Question

1. Which system of health insurance best serves the needs of the general population: a fee for service model or a managed care model?
2. What are the four models of financing health care? Describe each
3. How has the federal government tried to solve increased access to government-funded health care?
4. How do physicians get reimbursed?
5. How does capitation payment free insurers of risk?

Answer 1

• fee for service is better because it allows the clients to freely choose their physicians and hospitals, with very little interference from the insurance provider. A fee for service health plan demands high out-of-pocket expenses as clients may be required to pay their medical fees upfront and submit bills for reimbursement. One downside of managed care plans is that patients in certain plans might not be able to easily see their preferred health provider if that health provider works outside of the patient's approved coverage network.
• Four major healthcare models: four major healthcare models:

1. The Beveridge model:Beveridge model provides health care for all citizens and is financed by the government through tax payments. ... The Bismarck model uses an insurance system and is usually financed jointly by employers and employees through payroll deduction.
2. Bismarck model:The Bismarck Model (also referred as "Social Health Insurance Model") is a limited health care system, in which people pay a fee to a fund that in turn pays health care activities, that can be provided by State-owned institutions, other Government body-owned institutions, or a private institution.
3. National health insurance:The national health insurance model is driven by private providers, but the payments come from a government-run insurance program that every citizen pays into. Essentially, the national health insurance model is universal insurance that doesn't make a profit or deny claims.
4. Out-of-pocket model: The final model, the out-of-pocket model, is what is found in the majority of the world. It is used in countries that are too poor or disorganized to provide any kind of national health care system. In these countries, those that have money and can pay for health care get it, and those that do not stay sick or die.

• The federal government has Developed and implemented national standards for examination by which doctors, nurses and pharmacists are able to practice and get employed. Rapidly developing and implementation national accreditation of hospitals; those that do not comply would not get paid by insurance companies.
• The patient pays all charges at the time of service and takes the paid bill home to send into their insurance company for reimbursement. If a patient is referred to another provider or admitted to the hospital, the insurance is billed on the basis of the participation of the specialty physician or hospital.
• Capitation payments control use of health care resources by putting the physician at financial risk for services provided to patients. ... If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.