What are some potential advantages of using high-risk pools

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Reference no: EM133875639

Section 1.

Some PPO plans differ in how many healthcare providers they include in their networks. A "wide" network gives members access to more providers, while a "narrow" network offers fewer choices. Would you expect a PPO with a narrow network to have higher or lower premiums than one with a wide network? Why?

Section 2.

Suppose you work for a Managed Care Organization (MCO) preparing to negotiate payment rates with a hospital. You've received the hospital's chargemaster, which lists over 10,000 procedures along with their associated charges. Your task is to determine which procedures are most important to negotiate strongly on.

a. In general, does an MCO aim to negotiate prices up or down? What about hospitals?

b. As an MCO, how would you decide which procedures to focus on during negotiations to push for better rates (based on your goal in part a)? You may refer to the "flat of the curve" concept to support your explanation.

Section 3.

A common approach to addressing adverse selection in insurance markets is the use of a "high-risk pool," where individuals with the highest health risks are either provided with public insurance or receive government subsidies to help cover the cost of private insurance.

a. What are some potential advantages of using high-risk pools?

b. What are some potential downsides or challenges associated with high-risk pools?

Reference no: EM133875639

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