Reference no: EM131484992

Assignment: Spending on Healthcare

Write 200 words for each point. Explain your position on national health care spending in the United States. Include information on the following:

• The level of current national health care expenditures
• Whether the spending is too much or not enough

Economic Issue: HMO Simulation

Review the Health Care Economics Issues HMO Simulation.

In the simulation, select either Construct it or E-editor for analysis to complete your paper.

As a representative of Castor Insurance, your job is to maximize profit and minimize risk for the company.

Prepare a 700- to 1,050-word paper in which you do the following:

• Present a profile of the chosen company. Include the following:

o Demographics of the employees
o Health care risk factors or potential areas of high utilization
o Premiums the company is willing to pay

• Based on your analysis of potential utilization, provide the following:

oAt least two reasons why each plan could be selected
oState which plan to sell to your chosen company

What are the reasons for this decision?
Why did you decide against the other plans offered?

Public Health Tools and Methods Study Guide

As a team, complete the following table in which you identify 4 to 6 tools or methods used to address financial and economic challenges in the health care industry. An example has been provided.

Resources: this week's readings, the Economic Tools in the Public Health Economics and Tools section on the CDC website, the Department of Health and Human Services website, and other resources as needed that are available through additional research.

Tool/method Identify the purpose and use of the tool or method Identify the payment source and mechanism used with the tool or method

Return-on-Investment Forecasting Calculator (ROI Calculator) This tool evaluates the net financial benefits of initiatives designed to improve health care quality and reduce costs.

Two modules allow Medicaid stakeholders to develop ROI forecasts for initiatives designed to improve health care quality and reduce costs. Medicaid.

Healthcare Reform Project

The Health Care Reform Project consists of three parts that you will complete in Week Two, Three, and Five. Each part builds upon the last portion completed.

Select a current health care economic issue, such as managed care, health care spending, prescription drugs, the influence of current legislation on health care, medical care for an aging population, or the influence of illegal immigrants on health care economics in the United States.

Write a 150-to 350-word summary describing the issue.

Perform a literature search on the issue. Find at least three articles and summarize each article in 150 to 200 words.

Resources: Results from Health Care Reform Project: Part I

Research three possible solutions to your selected health care economic issue as determined in Part I. The solutions do not need to be extensive, but they must represent solutions identified in your research.

Describe your findings and proposed solutions in 700 to 1,050 words from the information and articles collected in the Health Care Reform Project: Part I assignment.

Understanding Economic Issues Worksheet

This simulation looks at providing health care insurance coverage from the standpoint of a health maintenance organization (HMO). As HMO executives, your obligation is to provide health care for the members you insure. You must do this with a high degree of quality at a price that covers services rendered. To do this, you must offer only those services you may provide at the cost the customer can pay.

In this simulation, you are presented with two potential customers: Constructit and E-editors. Each company is willing to pay a different premium for insurance coverage, and each company has a unique employee profile for health care risks. Your job is to determine what health care plan would best provide services and cover costs. Remember, at the end of the simulation, you may decide to deny coverage to either or both companies.

Answer the following questions about the insurance coverage and the health care profile. Then, determine what coverage is best for each company.
Health Plans Offered Castor Standard Castor Enhanced

List the major difference of each plan.

A third plan called Castor Enhanced Minor is also available. What is the major feature that makes this plan different from the two listed above?

Complete the following chart about the two customers seeking health care coverage.

Constructit E-editor

Premium willing to pay $4,000 $4,500

Three major demographic features of employees

% of population with major health risks

Review the demographics and the risk factors of the employees at each facility. The following chart shows services covered by Castor Insurance. Based on the demographics and risk factors would you expect the employees to be high or low utilzers of each service listed?

Service Provided Constructit E-editor

Inpatient hospital

Inpatient surgery

Emergency room

Inpatient mental health

Maternity care

Male/female sterilization

Skilled nursing care

Obesity care

Physician office visits

Hearing/vision screening

Immunizations

Ambulance services

Outpatient mental health

Diabetes care

Pre and postnatal care

Prescription drugs

As Castor Insurance, what plan would you choose for Constructit?

As Castor Insurance, list three reasons you have selected this plan.

As Castor Insurance, if you were going to sell Constructit the customized Castor Enhanced Minor plan, what two services listed above would you eliminate? (Remember, as the insurance company, you want to eliminate what would be the most costly for you.)

As Castor Insurance, what plan would you select for E-editor?

As Castor Insurance, list three reasons you have selected this plan.

As Castor Insurance, if you were going to sell E-editor the customized Castor Enhanced Minor plan, what two services listed above would you eliminate. (Remember, as the insurance company, you want to eliminate what would be the most costly for you.)

If you have selected not to cover either or both customers, provide three reasons you have made that choice.

Presentation - Prescription Drugs economic issue

Prepare a Microsoft PowerPoint presentation in which you summarize health care reform material.

Assume you are making a presentation to the board of directors concerning your investigation into the economic issue you submitted for your Health Care Reform Project assignments in Week Two and Three.

Have a minimum of 10 to 15 slides with extensive speaker notes, augmenting and expanding on the information presented in each slide.

Include the following in your presentation:

• Describe the economic issue selected.

• Identify methods and tools common to addressing economic challenges in the health care industry.

• Discuss how the methods and tools identified relate to health care reform.

• Determine the most effective method(s) and tool(s) that could be used to resolve the economic issue selected.

• Identify various payment sources and mechanism used in the health care industry.

• Determine which payment source(s) and mechanism(s) are the most effective to resolve the economic issue selected.

• List the steps needed to implement your solution.