Most people have a managed healthcare plan through an employer or self employment. Premiums are paid on the insured’s behalf for the purpose of covering healthcare costs. The two major healthcare plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Health Maintenance Organization (HMO) is an organization that provides healthcare coverage through hospitals, physicians, and other providers which are contracted by the HMO; this type of insurance coverage only pays for services rendered by physicians and other providers who are within the network and have agreed to treat patients according to the guidelines of the HMO contract. The HMO plan is usually less expensive because the patient is limited to certain providers.
In this journal, I will be reflecting about how insurance companies, hospitals, and patients can use Cost-benefit analysis for sustaining a life. First and foremost, Insurance companies routinely use cost-benefit analysis in healthcare to set policies and decide whether to approve claims. Many companies have blanket policies on general treatments, to either approve or deny them. If the cost is unacceptably high and the benefit is marginal or low, the company may deny treatment. In the event of an appeal, it can perform a more rigorous analysis of the situation.
This part carries a deductible and a monthly premium. Part B is also voluntary enrollment. • Part C – also known as Medicare Advantage Plans work with HMO and PPO to provide a custom plan for patients to receive accurate care with specific needs. • Part D – requires a premium and a deductible. This part works with private insurance companies.
Everybody would have access to health care through an application process and health care would be paid for based on tax revenue. Based on how much they make would determine how much help from the government they would receive. Every person with health care would receive a “smart card” with medical information and the bill will be sent to the government. The state will set fixed prices on procedures and medication based on income. There will also be a Co-pay every three months, and government would automatically pay for the poor and pregnant women.
A copayment is: A set amount that each patient pays for each office visit 9. Under this type of plan, insured patients must designate a primary care physician (PCP) Health maintenance plan 10. When physicians, hospitals, and other health care providers contract with one or more HMOs or directly with employers to provide care, this is called. A physician-hospital organization 11. Under this type of plan, a patient may see providers outside the plan, but the patient pays a higher portion of the fees: Preferred provider plan 12.
The deductible that must be paid by the patient in 2013 is $1184.00. This amount covers days 1-60 in the hospital. The patient’s responsibility for charges for days 1-60 in the hospital are $1184.00 ("Medicare Handbook," 2012, p. 30). After a patient has been admitted for a minimum of three days as an inpatient for a medically-necessary condition, they are eligible to be transferred to a SNF if daily skilled care is required. Examples of skilled care are daily physical therapy and intravenous medication.
Description of the problem and proposed change: The goal of the change project is to make congestive heart failure (CHF) patients with transportation problems aware that the hospital offers state funded program (Measure A) that provides free transportation to their clinic appointments. The implementation of this project was a decision made by the family nurse practitioner with full support of the director of nursing and cardiology. The ultimate goal is to decrease the number of no shows to clinic appointments. This plan was broken down into three phases. The first phase was to get all CHF patients approved for free transportation based on their disability and limitations secondary to heart disease.
The government covers the cost of all primary care and inpatient treatment, while drugs and advanced tests require co-payments of up to 30 percent. Children and the elderly do make these payments. You must have health insurance if you want to live in Italy. The government gets the resources to pay for this system from taxes collected at a national level combined with taxes collected at the regional sectors, the doctors and other medical care provider’s work for both the private and public sectors, where they received their payments from. If receiving public health insurance you sign up and you choose a doctor.
Consumers who have HMO pay a premium for coverage on medical cost and delivery of health care. Point-of-service plan (POS) is an open HMO. This plan allows members to choose a provider not on the HMO’s network and reduces restrictions. Out-of-network service must be paid by members and the deductible can be costly. The preferred provider organization (PPO) has premiums and copayments that are higher than the ones in HMO and PPO plans.
Under general social security health providers are earmarked by the public or private insurance carrier in which an injured party is required to file their claim. Once the claim is approved the injured party is referred to a hospital of the carrier’s choice for medical care and income replacement as is the case in no-fault compensation schemes. The major difference between the two is the fact that the funds under general social security is obtained from the taxpayers’ coffers. 1.2 TORT LIABILITY Tort liability is deeply rooted in the traditional tort principles of existence of