Meeting the health needs of the citizenry is complex, tedious and expensive, most of the times, requiring millions of dollars for implementation of health care services, policies and programs. Health care economics is the lifeline of health care delivery. The greater the demand for health care services, the greater the need for available and adequate funding. And as such, the intricacies of health care financing displayed a remarkable degree of continuity from the days of ancient civilization until the current 21st century. Developments in medical science and technology led to critical reflection on the outsourcing of finances vital to health care. In order to maintain a delicate balance between health expenditures and the quality of patient …show more content…
An insurance is a financing mechanism that aims protection against risk. If placed within the context and scope of health care, risk means the potential economic loss incurred by health consumers as a result of illness, accident or death. Therefore, health insurance is the financial mechanism through which people at risk of illness, accident or death can avail of health care services. Health insurance is the type of insurance that covers protection against the costs of medical services, disability or long-term care.The health insurance industry in the U.S is primarily pluralistic with many key players involved. Primarily, there are two types of health insurance: private health insurance and public (government) health insurance. The funding for most health insurance comes primarily from employers and the government. , Meanwhile, private health insurance is mainly voluntary and involves various health plan providers. (Liu & Singh,2008).
In lieu of this, health insurance manifests the following key concepts: First, there must be an "insured or beneficiary". A person protected under a particular health plan against substantial loss secondary to illness or death is known as the insured. The two classifications of employer-sponsored plans are single coverage plans and family coverage plans. In single coverage plans, only the employed individual is covered by the health insurance plan. While, family coverage plans provide protection not only to
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A health consumer who wishes to avail of a health insurance plan must take into consideration all of the above-mentioned general concepts. Furthermore, an individual can only make a sound decision and judgment if he knows which is the best health plan suited for him and his family. So, what are the different types of private health insurance?There are five private health care plans in the U.S.: managed care plans, indemnity plans, health maintenance organizations, preferred provider organization plans, and point of service plans. How does one differentiate each types of private health insurance plans?
Managed care plans have contract with designated health care providers and health facilities, who in turn provide health services at a discounted rate. The designated health care providers are part of the insurance company 's network and usually have guidance rules which speficy how much of the health care cost will the plan reimburse or pay for.
The contracted network of providers includes hospitals, clinics and health care providers that have signed a contract with the HMO. In this sense, HMOs are the most restrictive form of managed care plans because they restrict the procedures, providers and benefits by requiring that the members use these providers and no others. HMOs were intended to take health care in a new direction. They were designed by the government to do away with individual health insurance plans and to make affordable health insurance available to everyone. At that time employers were purchasing individual health insurance plans for their employees ~ a costly expense that many were starting to
Prior to the implementation of the Affordable Care Act (ACA), few people anticipated employer-provided health care would disappear as a major player in the United State healthcare arena. However, ACA adoption and has put more than 169 million employees at risk for losing their workplace coverage. Several studies indicate employer-based coverage will decline rapidly over the next decade as the traditional US system is displaced by the healthcare exchange system. While consumers grapple with finding affordable coverage options and providers adjust to the new norms, there is another wrinkle in the mix. In January, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced the agency's push toward value-based and alternative reimbursement models.
Medicaid managed care offers members a chance to choose a medicaid program that is more equlivalently relevant to their lifestyles. It focuses primarily on preventional health care and provides members with an enviornment in which they could be stable, as well as, cared for. In the article by Mary Caffrey titled “Kaiser Report: Medicaid Managed Care Policies Can Limit Access to Long-Acting Contraception”, she elaborates on her findings in the Kaiser Reports, including their findings as well. She analyzes how medicaid managed care policies can limit the access to long-acting contraceptives, ultimately affecting low-income women.
With taxes from healthcare slowly creeping into one’s income, a person under government healthcare is essentially paying the same, if not more, than a person under independent healthcare (Peikoff). Whether it is the scary policies in the PPACA or the destruction of market drive through government handouts, government healthcare is not the best route for the US. A free-market system provides much more advantages than a government system. A free-market system also puts more freedom in the hands of a consumer.
Medicare Kelsey Reinholt SOC 400 10/22/2015 Les Lazarevic ABSTRACT The focus of this paper is to provide knowledge over the Medicare and its requirements. This paper explains some challenges that might occur with the choices on Traditional Medicare, with Medicare+Choice, there is usually an incentive financially or at least an encouragement for a transfer to the private sector for little to no cost. Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated.
Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan.
the states regulate the business of insurance, which includes the MCO (such as a health maintenance organization (HMO)) that offers a managed care policy to an individual, employer, or other purchaser. If a private sector employer sponsors a plan that is not purchased from an MCO (i.e., the plan is self-insured), The details and the extent of these state laws vary considerably, but they remain in force as a mechanism for regulating HMOs and other forms of managed care organizations. A number of states require managed care plans to provide current and new enrollees the opportunity to continue to receive care and services for a period of time with a provider that has been terminated or dis-enrolled from the plan. Many states call for health plans to institute procedures that provide an enrollee that requires specialized medical care over a prolonged period of time to receive a standing referral to a specialist. Many state laws specify automatic coverage for emergency medical conditions "of sufficient severity, including severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of medical attention to result in placing the person’s health in
The Uninsured With the 2016 election passing just a mere month ago, we have all had our fair share of politics. And without a doubt, if you watched any of the debates, you heard about the Affordable Care Act, more commonly known as Obamacare. While Trump, along with Republicans. wants to repeal this law, Hillary, along with Democrats, wanted to build off of it(What Donald Trump, Hillary Clinton Have Promised To Do To Obamacare).
Eligibility for Medicaid is income based and most often provides coverage for children of low income families. Here in Colorado they cover all child services at 100% percent, no form of copay. With adults it will cover family planning, items to assist with quitting smoking and emergency services. Medicare is funded through payroll taxes and can only
The United States is the only Western nation that does not authorize free health services to its people. The cost of healthcare to the uninsured is beyond prohibitive, and insurance plans are far more captivated with profit costs, rather
The United States no longer posses the ability to effectively drive down premium costs through the means of insuring healthy people. For example there is a town with ten houses, and, on average, one house a year burns down. If no one in the town pays for insurance they have a 10% chance of their house burning down each year. If everyone in the town pays insurance they spread the risk because no matter whose house burns down no one will have to pay anything as the insurance company will cover the cost of the house that burns down each year and make a slight profit. This is the same logic applied to the whole medical insurance market.
In general, healthcare is from private insurance companies, however, we also give government healthcare to people in need through systems like Medicare. America’s current mixed system is a better fit for the United States because of its greater efficiency and lower cost. A mixed system of healthcare is more beneficial for America than a Universal Healthcare system would be due to its substantial
The United States has multiple health care options such as Obamacare, Medicare, Medicaid, and health insurance through employers or on their own. Most of the people living in the United States, around 70% of individuals, get health insurance through their work or union. Other individuals get insurance on their own or a family plan. Some averages of individual and family premiums and deductibles are around a $280/month premium and $4,120 deductible for an individual, while for a family plan it is around $930/month premium and $7,760 deductible.
Before the Affordable Care Act was put into work, over 45 million Americans were uninsured. The Affordable Care Act, also known as Obamacare, was then made to help those who were uninsured. It allowed people with financial struggles with the same opportunity as everyone else to have a healthcare plan. Even though the law was passed in 2010, it took a full year of back and forth to get it passed in the Senate. Obamacare may help you get coverage, but charge you an annual fee if you don’t have one.
Health insurance is one of the main insurances ones can have in life. Without reliable health insurance any small treatment can wipe out a person financially. " health insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured" as defined by Investopedia, 2015. The term ‘Health insurance’ was firstly discovered in the United States during the civil war.