Preferred Provider Organization Essay

PPO- This plan contracts with physicians and facilities to perform services and a specified rate. Its to ensure that PPO members are charged less than nonmembers

By the 1960s, the formation of unions help to standardized employer health benefits and the access to insurance was prevalent for workers. This system seemed to be well established as the employers, private health insurance carries, physicians and hospitals would recycle health cost amongst each other. However, there were many underlying problems with this tightly organized system. Self employed individuals, small companies, the poor, and the unemployed had no organized access to health insurance. Also, at this time the majority of elderly retirees lost their health insurance in old age when they needed it most. These underserved populations began to seek care in emergency facilities driving the cost of urgent care back on the hospital and

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

What’s next? Some experts say that if the consumer-directed approach doesn’t succeed, em wash their hands of health care altogether. A recent study by the Employee Benefit Researc showed that the proportion of U.S. residents covered by employment-based health benefits d percent in 2000 to 60 percent in 2004. Decades from now, observers may conclude that a counter- revolution in employer coverage began in these early years of the 21st century. —Terence F. Shea

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits. This mandate of cost control, efficient operations and market share has facilitated a constant analysis of the dynamic health

The subject of insurance and how heavily the government can mandate it or not mandate it is a constant struggle in politics. There is always the question of “what kind of relationship should the government have with its people and what role should it play with businesses?” Currently, a popular subject is the Affordable Care Act (Obamacare) and it is challenging the boundaries by requiring people to have health insurance and requiring businesses to offer health insurance to everyone and anyone. Mandating insurance is a hot button subject in other areas too that we will discuss like auto insurance, workers’ compensation insurance, and professional malpractice insurance.

Societal beliefs and values influence the Affordable Care act. The health care budget is under constraint, how to provide the most recent and enhanced health care while saving money has become a major issue. With this new health reform, millions of Americans who could not afford insurance with their employers or are uninsured due to lack of employment have the opportunity to become insured. The major economic change in this society has created enormous challenges for workers, families, as well as employers. The implementation of this act reduced this plague in the health delivery system.

The current system of healthcare in the US evolved from a circumstantial set of laws passed during World War II. Because wages were limited by law, employers resorted to fringe benefits as a means for attracting top talent. Healthcare plans existed prior to the conflict, but due to the war, these plans became an ingrained national phenomenon (Blumberg and Davidson). Tying health insurance to employment proved problematic because the unemployed, or self-employed, often lacked coverage. Around the beginning of the 1970s, increases in healthcare costs began to diverge from the Consumer Price Index (CPI). This trend has only increased since then and has

If one specific job entitles healthcare while others do not, this means people are more likely to stay with that job and not move to another position, [3].

The expenses for managers will keep on rising, the quantity of uninsured individuals will likewise keep on increasing with an augmenting gap between what can be afforded and what is accessible. The rate of the uninsured will reach out into the present working class. These disappointed people, and their managers, may vote in favor of an adjustment in the health care

Many employees must designate a health plan through their employer. These days, as HMOs (health maintenance organizations) and managed care plans continue to proliferate, that means a choice between bad and worse. As employees line up in the lunch-room for a process called open enrollment, they may be surprised to learn that managed care rates have gone up — again. The mirage that managed care is cheaper care is finally fading. And, for the first time in years, employees may also have the promise of free choice in medicine in the form of a new method of financing health care. Consumers are already aware of horror stories involving HMOs, but cheap rates persuaded many that managed care is less expensive. Recent

The implementation of the Patient Protection and Affordable Care Act introduced the Employer Shared Responsibility Provisions that requires employers to provide health insurance to full-time employees, or pay a tax penalty. There are dire predictions that under “play or pay”, large employers would try to eliminate health benefits or cut workers’ hours to get under the cap requiring health benefits. Employers would achieve this by re-designating full-time employees as independent contractors.

The United States being referred for specialties depends on the insurance plan (Mossialos, Wenzel, Osborn, Sarnak, 2016, pp. 171-177). Health Maintenance Organization (HMO) plans give access to certain healthcare organizations and physician within their network that have agreed to lower rates for their services. The individual must agree to these services to have services covered. All services will be coordinated by the primary care physician PCP. Medicaid coverage is also based on these principles. Preferred Provider Organization (PPO) plan have higher premiums but give more flexibility. PPO allows the individual to see any physician they choose but cost is less if the individual stays within the network. PPO does not require that the individual have a PCP. No referrals for specialist are needed.

One of the must have necessities of a human being is the provision of sound health care and every government, both national or local is obligated to offer this essential service to all the citizens without favor or any discrimination of any kind. Where else it is paramount that every employer to make sure the health and the safety of the employees are given the first priory. This will make sure the employees who are injured during the work are taken care of, and they are relieved the burden of the cost of health care. Thus, it is common to find most companies get the services of insurance companies and other organizations which provide health care programs for workers such as IndUShealth to make sure the welfare of the employees is in safe

There is no denying the fact that the cost of health care in the United States has been on a constant rise than the wage of the employees that pay to have access to better healthcare. There is the general fear among these employees that if the rising cost of the health care is not brought under control, there will come a time, and some analyst think, the time is already here, when those employees will not be able to afford health care for themselves and their families. This fear of the unknown is particularly evident among those closer to retirement. Employers of labor have for quite sometimes now, been shifting the burden of the high cost of affordable health care to their employees, and that has significantly reduced employee standard of