HSM-541 Week 3 Discussion Question 1: Private Insurance (GRADED A)

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HSM-541 Week 3 Discussion Question 1: Private Insurance Week 3 Discussion: Week 3: Private Insurance Let’s consider the general concept of insurance. How does health insurance differ from o... ther kinds of insurance? What are the similarities and differences between them? Next, let’s consider what might happen if value-based reimbursement completely replaces volume-based (i.e., fee-for-service) reimbursement. What are the implications for providers? For patients? For healthcare managers and administrators? - How does health insurance differ from other kinds of insurance? What are the similarities and differences between them? When you compare health insurance to another kind of insurance, like life insurance, there are similarities and differences between them. Life insurance is a voluntary benefit a person pays a premium for in order for the identified beneficiaries to receive a death payout. This payout is used to cover funeral expenses and to give some monetary relief due to the loss of income resulting from the death (Kurt, 2020). Other than the monthly premium, there are no other out-of-pocket costs. Health or medical insurance is a voluntary benefit a person pays a premium for in order for the insurance to cover medical services for preventative or curative reasons. Along with the weekly or monthly premium, there are other out-of-pocket costs such as co- pays for provider visits or pharmaceutical costs. If health/medical insurance is provided through an employer as part of a PPO plan, any out-of-network costs for services provided from a physician outside of the designated network would be the responsibility of the patient. What might happen if value-based reimbursement completely replaces volume-based reimbursement? Though fee-for-service has been the historical reimbursement model for the United States, there has been traction around a move to a value-based reimbursement model. The fee-for-service model is a costly model by encouraging physicians/providers to bill for every billable service. This model is also not sustainable in the economy today. Therefore, there has been a push to value-based model. This model would contain costs by tying reimbursement to quality outcomes of the patient. This places the responsibility of ensuring treatments and procedures are not done unnecessarily. Additionally, it ensures the procedures/treatments that are performed are done with the highest quality. Those providers who meet the quality metrics have additional reimbursement, but those who perform badly can be financially penalized by withholding additional reimbursements. Patients would benefit ultimately from the value-based model. Kristi Melton Reference: Kurt, D. (2020). Life vs. Health Insurance: Choosing What to Buy. Investopedia. https://www.investopedia.com/articles/personal-finance/100115/life-vs- health-insurance-choosing-what-buy.asp (Links to an external site.). - Good morning, Having insurance means you have a contract that is meant to protect you from financial lose, it is a policy that that people that have it receive financial protections or are reimbursed for losses. Insurance works by pooling together many people that have the same thing to lose, they all pay a premium and all in a sense cover each other. Say a company covers 100 people that own a home, everyone pays home insurance every month and at the end of the year one house floods, well the insurance has the money to give that house to get fixed properly. It is pretty much an "in case" thing to have, and we all have it on our homes, cars and lives. Health insurance is a little different "because the losses it attempts to cover are not limited. Everyone inhabits a body that is subject to illness and injury with the potential for losses far beyond one’s ability to pay. Only the truly wealthy, and here we are talking about the billionaires, can afford to self- insure (Crisp 2018). I did not have health insurance for a few years after I turned 26 and was no longer on my dads, luckily I did not get sick at all, I remember having an ear ache and going to see my family doctor. He charged me a very small amount for the visit and prescribed me a generic medication and I was fine thankfully. I could not imagine having something very serious happen and stress even more because of knowing once the bill came I was not going to be able to pay it. I know have a better job that offers health insurance but it is still so expensive. I see doctors more frequently because I am a bit older and want to make sure I am healthy but I still have to pay monthly, a copay and the 10% of the visit that my insurance does not cover. Which is just crazy to me, I understand it is a business at the end of the day but it really makes me believe that you just have to be rich in order to receive the best quality healthcare in the U.S. Crisp, J. (Feb 19, 2018). Here's why Health Insurance is Different from other Insurance. Kevin MD. https://www.kevinmd.com/blog/2018/02/heres-health-insurance- different-insurance.html (Links to an external site.) - Generally, “Insurance is a contract, represented by a policy, in which an individual or entity receives financial protection or reimbursement against losses from an insurance company. The company pools client’s risks to make payments more affordable for the insured” (Kagan, J: March 30, 2021). Insurance, generally, involves a company accepting to bear risks through aggregation of funds paid upfront. Health Insurance is a way of shifting the risk of financial loss caused by illness to a third party (Austin & Welte 2017). In the case of health insurance, it is a way of paying upfront for health services. The difference I see between health insurance and other types of insurance is that it is almost certain that someone with health insurance would use its services at one point or another. Even if the person fails to fall ill, s/he may decide to have preventive healthcare. A chiropractor visit is now usually reimbursed by insurances. The probability that house or car insurance may not be used by the person insured is higher than in health insurance. Since I came to the USA in 2001, I have not been involved in any car accident, yet I have always had a car with insurance. On the other hand, I go the hospital every now and then. What may happen if a value-based insurance replaces volume-based insurance is only presumed. There may be need to study other countries and what is working for them. Will value-based insurance reduce fraud and the political skirmishes maneuver that seem to define the health insurance landscape in the USA? Will it make health care more affordable, accessible, and with more quality? I doubt what the implications could be for providers. Maybe, having patients do only necessary procedures and providing only necessary medication. What if the provider chooses to withhold necessary procedure because a patient has gone above the amount provided by her insurance company? I guess health administrators would have a big job balancing what providers prescribe for a procedure and medications which would be tough. In all these, where is the compassion that should define healthcare? Austin, A., & Wetle, V. (2017). The United States health care system: Combining business, health, and delivery. Pearson. Kagan, J. (2021) Insurance. Investopedia, Retrieved July 19, 2021. https://www.investopedia.com/terms/i/insurance.asp#:~:text=Insurance%20is %20a%20contract%2C%20represented,more%20affordable%20for%20the%20insured (Links to an external site.). An aside: I started this week’s readings and work hoping to gain more clarity about the health insurance system of the USA. Let me note that I have become more confused than I was. I have read all the required readings, read through the modules, and other internet sources. All I can do is to take a deep breath and shake my head. When will the USA simplify its life? - f you're looking for an exciting and fast-paced career, the healthcare industry may be right for you. There are many different kinds of jobs in healthcare, each with its own unique set of responsibilities. Learning about the different types of jobs available in healthcare and the salary and outlook for each can help you evaluate whether a career in healthcare is for you. In this article, we discuss eight advantages of working in the industry and the job outlook for different careers in healthcare. Eight advantages of working in healthcare The healthcare industry offers many compelling careers, regardless of your specific interests. Here are some specific reasons why you might want to consider a role in this expanding industry: 1. Fulfilling work. Healthcare workers spend their time making a difference in others' lives, which can increase their motivation and overall job satisfaction. 2. Above-average earning potential. Many careers in the healthcare industry offer an above-average salary, especially when you work in hospitals or for government organizations. 3. Strong job outlook: Due to the aging Baby Boomer population, the healthcare industry is continuing to expand and is anticipated to grow by 14% from 2018 to 2028. 4. Stimulating work environment. Most healthcare professionals experience a fast-paced workday with a continually changing atmosphere. 5. Variety of career opportunities. There are a wide variety of different career options within the healthcare industry, and many professionals can even change their positions multiple times to try different things before deciding on a specialty. 6. Opportunity to travel. Healthcare professionals are in demand around the world, from large cities to developing communities, giving candidates the opportunity to explore new parts of the world while earning a great income and helping citizens globally. 7. Positions at all educational levels. There are hundreds of positions available in healthcare, whether you have a high school diploma, a bachelor's degree or a specialized medical degree. 8. Flexible schedules. Since citizens need help from medical professionals day and night, healthcare offers a flexible work schedule, including the option to work overnights, short work weeks or even remotely. Why Work in Health Care? 8 Reasons To Consider a Career in Health Care March 18, 2021. (2021, March 18). Indeed Carrer. https://www.indeed.com/career-advice/career- development/why-work-in-healthcare - Hello Classmates and Professor, Most nations have some form of a nationalized health care system. The United States has Medicare as nationalized health care. Having nationalized health care means that there is a guarantee that someone will be able to access health services when they need it. There are Pros and Cons when it comes to nationalizing health care. Pros: • Allow everyone to access a doctor without ruining their budget - Patience would seek treatment for issues that are bothering them but may put off- health care treatments for other issues. • Could lessen the cost of care - There would be less of a cost after a doctor's visit and have higher taxes, but the direct spending comparison was saved most households money every year. • Could raise the standard of health in a country – More access to health care means more access to Wellness services. Cons: • Could create patient runs on doctors -People may go to the doctors more often than normal for exceedingly small issues that they may be experiencing. This will create higher patient loads for all doctors. • Could raise the cost of health care - More patients mean more chances for malpractice to happen and doctors carry malpractice insurance in case it does, but premiums would likely go up for doctors if their patient load goes up. • Would expand doctor shortages where they currently exist - With higher patient loans potentially lower salaries and no subsidy's for college tuition there could be reduced doctor enrollments that may lead to even larger shortages. Apecsecadmin. (2015, January 14). apecsecadmin. apecsecorg. https://apecsec.org/nationalized-health-care-pros-and-cons/. - Comparing health insurance to car insurance we do see some similarities. Car insurance is required by law, health insurance is not required but a person may incur a penalty if it isn't carried. Car insurance policies are selectable to vary the amount of coverage the insured wants to carry. Health insurance generally offers different options for people who want to pay less for coverage and are willing to assume more as a deductible/out-of-pocket. Each may have a discount program that people can take advantage of for driving safe or for proactively improving health and wellness. Should value based care replace fee-for-service care, patients would likely find that they receive better overall outcomes of their healthcare services due to reimbursement being tied to that quality. Unnecessary services may be avoided, as practices won't be reimbursed for things that aren't required to treat the patient. Practices will have a focus on keeping costs low, rather than keeping profit margins high. Overall, it may very well increase volume by increasing access (A Shift to Value-Based Healthcare, 2020). Reference: A Shift to Value-Based Healthcare: UIC Health Informatics. UIC Online Health Informatics. (2020, July 13). https://healthinformatics.uic.edu/blog/shift-from-volume- based-care-to-value-based-care/. [Show More]

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