Health Insurance Matrix - Assignment Example

However, these payments are only released once an individual has cleared a deductable amount. This is usually an annual payment that ought to be cleared before discharges takes place. Who pays for care: The consumer and the insurer pay for care. This sort of arrangement is known as coinsurance and may be 80% of the total medical charge (Goodman, 2008). Consumers are expected to pay for the remainder as well as extra charges that arise from a physician’s charge. In this scheme, insurers determine what is reasonable and usual for medical services under consideration.

They will consider inflation as well as market rates for this. If a provider charges more than normal, the consumer will also pay for the difference. Access Structure: One of the key advantages of indemnity cover is that it has open access. Here, consumers have the liberty to select a healthcare provider of their choice. They do not require special referrals to a network of medical practitioners. Such a mechanism is quite useful to patients with lifetime diseases like cerebral palsy. They are also suitable for individuals with little concern for healthcare costs.

How patients are affected: Patients can benefit from greater flexibility under this model. Since the plan is non-networked, persons who require specialized care gain a lot from it. They also pay for services only after accessing healthcare services so reimbursements are understood. Conversely, financial costs are quite high as out of pocket coverage and deductibles are included. Furthermore, this plan places caps on what one can get throughout their lifetime. It even determines rates and what is a reasonable charge.

How providers are affected: The major pros for providers under such a scheme are that they get to provide quality care. They are not under pressure from a gatekeeper on the services they can provide. They have the freedom to charge what they see is fit. Conversely, they lack a set standard against which to charge