Question

1. Compare and contrast FFS insurance plans to managed care insurance plans (HMOs) with respect to:

(a) How providers are paid

(b) Patient choice of providers

(c) Patient access to medical services

Be as specific as possible.

Answer 1

1.a. How providers are paid

FFS plans or Fee for service plans is one of the traditional ways to pay for the insurance services taken. It is slightly expensive compared to other plans , in this plan the service providers(doctors, nurses, healthcare centres etc) are either paid directly by the plan providers or they are paid by the service receivers(which is reimbursed by the plan providers). However the payments are issued only after the service is provided.

In managed insurance plans like HMOs the service providers are paid differently based on their type. For IPAs(Individual practice associations ) only individual practioners are contracted and they are paid for each patient or FFS basis. The second way of payment is for group practioner, where they are contracted for a certain rate for each patient and it solely depends on the group how they will compensate the practioners. The third way is hiring group of specialized practioners and they are paid according to contract rate. The fourth and last way adopted by the HMOs is to hire practioners for a ceratin salary and provide medicare service from their own facility.

b.  Patient choice of providers

In FFS the enrollees get to avail the service from doctor or hospital of their choice. It means they can go to any doctor or hospital of their choice.

In HMOs plans the enrollees can avail service only from listed or approved doctors or hospitals.

c.Patient access to medical services

FFS plan which is a free to choose plan gives the enrollees more freedom as to access of medical services, they can visit the doctorsof their requiremnt and preference. They can get the required amount of test and imaging done also there is no limitation in time which they can spend with the doctors.

In HMOs the members initially will be examined of their needs by the general physicians or staffs, then if required will be sent to specialised doctors. Here the direct access of patients are comparatively lesser.