This policy covers hospitalization expenses which intends to provide coverage to people as well as their family in the eventuality of high treatment costs for any injury or disease related contingencies like hospitalization, organ transplantation etc. on the other hand , people opt for a compulsory deductible amount, which their bear either through existing health coverage or through own/other sources. The policy acts as an additional cover over and above the deductible amount. The policy therefore addresses galloping medical inflation at a very reasonable
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There is a move from a noncompetitive insurance environment to a competitive one because the competition was not by hospitals to provide the best and cheapest care, but rather among the insurers to get the healthiest patients. Consumer driven plans are central to the process because they are ideal for risk selecting the young and fit who have been driven to new plans. Healthy people could watch their account balances grow which leaves the truly sick behind in traditional plans. This particular type of competition is being used to attract the healthy and in turn lead to price increases because insurers have little incentive to control the prices medical providers are charged. It is the responsibility of the patients to worry about the cost and the patient does not have the same power as the insurance competitors do. According to a key South African regulator, Alex van den Heever of the Council for Medical Schemes, “Competition based on the shifting of risk
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.
Large populations of Americans are uninsured mainly because of the high cost of insurance. Majority of the uninsured are the low-income working families’. The adults represent a higher percentage of the uninsured than children. Before the law, you could be denied coverage or treatment because you had been sick in the past, be dropped mid-treatment for making a simple mistake on your application, hence, the Affordable Care Act was implemented into law on March 23, 2010 by President Barrack Obama to make sure that every American irrespective of their status will be insured and have full access to proper health care benefits, rights and protection(1). To understand the
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).
One of the issues is the increasing cost of healthcare which is dominating the health policy in U.S. this is accompanied by an increase in spending on healthcare. According to projections by the government, the spending on medical care will continue to rise. U.S spends more money on health care than any other nation globally (Holtz, 2013). The increase in the spending is as a result of improved tools for disease diagnosis, better surgical interventions among others. This raises an issue for the policy makers on the maximum GDP percentage that a country has to spend on healthcare, and whether the nation will afford the cost that is continually growing. In contemplating any change in the health policy, policy makers should consider the cost of the healthcare and the ability of the nation to support that high cost.
This insurance encouraged people that had this basic form of insurance to get a second opinion on their medical issues especially elective surgeries. You had to pay for services that you were receiving right away.
Close to half of each dollar spent on healthcare is inefficiently used both at a clinical and administrative level. Three other areas that funds are not appropriately in are insurer overhead and profit and over priced pharmaceuticals. Projected figures for the first year estimate that just in administrative costs alone the citizenry should see approximately twenty billion dollars worth of savings in the first year. Another area that will put approximately $5.2 billion dollars back into the budget will be that this program will allow the state purchasing power for mass quantity pharmaceuticals and durable equipment. Finally by increasing the emphasis on preventative care and making a primary care physician available to all will add another $3.4 billion. Last but definitely not least, it is estimated that this bill will dramatically reduce fraud approximately $800 billion dollars in healthcare spending. Total savings for the first year are projected to be approximately $29 billion dollars. The projected plan is to use this money for the purpose of providing healthcare to the populous that is currently without health insurance. With these savings and more efficient use of funds all residents will have comprehensive healthcare that at this point was leaving twelve million without it as well as not increase spending (Amaro
The second obligation pertained to the circulation of the yearly prescription costs that followed the simple design for health costs which was normally the main part of the program’s expenses which were caused by a small number of the programs enrollees. The costs from the small amount of enrollees have the ability to be an enormous amount. Therefore, in order for the Medicare prescription program to offer most support for the participants that required it more than the catastrophic coverage had to have a lower co-pay amount attached to it. The model’s ending fee level has a five percent co-insurance obligation without a limit of on coverage. (Kaplan 2011)
Chapter five from the text Health Policy the organization, financing, and delivery of Health Care in America third edition by author Donald Barr M.D., Ph.D, confirms healthcare’s complexity. The text describes many healthcare, competitive options. Each time a health dilemma has arisen instead of repairing the current health care model, the government develops a new plan. Healthcare plans are similar to software upgrades. Each time a technological glitch occurs the software manufacturer creates an update of the previous version. Most often the software update is another expense for the consumer; not a viable option. Furthermore, the upgrade does not guarantee the new version will work any better. Typically, there is yet another glitch to fix in the latest version. In essence, the health care system should problem solve the healthcare plans that have failed.
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
Through the formulas we can manage resources and revenues which is what chapter 15 explains about. At the beginning of this chapter it brings about the subject of healthcare insurance which protects the individual from “paying the full price of healthcare” (Sayles and Gordon 2016) and also the Affordable Care Act which is more commonly known by its nickname Obama Care. There are a number of ways a person can ways an individual can pay for such insurance is by out of pocket which means that the money for the procedure is coming straight from the patient and copayment also called co-pay which ‘is a cost-sharing measure in which the policyholder pays a fixed dollar amount per service. All of this depends on eligibility which pertains to the verification
An uninsured population creates market instability to the insurance and health care industry because many individuals do not seek health insurance or medical care until they are very sick. This creates an economical dilemma where patients will either seek insurance at the point of their illness which creates a burden on the insurance company or if that patient is uninsurable then they are likely not able to pay for the hospital bills that will accrue and then the burden is put on the hospital. For those that are chronically ill the same concept occurs on a regular basis and these patients are then forced to seek primary care through Emergency rooms, etc. If they are not able to pay then the cost is distributed to the hospitals and society. The PCIPP plan and section 2704 of the Public Health Service Act was an attempt to initiate the distribution of that financial burden and to stabilize the healthcare market across the U.S. in addition to giving better access to care for high risk patients.
As a “comprehensive major medical insurance policy,” the Dumonts’ coverage includes basic health insurance for hospital, surgical, and physician expense needs, as well as major medical expense coverage. The latter is very important to extend the basic coverage to protect the Dumonts from the financial effects of a catastrophic illness or accident. The policy has a very adequate lifetime cap of $3,000,000 per insured. The Dumonts should continually analyze the health plans from both employers to determine which offers the best overall plan. But, the annual coinsurance, stop-loss amount, and family
Consider the "Excluded Services" section and the "Payment/Premium" section from your own health insurance contract. Which one is easier to understand? In plain English, discuss what each one means to you as a patient.