Essays on Capitation

Managed care is an essential system of delivering health care across the country that works towards the provision of a generalized structure necessary to focus on the use, access, effectiveness, quality, and cost of services offered. The management aspect creates a link to the patient, which deliberates on the provider services noted across the industry. Two main modes of managed care provisions include provider reimbursement as well as hospital reimbursement aspects. Working on these aspects requires a premium understanding of issues within the community. Provider networks attempt to reduce costs that emanate from providing better fees for the services ...

Abstract

The healthcare systems comprise of many services that can lead to the successful delivery of treatment to the patients. Patients can receive their treatment and then the member or the hospital can contact the third party payer to reimburse them. There are numerous reimbursement methods and clients chose one that they. The methods include; the Value-Based Purchasing Medical Reimbursement, pay for performance, fee-for- service and episode-of-care payment. Each method has both its advantages and disadvantages to either the patient or the hospital. An acute care hospital which provides quality treatment to the patients within a short period utilizes the ...

Introduction

Undeniably, the cost of the Healthcare system in the United States has been increasing rapidly. Despite the introduction of Affordable Care Act (Obama Care) in 2010, the Americans continue to face a rising cost of medication. In fact, according to the report on 2015 healthcare provider outlook, the U.S health care expenditure is likely to increase to about 17.9 percent of GDP by 2018, making health be the largest sector in the U.S economy (Healthcare provider’s outlook United States, para 1). In this paper, we analyze some of the major facts on U.S healthcare system. Next, the paper ...

          The health care delivery system in the United States is unique when compared with delivery structures in other developed countries. In most developed nations, the government manages the national health insurance programs. These programs are financed through taxes collected within the country. Approximately all the citizens of such nations are entitled to insurance services paid by the government (PAHO, 2014). In America, such an insurance policy does not exist. There is a slight difference in the health care structure of various states in the country. This paper is set to analyze the health care structure, compare, as well as ...

Until what age can kids stay on their parent’s health insurance?

The affordable care act allows young people to stay on their parent’s health insurance until they are 25 years of age. On the 26th birthday, the young people have to shop for their own policy cover.

What are two changes that make getting coverage easier than before for certain groups of people?

It is currently easier for people who have pre-existing conditions to access insurance at the same cost as those without such conditions. Previously they would have to pay higher costs because the risk factor for such people was considered to be higher. Under this reform, women will also not be required to pay more than men for healthcare policies (Public Law 111). ...

Key Facts and Critical Issues in PhyCor, Inc.

PhyCor, Inc. was founded as a corporation for physicians that had prominent roles as players in the Physician Practice Management group of companies. PhyCor, Inc., had several programs that promoted efficiency and growth such as budgeting and strategic planning on issues such as expense reduction, cost containment, and revenue enhancement. It negotiated the different contracts, procedure coding, conducted productivity, and assisted in recruitment efforts for physicians in different clinics. The quality improvement initiatives it designed aimed at enhancing the systems of service delivery to patients. Initially, PhyCor had a revenue of $1.2 million, which later soared to $240 million ...

HEALTH CARE REIMBURSEMENT PROGRAMMES.

Health care professionals play an important role in society. As such, there is a need for these professionals to understand the various health care reimbursement systems and methodologies to discharge their duties. There exist various financial systems adopted to cater for the financing of healthcare with each plan posing its risks as well as the incentives these systems exists solely because most patients have an insurance plan.

Fees for service reimbursement program mean that a fee is paid dully to the healthcare provider for each specific service rendered. This system is widely used as it guarantees total independence of which services ...