Question

Write a essay about the different types of health care payment options. Address the following in your essay:

1. Explain how the charging and pricing processes of health care facilities are different from those of other industries.
2. Explain how private and government insurers and payers impact actual reimbursement.
3. Explain the impact that these payment structures have on the strategic planning of a health care facility.

List references please

Answer 1

Different methods of healthcare payment :-

Health insurance plans

help pay for the costs of health care, reimbursement regardless of who provides care

Premium

the cost you pay each month for the insurance policy

Deductible

the amount the patient pays for a medical service before the insurance company pays

Co-insurance

percent of expense shared by the patient

Co-payment

specific amount a patient pays for a particular service

Employer-sponsored (group insurance)

employer assisted health insurance coverage for employees. employer often pays part of premium

Private insurance

purchased by an individual, sometimes called a 3rd party payer

Managed Care

an effort to provide quality care at the lowest possible cost. a second opinion or pre-approval is often required for special care, focus is on preventive measures, Network of providers (doctors, therapists, hospitals, etc.) provide care at the most reasonable cost

Health Savings Aaccounts (HSAs)

personal savings accounts that can be used along with a high-deductible health plan to help pay for unreimbursed medical expenses. These accounts offer certain tax advantages to the individual in that the employee places pretax dollars into the savings accounts. Contributions to HSAs can be made by employers and/or individuals. Annual contributions are limited, as are out-of-pocket maximums, though persons aged 55 and over can make additional contributions. HSAs are portable from one job to another.

Medical Savings Account (MSA).

accounts may be used to pay for medical expenses along with a high-deductible health insurance plan. In order to be eligible for a medical savings account an individual must be employed by a small employer that provides a high-deductible health insurance plan or be self employed and covered by a high-deductible health insurance plan. Contributions may be made by the individual and/or the employer, but not both in the same year

Flexible Spending Accounts (FSA), also called healthcare reimbursement accounts (HCRA)

allow individuals to set aside a portion of their pre-taxed wages to pay for certain out-of-pocket healthcare expenses. Money from flexible spending accounts can be used to pay for expenses not covered by health insurance such as:

- Deductible and copays

- Prescription drugs and medical supplies

- Dental services, dentures, and orthodontics

- Eyeglasses, contacts, solutions, and eye surgery

- Chiropractic services

- Psychiatric care and psychologist's fees

- Smoking cessation programs

Money set aside in flexible spending accounts in any given year must be spent by a certain date, typically March 15th of the following year or the money is forfeited.