Health Insurance Matrix

16 September 2018 Health Insurance Matrix

Coursework is a type of assignment that most students once or more than that in their academic careers. Such are written by our professionals and the tutors will most of the time take and advantage of teaching the students to make sure that they understand what they were supposed to catch during classwork and the probably missed. We have examples of the type of coursework that you may be interested to look at.

Sometimes a professor may ask to explain and research about the health care system and write down the conclusion according to your research. look at the following question/explanation that requires a student's response. ''As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care employee. 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.'' 











Model

 

 

Describe the model

How is the care paid or financed when this model is used?

What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?

What are the benefits for providers who use this model?

What are the challenges for providers who use this model?

Health Maintenance Organization (HMO)

 

 

 

 

 

Preferred Provider Model

 

 

 

 

 

Point-of-Service Model

 

 

 

 

 

Provider-Sponsored Organization

 

 

 

 

 

High Deductible Health Plans and Savings Options

 

 

 

 

 

This is an example of the papers and instructions that we receive on a daily basis. It is through the professional intervention that will make the best write-up according to the needs of the clients. Look at the following example that some of the writers wrote. If in case you may need the paper to be written and filled all the boxes is very possible to engage the writers and receive the best and unique work.



 



References

Momoh, O. (2018). Health Maintenance Organization - HMO. Retrieved from https://www.investopedia.com/terms/h/hmo.asp

Slee, D., Schmidt, H., & Slee, V. (2009). Slee's Health Care Terms (5th ed.). Jones & Bartlett Publishers.

Model

 

 

Describe the model

How is the care paid or financed when this model is used?

What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?

What are the benefits for providers who use this model?

What are the challenges for providers who use this model?

Health Maintenance Organization (HMO)

HMO is a medical insurance group which operates in the united states to provide health services for the fixed yearly amount.

HMO uses a fixed cost that is paid by an employer or government. Payments are done on a prepaid basis regardless of the amount spent on medical services.

HMO is a gatekeeper model  (Momoh, 2018). In this case, one chooses a physician who   should treat them. On the other hand, physicians in the HMO network are paid by the insurance for the services they provide to the patients.

It provides healthcare services at very low cost. One pays a fixed amount of money regardless of the amount they spend for their care.  

The model is restrictive, meaning that any kind of changes in the healthcare system may not be acceptable. Members get stuck with primary care provider because the model covers the cost of doctors in the network.

Preferred Provider Model

PPO is a healthcare insurance where there is an agreement between doctors, healthcare organizations and the insurer to provide healthcare services at a reduced cost to the person seeking insurance.

PPO is financed or paid for by the insurance holders or the unions representing such people. 

PPO is a gatekeeper model in which a participant is given the mandate to choose and designate a primary care physician. In this case, one is allowed to choose a preferred physician and healthcare providers that are within the network of PPO.

Allows more freedom than HMO. Members pay low cost when they remain within the provided network  (Slee, Schmidt & Slee, 2009). Members are allowed to see physicians that are outside the network.

The model is more expensive when a patient seeks services outside the network. Outside network services include more paperwork that is paid for by the member.

 

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