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.
(0.5 points) Health insurance helps pays for your medical bills and expenses. 5. What is COBRA? (0.5 points) COBRA is a federal government act that allows employees who lose their health benefits the right to continue participating in the insurance plan for a specific amount of time. 6.
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.
An effective policy should address how a practice handles prepayment for services they will provide and also any possibility for payment arrangements of unpaid balances on a patient’s account. If a practice offers charity care or discounts to patients with low incomes/financial need it should be stated in the financial policy. Clear medical office procedures that are consistently followed by staff members help support the office’s financial policy. When administrative staff members collect appropriate copayments and other fees as stated in the financial policy, they are helping to support the policy. Consequences that may arise when office procedures do not support
Policy Elements 1 Policy Elements Name School Policy Elements 2 The Pennsylvania Department of Public Welfare sponsors a program designed to help cover the costs of employer-sponsored medical coverage. This program is called the Pennsylvania Health Insurance Premium Payment Program (HIPP). Those individuals that are eligible for Medicaid, with an employed member in the household would qualify for HIPP if the employee’s employer sponsored insurance will cover those individuals. The HIPP program will then reimburse the employee for any expenses deducted from the employees pay for insurance, in addition to covering any co-payments that may be due at the time medical services are rendered. The mission of the Pennsylvania HIPP program is simple.
Certification affords hospitals to participate in federally funded Medicare and Medicaid programs. Accreditation is defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve.” (Raik, 2001) Continuous improvement should be the ultimate goal when providing health care to the public whether it is a private for profit organizations or a community health center that is not for profit. There are both national and international accreditation bodies that survey and provide hospitals with accreditation. In the United States the standard for hospital accreditation is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which per
Costs and benefits of intervention are evaluated in terms of public willingness to pay for pay benefits and pay to avoid costs. Inputs are typically measured in terms of opportunity cost Process=monetary value of initial and ongoing expenses vs. expected returns. Cost effective analysis A number of approaches are available to understand the economic costs and impact on health outcomes. The most common type of economic
Economic Issues for HMOs Dana Carter HCS/440 December 7, 2010 Tom Flora, PhD Economic Issues for HMOs This simulation looks at providing health care insurance coverage from the standpoint of a health maintenance organization (HMO). The obligation of Castor Collins is to provide health care for potential members of two companies, Constructit Construction and E-Editor. Castor Collins had to decide about quality of health care at a price that covers premiums and potential earnings from the plans both companies can purchase. Castor Collins also had to decide if insuring both companies would be optimal in the HMO and would they have to deny coverage based on a risk and utilization assessment. Insurance Plans The simulation
Health insurance plans pay doctors, hospitals and other providers in various ways such as fee for service, bundled payments or a fixed amount for all services that a patient may receive over a period of time. * * Inflation- rising costs of supplies, facilities and drugs used increased volume * Investment- what investment is health care – new facilities (buildings) research – adaptation
Healthcare plans are beginning to offer financial incentives for quality patient care referred to as pay-for performance programs. The national Pressure Ulcer Advisory panel recommends to conduct regular prevalence and incidence surveys to gather data on facility-acquired