Question #2: This week focuses on stakeholders in health care. What do you see as the...

Question #2: This week focuses on stakeholders in health care. What do you see as the main conflicts between patients and families and payers (insurance companies, government payers (Medicare, Medicaid) in defining a high-quality, high performing healthcare organizations? Can you think of one approach to resolve one of the conflicts?

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Ans:- The main conflict between patients and payers are :-

1. Authencity of claim raised :- The insurance companies are always concerned about authencity of claim raised by patients. For ex:- Submitting false bills and medical reports, submitting enhanced bills etc.

2. Conflict in claim settlement:- There are various conflicts in claim settlement arise because of lack of clarity in deceases covered. Various insurance and medicalim plans declare to cover certain decease at certain level of severity. This creates conflicts in claim settlemet where companies decline the claim.

So a high quality, high performing healthcare organization should mention every detail of coverage and explain it to the customer with clarity. The healthcare organisation should also not look for loopholes to decline the calim rather that honour it with full integrity. Now a days health care organisations are rated on claim settlement ratio which can help build a brand image of the company.

keosha answered 10 months ago

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