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)
HMO’s were first introduced in the 1940’s. In the time that has passed they have since evolved. This came with help from the Health Maintence Act of 1973. HMO’s are a form of prepaid health plan. This means that you receive services that are being paid for in advance either by you or your employer. HMO’s are usually on a prospective payment system. This is where providers are paid a set amount no matter how often their services are used. This means that you may have a set amount that you are allotted to use and if you don’t then the provider keeps the difference that has been paid out Usually when it comes to HMO’s the employer makes the payments to cover the employee and his/her family. With this being said there is usually an amount that the employer and the insurance go over in advance to work out a set amount for the coverage. This way that there is no confusion later on when it comes to...
Please join StudyMode to read the full document