health insurance matrix HCS/235 Essay

637 Words3 Pages
University of Phoenix Material

Health Insurance Matrix

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

Include APA citations for the content you provide.

Origin: When was the model first used?
What…show more content…
According to Austin and Wetle (2012), employers covered 83% of premium costs for single coverage and 73% for family coverage in 2009. The employee, or beneficiary, paid the difference. Then, the health insurance company pays the provider directly.
Example:
HMOs have the strictest access structure, called a gatekeeper model, where patients must have a primary care physician (PCP) through whom all care is routed. PCPs decide which diagnostic tests are needed and control access to specialists through referrals, deciding when it is necessary for a patient to seek more expensive specialty care (Barsukiewicz, Raffel, & Raffel, 2010).
Example:
HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.
Example:
Advantages of HMOs are that a known amount of revenue is guaranteed and the patient population number is fixed (Austin & Wetle, 2012). In addition, if providers use less in services than the capitated fee,
Show More
Related

  • HCS 235 Week 2 Completed Health insurance matrix

    1163 Words  | 5 Pages

    Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker

    Read More

  • Exploring Corporate Strategy - Case

    164366 Words  | 658 Pages

    ECS8C_C01.qxd 22/10/2007 11:54 Page 597 CASE STUDIES ECS8C_C01.qxd 22/10/2007 11:54 Page 598 ECS8C_C01.qxd 22/10/2007 11:54 Page 599 Guide to using the case studies The main text of this book includes 87 short illustrations and 15 case examples which have been chosen to enlarge specific issues in the text and/or provide practical examples of how business and public sector organisations are managing strategic issues. The case studies which follow allow the

    Read More

  • Acca F5

    111177 Words  | 445 Pages

    PAPER F5 PERFORMANCE MANAGEMENT P R A C T I C E & R E V I S I O N K I T In this January 2010 new edition We discuss the best strategies for revising and taking your ACCA exams We show you how to be well prepared for your exam We give you lots of great guidance on tackling questions We show you how you can build your own exams We provide you with three mock exams including the December 2009 exam We provide the ACCA examiner 's answers as well as our own to the June and December 2009 exams as

    Read More

  • Merger and Acquisition: Current Issues

    115629 Words  | 463 Pages

    Mergers and Acquisitions Current Issues Edited by Greg N. Gregoriou and Karyn L. Neuhauser MERGERS AND ACQUISITIONS Also edited by Greg N. Gregoriou ADVANCES IN RISK MANAGEMENT ASSET ALLOCATION AND INTERNATIONAL INVESTMENTS DIVERSIFICATION AND PORTFOLIO MANAGEMENT OF MUTUAL FUNDS PERFORMANCE OF MUTUAL FUNDS Mergers and Acquisitions Current Issues Edited by GREG N. GREGORIOU and KARYN L. NEUHAUSER Selection and editorial matter © Greg N. Gregoriou and Karyn L. Neuhauser

    Read More

More about health insurance matrix HCS/235 Essay

Open Document