health insurance matrix HCS/235

Topics: Health insurance, Preferred provider organization, Health maintenance organization Pages: 3 (651 words) Published: November 3, 2013
University of Phoenix Material

Health Insurance Matrix

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

Include APA citations for the content you provide.

Origin: When was the model first used?
What kind of payment system is used, such as prospective, retrospective, or concurrent? Who pays for care?
What is the access structure, such as gatekeeper, open-access, and so forth? How does the model affect patients? Include pros and cons.
How does the model affect providers? Include pros and cons.
Health maintenance organization (HMO)
Example: HMOs first emerged in the 1940s with Kaiser Permanente in California and the Health Insurance Plan in New York. However, they were not adopted widely until the 1970s, when health care costs increased and the federal government passed the HMO Act of 1973, which required that companies that offered health insurance and employed more than 25 employees include an HMO option. The law also supplied start-up subsidies for these health plans (Barsukiewicz, Raffel, & Raffel, 2010). Example:

HMOs often operate on a prospective or prepaid payment system where providers are paid a capitated fee—one flat amount per beneficiary—per month, quarter, or year, regardless of the frequency or quantity of services used (Barsukiewicz, Raffel, & Raffel, 2010). In staff model HMOs, such as Kaiser Permanente, providers are salaried, but this arrangement is the exception, not the norm. Example:

In group...

References: Austin, A., & Wetle, V. (2012). The United States health care system, combining business, health, and delivery. (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Barsukiewicz, C. K., Raffel, M. W., & Raffel, N. K. (2010). The U.S. health system: Origins and functions. (6th ed.). Mason, OH: Cengage Learning.
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