Buisness 201 Essay

3912 Words May 4th, 2012 16 Pages
Assignment 2
Financing and Restructuring Health Care
Dr. David Tataw
HSA 500 Health Services Organization
January 28, 2012

Abstract:
This paper analyses the Financing and Structuring Health Care by analyzing four important notions. Firstly it Identifies and describe the three main types of health insurances in the U.S. Secondly it explains the three methods for categorizing health insurance in the U.S. This is followed by a synthesis of the pros and cons of managed health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs.

Identify and describe the three main types of health insurances in the U.S.

Rodts (2010) talks about
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There are three common practices that are used to determine the amount of reimbursement in an indemnity plan:
"Reimbursement of actual charges" is a method where the insurer reimburses you for the actual cost of your medical care regardless of the cost - as with any plan; there may be procedures or services that aren’t covered.
"Reimbursement of a percentage of actual charges" is a method where the insurer pays a set percentage of the actual charges on covered procedures and services, regardless of the cost, and you pay the difference.
"Indemnity" is a method where the insurer pays a specified amount per day for a predetermined number of days regardless of the actual cost of care. The reimbursements; however, will never be more than the actual expenses.
Managed Care Plan: A Managed Care Plan is different from an indemnity plan in several ways. Basically there are three different types of managed care plans – they are similar in nature, but the programs are different. The basic types of managed care plans are:
HMOs (Health Maintenance Organizations)
PPOs (Preferred Provider Organization)
POS (Point of Service Plans)
The main commonality of these three types of managed care plans is that have an arrangement between an insurer and a network of selected health care providers. They offer financial incentives to the insured to encourage them to use the providers in the network. They usually have specific

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