Question

Describe the quad-function Model of the Health Services Delivery System. Why is it important to understand the interdependence of the system’s components?

Choose one country and describe the Health Systems of that country discussed in our text. What is the difference between national health insurance and a national health system.

Why is it important for a health care service experts, policymakers and managers to understand the basic demographics and intricacies of the population being served?

Chapter 1 discusses access to health services. Prepare a list andbrief explanation of at least five steps you believe will have a significant impact on increasing access to health services.

Answer 1

Transcript of Quad Function: Functional Components of the Health Care Delivery System

Insurance
Insurance protects against catastrophic risk and helps determine which packages individuals should receive.
Delivery
Any entity that delivers healthcare in exchange for payment from insurance companies and individuals is a health care provider. This includes physicians, hospitals, home health aides, nurses, health centers etc.
Payment
Health care services are paid for by the insurance company and the patient. The patient pays a copay and insurance premium. The premium goes to the insurance company, which uses it to pay for service. The copay goes right to the service provider.
Any entity that delivers healthcare in exchange for payment from insurance companies and individuals is a health care provider. This includes physicians, hospitals, home health aides, nurses, health centers etc.
Financing
Access
Ability to pay
Do you have health insurance
Availability of service
Rural areas have little to no service
Payment
Many providers don't accept Medicaid
Enablement Barriers
Transportation, Social, Cultural
Underwriting Risk
In setting premiums, the plan relies on ont he expected cost of healthcare utilization. This is a form of financial risk management that companies use as part of a managed care system to keep their costs relatively predictable. (See Capitation/Discounts and Utilization Controls)
Capitation: All the services are included under a set fee per covered individual. Predetermined fixed payment per member per month. Capitation is used for Health Maintenance Organizations
Discounts: Negotiated under the providers customary fees. Discounts are used for Preferred Provider Organizations.
Utilization Controls
The price charged for utilizing services is determined by the managed care organization. (See Underwriting Risk and Capitation/Discount)
Capitation and Discounts are essential to integrating the quad function with managed care organizations

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