Question

4)Scenario: You just got hired as entry level healthcare administrator and your employer offers two types of insurance plans. A married coworker/employee with two children asks your advice about which plan they should choose. Your coworker/employee reveals to you that their daughter is autistic and requires special medication and counseling. Although you can't tell your coworker/employee which plan to choose, what advice will you give your coworker/employee about choosing? Explain your reasoning in detail.

5) What are the main objectives for pay-for-performance? What is pay-for-performance?

6) What provisions has the federal government made for providing health care to military personnel and to veterans of the US armed forces?

7) What is the relationship between uncompensated care and cost shifting? Why do providers now have limited ability to shift costs

Answer 1

4. ANS: Insurance can be described as a mechanism for protections against various healthrisks. It can also be used to protect against a possibility for a substantial loss from anoccasion in which the likely of occurrence of such risk is relatively small. Private healthinsurance is insurance offered by employers and other organizations. These includeHealth Maintenance Organizations and the Preferred Provider Organizations.Government insurances, including Medicaid, are a state run program and targetindividuals with lower income. It also entails Medicare which targets the elderly of atleast age sixty-five years and disabled individuals.I will advise to choose the Health Maintenance Organization plan since the planspay for the care within the network of healthcare providers. In addition, it costs less thanthe plans that offer the greater choice of providers which is very good for the autisticchild.

Reference:

Kovner, A. R., Knickman, J., & Jonas, S. (2014).Jonas and Kovner's health caredelivery in the United States.New York: Springer Pub. Co

5. ANS: Pay-for-performance links reimbursement to quality and efficiency. Providers who candemonstrate improvement in care and more efficient performance stand to reap financialrewards. Its objective is to improve health care quality and reduce costs.

6. ANS: The Tricare program was developed in response to the growing health care needs of military personnel, an increasing number of who are retirees. Congress requires Veteran Health Administration to provide services on a priority basis to veterans with service-connected illnesses and disabilities, low incomes, or special health care needs.

7. ANS: Cost shifting is a mechanism used to make up for revenue shortfalls when uncompensated care isdelivered. Costs are shifted by charging extra to payers who do not exercise strict cost controls.Most payers now use some form of cost-containment mechanisms. Capitation and prospectivereimbursement methods, in particular, have eroded the margins for cost shifting. Consequently,providers have less ability to provide uncompensated care through cost shifting than waspreviously possible.