and uncontrollable factors, like age.
When it comes to health matters, everyone becomes attentive. People believe that with good health, one can virtually accomplish anything that they desire. This is the reason to as why health is given all the attention. It is important to have a clear understanding of the meaning of the term health, healthcare and systems that are put in place to facilitate healthcare.
In order to fully understand the uninsured and underinsured problem that hospital administrators face the cause must be examined. The health outcomes of uninsured individuals are generally worse than those who are insured. Uninsured persons are more likely to experience avoidable hospitalizations, diagnosed at later stages of disease, hospitalized on an emergency or urgent basis, and more seriously ill upon hospitalization (Simpson, 2002) Because the uninsured often lack an ongoing relationship with a health-care provider, they are less likely to receive preventive care and diagnostic tests (Kemper, 2002). Many corporations balance their budget through cost cuts and other moves, but have been slammed with an increasing load of uninsured patients, coupled with reduced payments from government and private insurance programs. In 2000, 564,476 uninsured patients came through Health and Hospitals Corporations health care centers, a 30 percent increase from 1996. In the same period, Congress reduced Medicare reimbursements to hospitals, while Medicaid reimbursements to primary care clinics remained basicall...
The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.
What is the broader implication of managed care for health care services is how healthcare providers control health care cost and quality care. With all the competition to pick from and the rising cost of health care the consumers’ needs to look at all options available. The keys to manage care are the types of organizations and insurance options that include health (HMO’s) maintenance organizations, provider organizations PPO’ and POSS. The health insurance industry is big on wellness and prevention as part of managed care.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
Trinity Community Hospital is based in an economically sound community. Structured 25 years ago, in a prime location this 150-bed, non-for-profit hospital offers to the community residents a broad range of general medical, surgical, and support services. Patient Protection and Affordable Care Act (PPACA) of 2010 signed into law requires a non-profit hospital is to conduct a community needs assessment. To justify their tax exemption every three years thorough analysis of community assessment will be widely publicize. Interventions will also need to be included to meet assessment needs must also meet at least one of the following criteria:
With the United Nations listing health care as natural born right and the escalating cost of health care America has reached a debatable crisis. Even if you do have insurance it's a finical strain on most families.
Unfortunately, this era also witnessed tumor in the medical community as the American Medical Association (AMA) greatly opposed the prepaid plans of the early 1900s while favoring the indemnity- type insurance that reimbursed policyholders. Therefore with the pioneers of prepaid services encountering daring degrees of oppositions, a strategy to discourage such opposition led to the development of the early Independent practice associations (IPA) model HMO (Fox & Kongstvedt, 2015; Kongstvedt, 2009).
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.