Health Insurance Case Study

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Introduction The concept of Health Insurance and managed health care the inventions of the twentieth century that were started as prepaid health care. The early insurance concept was merely a way for people to pay medical bills not a way of protecting individual financial assets as the case is today. Overall the health care industry has endured significant changes since its inception. The early years of Managed care (1910 to mid-1940) The hallmark of this era was the emergence of the prepaid practices and the emergence of the Blue Cross and Blue Shield (the Blue Cross and Blue shield were commonly referred to as the blues). It was noted that most hospital physicians continued to retain the Blues until 1970‘s (Kongstvedt, 2009). The pre-world …show more content…

These early HMOs included the Kaiser Foundation Health Plan, the Health Association in Washington, D.C. 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). Early Years of Managed Care: 1940’s to mid-1960s This era witnessed the expansion of the health benefits. Prior to world war II, only 10% employed individuals had health benefits but, by 1955 the number had increased to 70 %. For example, the health insurance plan of York was created solely for the employees of New York …show more content…

The early parts of this era also, witness the credentialing requirements of the various HMOs across the nation. For example state licensures were mandatory while federal qualifications were regarded as a voluntary act by the HMOs, however, it was in the best interest of the HMO’s to obtaining the approval of the federal government (Fox & Kongstvedt, 2015; Kongstvedt,

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