Cost Analysis: Low-Quality Health Insurance

The articles I chose for my annotated bibliography were about healthcare cost and quality. The theme in many of these articles was about healthcare cost and does it affect patients experience. In some settings like hospitals, the cost of quality affects patient experience. The largest component of the U.S. Gross Domestic Product goes to healthcare spending (17% in 2009), and yet the quality is unsatisfactory. It was also interesting to find out that more people die each year in the United States from medical errors than from highway accidents, breast cancer, or AIDS (National Academy of Science's Institute of Medicine, 2002).

Health care expenses are a never ending headache that create numerous liabilities. Liabilities are created when goods or services are purchased on credit and obtained through short- term and long- term loans. Health care expenses create liabilities such that payments are made late or no payments are made at all. In some cases, the cost of health care expenses are unaffordable resulting in those type of payments. To prevent large health care debt, many individuals seek health insurance. Health insurance is provided by private insurance companies or by the government. It covers health care expenses and provides the necessary health care. Although, health insurance is necessary it can also be very costly.

Health insurance in the United States is a highly politicized issue. In recent years, many strides have been made to extend health insurance coverage to all Americans with the passage of the Patient Protection and Affordable Care Act (PPACA). While the program has been vigorously debated in the public realm, arguments are often centered around political ideology rather than economic theory. This paper seeks to challenge the entire structure of the current health insurance model, since its inception in the 1950s. Through the overuse of a third-party payer model, a magnitude of problems have emerged that severely diminish the efficiency of health care allocation in the United States. This paper proposes a model that seeks to correct issues of cost, access, and market efficiency by adapting the Medicare Part D payment scheme for an all encompassing insurance model.

Since the advent of health insurance in the 1950s, there have been many models of care that are come to the scene in an attempt to both control cost of care and improve quality of care. Insurance models came into being because the fee for service model used until then was proving to increase cost of healthcare without any measure of quality of services and care provided. Health insurance models have evolved from the basic hospital offered insurance to employer sponsored coverage plans. The US health system is broken both financially and quality wise with more than 20% of gross domestic product being spent on healthcare (Blackstone, 2016).

In America, we not only have the problem of the non-insured but the under insured which causes just about as much problem as the underinsured. Each group has contributed to the vast growing cost of healthcare. Over the last decade or two, the amount of uninsured has risen due to the job market in the economy and the fact that most insurances are tied to employment, which is also a problem as the unemployment rate rises. The purpose of this paper is to explore this issue.

The Affordable Care Act, signed into law on March 23, 2010, consists of 10 titles which provide Americans with health benefits. Sometimes this is referred to as “Obamacare” or the Patient Protection Act. The basis of the ACA is to assure that Americans can afford quality health insurance, without discrimination, while making purchasing insurance competitive for buyers, while also eliminating the uninsured (U.S. Department of Health and Human Services [HHS], 2015a). This allows the consumer to take control of their health care while making informed choices. By providing affordable health care, this will help reduce wasteful spending that does not improve the quality of health care, which could generate an annual savings of around $140 billion after a five-year period (Sahni, Chigurupati, Kocher, & Cutler, 2015). All American’s were required to be insured either by purchasing private insurance, by their employer, or

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

Insurance companies and health care providers have several methods of controlling prices and making profits. The ACA makes efforts to restrict the high costs of health care through new limits on out of pocket costs, removal of life time limits in insurance companies, and placing restrictions on denial of coverage to enrollees with preexisting conditions. The lifetime limits and high out of pocket costs are ways for insurance agencies to spend less money on their beneficiaries. By restricting access to care for those with preexisting conditions, they limit the amount they need to spend on expensive treatments for patients with conditions such as cancer and HIV which can cost companies millions of dollars. These changes will grant care to those that need it the most. In addition to controlling the cost of services provided to enrollees, there will also be changes in prices for insurance itself. The law establishes insurance exchanges that will help regulate the premiums for insurance by keeping companies and their rates

One of the most tangible benefits of the Affordable Care Act is that costs associated with procuring healthcare should significantly decrease. This projection is largely due to the act's ramifications throughout the health care insurance industry. Currently, insurance companies substantially increase the rates for health insurance for patients who have previously existing medical conditions. Under the auspices of the Affordable Care Act, this practice

There are benefits to the industry when considering stabilizing the gains made by the ACA provisions. From a societal perspective, the ACA has been successful in making health insurance more widely available and attainable. The success of the ACA in reducing the uninsured population, one of the primary goals of the legislation, has been well documented. Blumberg, Garrett, & Holahan (2016) found a 46% reduction in the number of nonelderly adults without insurance as of March 2015. Without the ACA, there would have been 39.3 million uninsured nonelderly adults (Blumberg, 2016).

The Government is a very important body as a stake in the health-care sector. Policies, Acts, and reforms are enacted and passed by the Government for adequate and better healthcare to meet the needs of its people. Insurance policies are one of the many ways that most States use to provide affordable and quality health care to every citizen. Although some of the laws may not have had a great impact towards the health-care, many have improved the services offered to the health-care consumer (Schmeer, 2016). Moreover, the government is also responsible for developing up policies which help in regulating the health

Health care coverage in the United States is a big business with a relatively recent history. For a company like Castor insurance, providing health care coverage is just as much of a business enterprise as any venture undertaken by a modern organization. As with any business, the central goal idea is to ensure ongoing profitability and viability in an every changing and increasingly competitive environment. Therefore, before offering any company insurance coverage, there are, important economic factors that need to be considered such as which health care package best covers the needs of both the insured and the insurer. To determine the best decision as to which insurance coverage to offer it is important to understand the history and

When assessing the health and well being of a population, one must be able identify common health care deficits. Once identified, a nurse can plan appropriate interventions to address health care deficits and improve the population’s overall wellness. The presence of vulnerability among populations make the skill of recognizing and addressing such deficits of vital importance for nurses. In the United States, as well as throughout the world, one such vulnerable population is school-aged children.

In order for a company to establish the correct balance between their risk-retention and risk-transfer they must first complete a risk-retention analysis. This analysis allows an organization to establish their maximum level of risk retention. This is accomplished through a combination of the traditional analysis of principles based on investment and decision, along with pricing according to the insurance industry. The results of this analysis show the cost-effectiveness and trade-off of savings on premiums versus the increased risk of a higher retention level. Now that the company has successfully established the basic parameters of being self-insured ,with assistance from their actuary, "an individual that specializes in the measurement and management of risk"(www.soa.org) and their commercial insurance broker; the most cost-effective type of risk retention must be established. Commercial insurance companies often dictate clients that are self-insured as to what type of risk-retention the company will assume. This occurs because once the self-insured clients maximum limits have been reached it is at this point the commercial insurance company assumes responsibility for any remaining amount of a claim. There are several types of strategies of risk-retention that companies can assume when self-insured that fall within the established boundaries of the commercial insurance market. Each self-insured company has its own unique risk-retention capacity specific to their

This study explores areas where the life insurance industry has changed over time through different product offerings, globalization, evolving technology, and changes in the economic environment of Discovery Vitality Life. The study provides a framework to assist regulators in assessing which changes have been successful, which need improvement, and what needs to be addressed in the future.