Importance of Health Care Insurance - Case Study Example

Health Care Management Case 1 Cover for employees a. Pros and cons of insurance cover Pros Implementation of an insurance cover will ensure that millions of people will be in a position to get affordable and standard quality health medication. The uninsured people will also access free medical services while the out of pocket settlement will be affordable for the entire nation. The cover does not discriminate gender and women will not be demanded to pay more compared to men and vice versa. No extra fee paid by one getting sick or otherwise. Health insurance policy like the Obama care demands that employees with more than 50 employees should provide cover for the entire staff ('Debating Obamacare', 2012). Moreover, health cover policies require that when a business has a total number going up to 25 full-time employees, they will be mandated to tax credits covering a total of 50% the population of staff insurance premium cost. Health insurance is all-inclusive of children and will cover them until they mature enough without parents incurring extra costs when paying for the cover. By subscribing to insurance wasteful spending is minimized, fraud is regulated and the expansion program for the preventive services is well ensured. The general essence of health insurance covers cut on medical spending while giving individuals an array of choices when seeking for health care services. Cons For the cover to reach millions of people, extra taxes will be paid by mostly the high earners, which may affect an individual or a business. Health covers that come with many options will demand a complicated shopping affair hence confusing. To ensure full cooperation, the insurance policy demands that one pays monthly or else pay a fine for breaching the policy. It leaves nearly half of major nations without cover due to the inability to subscribe to it. Development of other features i.e. the CHIP takes away taxpayers money. Based on a full-time employment and employer mandate to pay insurance cover, many people have been put on shorter work hours in a bid to evade the payment of the cover. Lower paid workers get better benefits when compared to highly paid workers. It is generally accepted that youths are healthy and need no health cover, hence money paid for a youth is considered a waste. The focus of health insurance cover is to ensure that people are covered while it should consider that the cost of Medicare is addressed. b. Health coverage available Private health insurance Out-of-pocket settlement of bills Other private funds Public funds c. Cost According to Source of funds, 2008, expenditure is separated into the following levels of payment levels. Private health insurance=33.5% Out-of-pocket payments=11.9% Other private funds=7.3% Public funds=47.3% d. Best option The public funds option of payment for insurance cover comes at a slightly lower cost while they offer full benefits of medical cover. Case 2 Cover for patients a. Options for patient's cover Individual and family: It is sometimes termed as a comprehensive cover. The period is more than 12 months while renewable. Among the care, privileges one gets include emergency services, hospitalization, preventive care, maternity, newborn and pediatric care, mental health and laboratory services. Short term: it is a temporary plan for health lasts between 1-11 months; it is not renewable and cannot meet the affordable care act requirement. It can be tailored to budget and period. Dental: it covers dental cost for an individual and a family Medicare: The covering age is 65 years and beyond (Harrigan, 2010). Medicaid and children’s health insurance program (CHIP) b. Pros and cons Paying for health insurance has many benefits contrary to not paying for the cover. It helps one to plan finances well and not be caught without notice. Importantly emergency cases will be handled immediately caused by lack of funds. Public funds is a way to contribute for health cover for the public with the view that only a few person get sick at one time yet all pay for the cover. In addition, the individual pay is minimal to accommodate the low earning. On the other hand, the cover does not factor in the fact that not all people will pay for the cover and will only subscribe to the cover when sick and never remit monthly submission onwards. c. best potential The best potential for paying the cover is the public fund for individual and family cover. It comprehensively factors in the entire group at a lower fee than when it was for every individual. d. Teaching patients An insurance cover department should be set up within the hospital premises, and a workshop be carried for both in-patients and outpatients concerning the benefits and demerits of being under an insurance. Owing to the fact that benefits outweigh demerits. The clinics should liaise with the insurance bodies and have an office in the clinic that deals with cover for inpatients and outpatients. Elaborations and explanations about the same cover, as offered, will determine the reception the patients and public at large. The nurses should be as persuasive and detailed as possible. Case 3 FQHC a. Pros and cons of applying for status as FQHC for clinic Applying for the FQHC status calls for a clinic to meet various requirements; this might come at a cost. To apply one must be offering services to a wider area and be in a position to offer a sliding fee scale. In addition, their cover listing should only be a comprehensive cover and nothing else. Moreover, they need a good governing body of directors (Raconline.org, 2015). The benefits accompanying the same outfit include cost-based reimbursement, acceptance of alternative payment methodology, and one becomes eligible to buy the prescription and non-prescription medications for outpatients who come at a much-reduced cost. b. recommendation To achieve fully the status for one to be regarded as the FQHC status, the criteria to meet should be paramount in the management agenda for cause of action. Moreover, the cost will be shared while cover for the patients will be managed with ease. Increasing the service offered and scope of the clinic is imperatively a factor for the board to spearhead (Buchbinder & Shanks, 2007). Having s customer or patient base that subscribes to cover is a step the management should take the patient through to ensure they are well served. It will in turn enable the clinic management to run finances well with the aid of government through grants and waivers. References Buchbinder, S., & Shanks, N. (2007). Introduction to health care management. Sudbury, Mass.: Jones and Bartlett Publishers. Debating Obamacare. (2012). Chemistry & Industry, 76(9), 23-23. doi:10.1109/cind.7609_5.x Harrigan, M. (2010). Reflections on Healthcare Leadership Ethics. Healthcare Management Forum, 23(2), 97-99. doi:10.1109/j.hcmf.2010.04.003 Raconline.org, (2015). Federally Qualified Health Centers (FQHC) Introduction - Rural Assistance Center. Retrieved 1 March 2015, from http://www.raconline.org/topics/federally-qualified-health-centers Read More