Reference no: EM131159702

Replies should be in APA format and 250 words and include 1 Bible verse and a scholarly source.

Replies should offer peer-reviewed validation or challenges that demonstrate thoughtful analysis that contribute to the discussion, expound but not provoke.

REPLY TO DAWN

Topic: Financing and Managing Costs in Healthcare
The fee-for-service health plan model is based on the idea that a healthcare provider is paid a fee for the services rendered as part of the set of benefits purchased by the insured. In a prepayment healthcare model, "an insured individual pays a fixed, prespecified amount in exchange for services" (Buchbinder & Shanks, 2012, pg. 152).

In comparing each of the forms of payment options, copayments are used in both fee-for-services as well as the prepayment healthcare model. Under a fee-for services plan, deductibles must be met as well as a portion of the cost of their care before insurer begins making payments for the remaining costs. Additionally, "most indemnity insurance products are based on the fee-for-service model" while Health Maintenance Organizations (HMOs) have a fixed prepayment amount (pg. 155).

"Fee-for-service is associated with greater productivity but less continuity of care when contrasted with per capita prepayment which encourages more continuity and prevention" Levesque, Pineault, Provost, Tousignant, Couture, Silva, & Breton, 2010, pg. 3). Of the two health care models, the prepaid health plan seems to be the most beneficial for patients. "Pre-payment via capitation has previously been identified as an effective tool for cost containment and has been associated with a slower rate of growth of overall expenditures, program spending and patient co-payments per inpatient admission compared to fee-for-service" (Robyn, P. J., Bärnighausen, Souares, Traoré, Bicaba, Sié, & Sauerborn, 2014, pg. 233). Additionally, with a fee-for service, doctors and hospitals are paid for each services. The potential for an insured to be subjected to unnecessary tests, procedures or office visits would seem to be higher under this model because there is no cap for the billed services. It is more cost effective for both the insured as well as the organization to offer a prepaid healthcare model.

"The long-term financial effects of the Affordable Care Act (ACA) are expected to be profound and far-reaching" (Rollins, 2014, pg. 100). The positive impact of such a reform is that those who were previously uninsured will be forced to obtain insurance or pay a fee thereby significantly reducing the amount of bad debt and charity cases. This is offset, however, by the decrease in self-pay net revenue which occurs as the uninsured become insured (pg. 108). Additional financial hardships on the individuals who now must budget for the added cost of healthcare is also a factor. To mitigate the impact, hospitals will need to change the way they do business. Strategy planning and operational changes to finance the negative impact is in order for healthcare agencies (pg. 108). Mathew 10:8-9, Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received; freely give.

References:
•Buchbinder, S. B., & Shanks, N. H. (2012). Introduction to Health Care Management
(2nd ed.). Burlington, MA: Jones and Bartlett Learning.

•Levesque, J., Pineault, R., Provost, S., Tousignant, P., Couture, A., Silva, R. B., & Breton, M. (2010). Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie. BMC Fam Pract BMC Family Practice, 11(1). doi:10.1186/1471-2296-11-95

•Robyn, P. J., Bärnighausen, T., Souares, A., Traoré, A., Bicaba, B., Sié, A., & Sauerborn, R. (2014). Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study. Social Science & Medicine, 108, 223-236. doi:10.1016/j.socscimed.2014.01.034

•Rollins, R. L. (2014). Projecting the financial impact of healthcare reform. Healthcare Financial Management, 68(11), 100-108. Retrieved from https://ezproxy.liberty.edu:2048/login?url=https://search.proquest.com/docview/1648112191?accountid=12085

REPLY TO MANUEL
Healthcare in the United States has had a slow increase in its service costs, a combination of less usage from individuals and slight inflation in costs "has been the primary drivers for low rates of premium increases over the past years" (Insurance Journal, 2015). On average the cost of health care in the United States per individual is $8,233 per year (Kane, 2012), although that's the average cost, some medical services may have higher premiums which would increase that amount. In 2008, "healthcare expenditures in the United States were $2.3 trillion" (Buchbinder & Shanks, 2012, pg. 148).

Even though medical service costs may have been steady in past years, the cost of health care can be expensive. For some, paying for these services out of pocket may be a burden and possibly an unexpected expense, which if not prepared for such an expense could lead to a negative financial impact.

Preparing for such medical treatments, individuals have the option of opting in for health insurance. These insurance programs, depending on the treatment, often cover the full medical cost or would pay a percentage of the medical treatment leaving the individual responsible for the remaining balance. Two types of payment models exist, fee for service and prepayment, which an individual can choose to pay for their medical insurance needs.

Fee for service, is often more expensive than prepayment, but allows the insured more freedom to choose their provider of choice with minimal limitations. This plan often requires the insured to pay out of pocket for any medical treatment, then the insured can "submit bills for reimbursement" (The facts about PPO, HMO, FFS, and POS plans, 2016).

Prepayment health insurance offers various plans which an individual pays a fixed price either on a monthly or annual basis. This insured would be responsible for meeting set deductibles and co-payments at time of rendered health care. The insurance company would be billed for the treatment and the insured would be billed by the provider for the remainder of the balance. This type of insurance doesn't require the insured to pay up front all medical costs and requires less paperwork to be completed in comparison to the fee for service model.

The best type of insurance varies depending on the consumer, if the consumer has the funds to pay upfront medical costs and wants total freedom to choose his/her provider with minimal restrictions than a fee for service plan would be best. For a consumer that doesn't have the means to pay for medical services upfront or does not want to deal with extra paperwork to be reimbursed, a prepayment model would be in their best interest. As for the health insurance organization, fee for service may be in their best interest. Although the insured is able to visit their provider of choice the insurer still applies limitations on the covered costs and types of services rendered. The insurance company also requires the insured to fill out their own reimbursement which may save on time.

The new health care reform act also known as the Patient Protection and Affordable Care Act which was signed into effect on March 23, 2010 carries a major change for insured individuals. The reform was enacted to make health care more affordable and provide greater health care coverage for Americans. In theory, the idea was a good one to help the American people with expensive health care. The outcome has not been what was expected. Many insurance companies such as United Health Care Group and other major insurance carriers are abandoning participation in such reform due to the unexpected hikes in coverages and lost profits which are not fully recovered with government subsidies (Johnson, 2016). This is a major setback for the delivery of health insurance to individuals as the market has less options to choose from which means higher rates for the insured and less coverage.

References
•Buchbinder, S. B., & Shanks, N. H. (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Insurance Journal. (2015). Retrieved from https://www.insurancejournal.com/news/national/2015/11/12/388800.htm

•Johnson, C. Y. (2016, April 19). UnitedHealth Group to exit Obamacare exchanges in all but a ‘handful' of states. The Washington Post. Retrieved from https://www.washingtonpost.com/news/wonk/wp/2016/04/19/unitedhealth-group-to-exit-obamacare-exchanges-in-all-but-a-handful-of-states/

•Kane, J. (2012). Health costs: How the U.S. compares with other countries. Retrieved from https://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

•Atlas, S. W. (2015, March 4). How Obamacare fails the poor and middle class. CNN. Retrieved from https://www.cnn.com/2015/03/04/opinion/atlas-obamacare-poor-middle-class/

•The facts about PPO, HMO, FFS, and POS plans. (2016). Retrieved from https://www.allbusiness.com/the-facts-about-ppo-hmo-ffs-and-pos-plans-770-1.html