Essays on Managed Care

Medicare

What are the purposes of Medicare regulations other than the one mentioned above? Medicare was signed into law in 1965 with the intention of providing better healthcare to the citizen through medical insurance. It provides protection to its recipients, and it is a government program intended to provide insurance to the aged and people living with certain disabilities (Moon, 2006). It is mandated by the law to provide hospital insurance, medical insurance and cover drug prescription for its recipients. How will the federal government enforce compliance in the Medicare Advantage program? Which two other Medicare regulations do you think ...

Medicare and Managed Care

The U.S. government started initiatives to make medical assistance to as many citizens as possible. This program is one such initiative by the government. Medicare is a health program under the federal government that covers individuals who are 65 years and above. It also includes younger people with various disabilities. Also, people with renal diseases that require dialysis and any other medication are covered by this program. Medicare was created in 1965, ("What is the History of Medicare? | National Academy of Social Insurance", 2017). At this time, many people above 65 had difficulties accessing health care. In essence, this ...

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 ...

Challenges faced by MCOs regarding price variations and ways of overcoming these challenges

Challenges Utilization management acts as one of the most complex financial balancing act that managed care organizations (MCOs) try to utilize in an effort to manage health care costs and create value for future health care services (Bailit & Sennett, 1992). However, managing cost through utilization management concept creates price variations that pose major challenges to MCOs. One of the major challenges faced by MCOs regarding price variation is its diverse nature. The use of utilization management in MCOs has gained a lot of demand making it difficult to make a general conclusion on certain variations. Price variations linked to ...

Introduction

The term managed care refers to various healthcare insurance plans used in the United States, which are aimed at moderating the cost of providing care to the citizens. Essentially, the techniques used are intended to enhance the quality of patient care provided in the medical facilities. The approaches also include the systems of financing the enrolled organizations under the managed healthcare concept and techniques. In this essay, three types of managed care plans will be discussed. Furthermore, their impact on the way services are delivered at Healing Hands Hospital will be included. The paper will identify the changes that ...

Managed care models are strategies put in place to safeguard the functions and activities of the managed care facilities within a country. The managed care models usually have a continuum to guide their activities and operations. The continuum, therefore, is critical to understanding the differences between managed care plans. In particular, the continuum is responsible for the scope of control a managed plan has over the activities of health facility (Martino, Elliott, Haviland, Saliba, Burkhart, & Kanouse, 2016). As a result, it helps in clarifying the main reason behind the differences in the control of the managed care models. In ...

Compare Insurance Plans by States

Compare Insurance Plans by State Description of the Scenario After servicing in the military for many years, an elderly war veteran decides to spend his remaining years at home with his family. However, because of his age and the nature of his previous job, he is likely to face some of the health problems that may require frequent medication. Nevertheless, he may not be able to afford the high cost of medication because he is no longer on active payroll, which significantly reduced his level of income. Therefore, the elderly man needs a cheaper insurance plan that can cover ...

Health Care

Under conventional repayment protection, the cash takes after the patient. Patients select human services suppliers and visit them as they pick. Suppliers at that point charge the private guarantor or open payer and are repaid on a charge for-administration or per case premise. This is known as Managed Care. The key issues associated with Managed Care are: I) Cost Savings II) Provider Reimbursement and III) Quality of Care . Cost Savings: Savings done by Managed Care are either not genuine, or are unsustainable. In a late review of shoppers, 60% said that managed care had either not had any kind ...

Abstract

In healthcare financial management, health insurance contributes in determining the healthcare services. The fee schedule provides a list of charges reimbursed for service providers and suppliers. Center for Medicare services, CMS, uses the fee schedule to determine the facilities and non-facility in healthcare provisions. Physicians, ambulance and medical equipment services among others help in the determination of the fee schedule by Medicare Physician Fee Structure (MPFS). The study focuses on CPT code 99214-office visit as the reference in the service delivery by the center of Medicare services. The Medicare and Medicaid rates are essential in determination the fee schedule. ...

(Author, Department, University,

Corresponding Address and email)

Long-term care is usually required for those people, who have chronic illness and/or disabilities, thereby requiring personal care assistance for long period of time. This long-term care not only includes health-care services but also requires assistance in personal care and activities such as dressing, eating, bathing, walking, and transferring (Housing Bureau for Seniors, 2015). This paper deals with the information about the care required by older people and integration of long-term care services in a cost-effective and attainable manner.

Percentage of older people requiring long-term care

Older people require not only formal care at home but also require long-term care either at home ...

IT in Managed Care Organizations

Introduction The most important function of information technology (IT) in managed care organizations (MCO) is to support their business. MCOs are complex in nature, offering a wide range of services to a wide range of individuals. It is vital for management to align its IT department with the operational dynamics of the organization. In this situation, it is important fo an IT department to align its goals to managed the complexity of MCO. A MCO should reduce risk if they have a well-function IT department. Thus, the IT department main concern is designing, implementing, and operating an efficient system ...

For this assignment, I have chosen to review the information presented in the report titled, The Role of Medicaid Managed Care in Health Delivery System Innovation. Managed health plans can offer protection against financial and health risk. Patients who are enrolled into different health plan policies are motivated to seek managed care as it does not require ‘out of pocket payment’ and the payment is done by a third party. However, quite contrary to what is expected, many practitioners do not identify a managed system of care with the expected health care delivery reform. There is an excessive control ...

Introduction

Managed care refers to the approaches and methods designed to reduce the cost of healthcare and leverage financial disbursements in order to improve the quality of healthcare to patients. This refers to a series of services offered by private insurance companies that provide health insurance to patients in the form of fee-for-service and value-based health care system for members of insurance schemes. There are group and individual insurance packages that are offered to members who make regular contributions for healthcare services as and when they are needed. Health insurance has always existed in history. However, the Health Maintenance Organization ...

Introduction

Healthcare is an integral part of a nation’s well-being. Despite its importance, there has been an increasing trend in the costs of health care. With the current high national debt, health care reimbursement should be part of the equation ("Healthcare Reimbursement | Knowledge Hub | athenahealth", 2016). The policy makers, physicians, and patients are well aware of the steps they need to take to reduce the costs of health care by considering health insurance plans. The insurance policies enable the doctors and other health practitioners to provide quality and efficient health care to the people. Health insurance payers are provided ...

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 ...

The health care reforms have brought about a dramatic change in the way people seek healthcare. Before health reforms, people choose to remain untreated, as treatment costs was too expensive. This scenario has changed with the introduction of managed care. More people are seeking health care and more transparency has been introduced into the care process. The healthcare has been reengineered to effectively integrate various players that form a part of the managed care system. The health providers, pharmacies, health delivery, payers, specialized services are integrated to form a multifunctional health care system. (Hoffman & Emanuel, 2013) Nurse’s role ...

(Author, Department, University,

Corresponding Address and email)

Healthcare Reform and Role of the ANP Psychiatric mental health nursing is the profession working for people having mental illnesses such as bipolar disorder, schizophrenia, and other such problems. It works on managed care that is the system of utilizing finances in the most efficient way for appropriate and managed health care delivery. In the managed care, nurses assure the cost effectiveness by developing clear boundaries for planning, targeting, and delivering needed services. Funding for advanced nursing practice may come from the government and/or other healthcare organizations. Researchers have reported certain factors that may become barriers ...

Summary

A number of national policies are discussed and aired daily on mass media platforms and newspapers. The three national policy issues that I found interesting are sourced from these three newspaper articles:- The Associated Press. (2016, May 14). Reyes banned through May under MLB domestic violence policy. USA Today. Retrieved from http://www.usatoday.com/story/sports/mlb/2016/05/13/reyes-banned-thru-may-31-under-mlb-domestic-violence-policy/84344426/ Reuters. (2016, June 11). California Governor Signs Bill Letting Undocumented Immigrants Buy Insurance. New York Times [New York]. Retrieved from http://www.nytimes.com/reuters/2016/06/11/us/11reuters-california-insurance.html?_r=0 Shear, M. D., & Lichtblau, E. (2016, January 4). Obama to Expand Gun Background Checks and Tighten Enforcement. New York Times [New York]. Retrieved from http://www.nytimes.com/2016/01/05/us/politics/obama-says-he-will-act-on-gun-control-in-coming-days.html

Gun Violence Research Act

This ...

Abstract

The current government has consistently been trying to reduce the costs of healthcare and at the same time improve its quality. This paper focuses on the current state of healthcare through an extensive research on the population. The research uses a cross sectional design to collect data and come up with relevant conclusions. The research project aimed at using a homogenous population to come up with accurate results. Such a population involves participants who have the same knowledge about the subject. Such participants are easily obtained through a referral process where one participant refers another. A total of 50 ...

The Past Health Care Initiative

In order to solve the problems regarding the increasing cost on health care, different organizations in the United States developed a new integrated system wherein the components such as the system’s organization, the financing division, and healthcare processes are all assimilated into one governing system. The organizations believed that this new system, which is coined ‘managed care,’ will provide an adequate healthcare to all patients while preserving the resources (Shortell, Gillies, & Anderson, 1994).

Similarity and Difference

However, the article was written prior to the establishment of the Clinton health care initiatives, thus, there were changes that happened when the new initiative ...

Articles Review

Healthcare system is a complex system of relationships on various organizational levels. While organization-client relationships are essential, the success of the companies in the sector depends on their ability to recognize the trends and opportunities and build stronger bonds between public, private and not-for-profit (NFP) sectors. Globalization, technological advancement and others aspects of the environment in which healthcare professionals and organizations operate places more pressure on the healthcare system with regards to strategic development and implementation of appropriate strategic alternatives, which can ensure sustainable and high-quality service in all the services.Martin Healthcare Systems is subject to all these influences ...

How Universal Health services revenue mix compares to revenue blend of not for profit entity; St Jude Children Research Hospital.

The Universal Health’s revenue mix Inc has its basis on services that are provided to the inpatients while that of St Jude is based on contribution sources. In that respect, the revenue mix percentages for Universal health and St Jude is summarized in the following table. In view of the above table, Universal’s revenue mix is marked by third party payments through Medicaid and Medicare. Other sources include the managed care and individual patients’ payments. In that respect, Medicare is the largest source followed by managed care and other sources. On the other hand, the non-profit organization’( ...

Abstract

The healthcare environment is characterized by various dramatic as well as rapid changes whereby this is usually leads to various difficulties especially in regard to effective change management. In regard to this, the various stakeholders involved in the management of healthcare organizations should effectively monitor change in order to anticipate the effects of these changes and come up with the appropriate measures to effectively deal with the challenges presented by the changes. As such, it is crucial and necessary to effectively understand the continuing trends that include; changes in managed care, client characteristics and pay-for-quality so as to effectively ...

Abstract

The above paper seeks to outline the role of Advanced Practice Registered Nurse (APRN) with a comparison of practices in two main states (Louisiana and Arkansas). The paper starts with a review of the prescriptive authority of APRN's in Louisiana, with an emphasis that the area faces a shortage of health professionals. According to the regulations of the state, it is a requirement that NP should offer prescription with an oversight of a physician. The collaborative practice agreement helps guide the two practitioners to work in close collaboration with one another in providing quality health care to the residents. ...

Introduction to Economic Thinking

Introduction to Economic Thinking

Aside from the obvious economic regulations of demand for health services, the existence of health insurance has effects on demand for health care goods as well as the services. Health insurance assumes the role of buffering between consumers as well as the healthcare costs goods and services (Folland & Stano, 2007). From the perspective of an insured consumer, healthcare goods as well as the services cost less because of providing full prices; the consumer might simply be in a position of paying, for instance, a co-insurance rate of 20 percent, after satisfaction to the deductible. For ...

Managed care does not involve an entity, rather a wider category that involves various healthcare delivery practices and structures, physician incentives as well as the developed relationship with physicians. Even though managed care structure undergoes the challenge of avoiding conflicts of interest hence leading to under-treatment, others are more challenged compared to some. Whether the MCO minimizes physician conflicts of interest depends on the manner in which they are organized and financed, the degree of physician involvement in managing patient care quality as well as the nature of the incentives used in controlling costs. The structure of managed care ...

Abstract

The transformation of the Primary Care Practices (PCP) into The Patient- Centered Medical Home (PCMH) model is expected to improve patient’s care, comprising even the ones with complex needs. According to Rich et.al (2012), PCMH is expected to reduce the risks associated with fragmented care and poor outcomes. The paper will also address factors as whether or not patient health care needs and even preferences are being met, whether the care is appropriate for the illness, timeliness, and procedures involved. Moreover, it will comprehensively address the state of provider contracting and its direction in the future. Nonetheless, the ...

Summary

Differences The Kaiser Permanente (KP) is an autonomous integrated not-for-profit health care organization. It comprises of the Kaiser Foundation Health Plan, Permanente Medical Groups, and Kaiser Foundation Hospitals. The organization has its services spread across eight regions. It focuses on the successful evolution of a system that encourages physician and managerial partnership for quality and efficiency in patient care. The Mayo Clinic is a non-profitable healthcare organization based in Rochester Minnesota. This organization concentrates on education, medical practice and research. It operates as one of the largest nonprofit organizations in the world that specialize in complex healthcare issues through ...

Section One Discussion Questions

- What significant events contributed to the evolving nature of clinical psychology in recent times? Whom do you identify as major contributors to the discipline? What are those contributions? - The increasing costs of health and mental health care have resulted to longer periods of care and greater levels of care for individuals. Additionally, the increasing use of pharmacotherapies has resulted to an increase in the population of individuals receiving mental healthcare. Major contributors include Sigmund Freud, Abraham Maslow, and Carl Jung. Sigmund Freud identified the influence of the subconscious mind on behavior, ...

Question 1:

Managed care has had a significant effect on the service delivery in the US. First of all, it has given the general population a chance to choose the kind of service they wish for and who they prefer to give the services to them. As such, the citizens have a chance to access the services of their choice. This is very important as it makes the people have both physical and psychological relief after getting teh services. This facilitates quick recovery. Managed care system has also helped in raising the standards of service care delivery. The different health personnel ...

Introduction

Fraud waste and abuse are always a big issue in the healthcare sector across the world. According to the research carried out by centers for Medicare and Medicaid services, taxpayers lose billions of dollars annually due to fraud waste and abuse. The estimated amount lost within CMS ranges between three and ten percent. The private sectors are not spared by this menace either. Private players such as self-insured companies and managed care organization are struggling in trying to find out an effective way of managing fraud waste and abuse. The effects of fraud, waste and abuse in the health sector ...

Fraud and Abuse in Managed Care in America: An Introduction

The American government significantly knows more about health care reforms, and what requires to be put into practice to resolve the poor health care system. The major trouble the government is trying to deal with the considerable rise in health care expenditures that are creating a large number of patients that are registered all over the USA. There exist various factors that are linked to ...

Veterans today are the heroes of yesterday. They stood up for us, risked their lives just to protect us, and sacrificed their personal needs and wants for our country. We should look up to them, we should be thankful to them. They are our heroes without special powers; heroes who are just the normal people like us. Despite the heroic deeds that they used to do, it is saddening that they do not get that much compensation for their actions. I am not saying that we should always give them praises but simple acts of gratitude like good benefits ...

Healthcare organizations earn revenue through different means. Examples include; payment from provision of medical and non-medical services, donations and grants from persons, organizations and the government, and also from various forms of investments. Different factors affect the revenues generated from payments of medicinal and non-medicinal services. They include; the nature of medical services provided to patients, volume of outpatient procedures and the costs of such services. The main sources of revenue are as follows:

- Medicare

Medicare is a wellness program whose management lies with the Centers or Medicare and Medicaid Services. The program majorly avails healthcare services to individuals ...

Fee-for-Service (FFS) Reimbursement

In this hospital reimbursement model, services are unbundled and each is paid for separate from the rest. This model is founded in order to motivate and provide incentive for physicians to provide as many treatments as possible. Therefore this reimbursement model or basis will increase the number of admissions since physicians are compensated depending on the quantity of treatments. The average length of stay and volume of services per day will also be affected in the same way. This is attributed to the fact that quantity is favoured over quality.

This basis however raises the unit cost of ...

When a clinic joins a management care organization, there are several benefits and effects that the organization undergoes. The main aim of a clinic joining a MCO is to ensure proper staffing, find a balance in its financial stability and to be able to effectively manage its patient volumes. According to Burns (2008), managed care organizations have programs that ensures patient outcomes are achieved through the provision of affordable, appropriate and extensive coverage of accessible benefits of prescription drugs. Clinics are thus able to choose from the numerous plans and programs to reduce their costs and be able to choose the best remuneration for ...

Health Care Delivery/Integration

Managed Care Managed care, arguably one among the most common emerging trends in the field of health care, is exceptionally controversial as it has impacted differently on people and societies. Managed care is aimed at reducing the costs of accessing healthcare benefits. It lays emphasis on such techniques as preventive care and the use of financial incentives (Wolper, 2004). Looking at it from an micro-level point of view, managed care is associated with conflict of interest on the part of the physician. On the other hand, it makes it difficult for the physician to prioritize the interests of ...

1. Healthcare Delivery on Micro and Macro Levels

Managed care is a healthcare plan or system that contract with health care providers and medical facilities to provide care for members at reduced costs. On the macro-level, managed care plans take into consideration on major issues such as system design and organizational structure. The funding system used by Managed care promotes efficient use of resources, such as payment using diagnosis-related groups or other care mix approaches to create an incentive to reduce length of stay and avoid excessive servicing during an episode of care (Andreou, 2011). For example, managed care providers emphasize on keeping enrollees healthy to reduce use ...

How will health care reform impact the small, medium, and large employer’s organization?

Major challenges to managing the enrollment information on a managed care plan.

An inefficient database system. This poses the major challenge for all organizations as the database system used influences the nature of information to be processed. The information system in place is a crucial factor that influences the nature and availability of information regarding to the health care enrollment information. Due to this challenge, the state of Illinois has developed various systems to help to store the data in regard to the particular patient. They include integrated care program and primary care case management program. Information backup systems. It is a ...

In past years there was a constant increase in the health related costs. The expenditure touched $2.3 trillion in United States in 2008 alone which was just $714 billion in the year 1990. The expenditure was eight times more in 2008 compared to 1980. It accounts to $7681 per capita expenditure spent by US health care in 2008.Adverse effects has been observed amongst citizens and government due to unprecedented rise of health care costs. Obviously, US government is spending less in economic growth and more on health care. Concerns were raised by citizens and businesses to implement health care reforms ...

Public Health

A. Based on the nurse biographies you read this week in The Neighborhood, do you see each nurse's role as a public health or community nurse? Explain. According to Stanhope and Lancaster (2004) the primary role of public health nurses is to provide managed care, primary care, and health education to families and individuals who are categorized as high risk and vulnerable population. The nurse biographies provide insightful life experiences of public health nurses and challenges undergo when providing health care to high-risk communities and vulnerable population. For example, Kate Williams, a 57-year-old geriatric nurse provides counseling services to the ...

How do providers influence the decisions that patients make?

Health is a sensitive matter in any part of the world. In the US, the importance of better health is reflected in the huge budgetary allocations (around 20% of the entire budget goes to health (GUWS Medical, 2015). Of course, the budgetary allocations have been increasing year in year out as a result of the push and responses from both the patients and healthcare providers respectively. However, one of the most forgotten aspects is the influence that the healthcare providers have on the choices that the patients ultimately choose or have. The Institute of Medicine in 2010 put the figure for ...

This essay covers the topic of Accountable Care Organizations (ACOs). ACOs are health care organizations envisaged in the Affordable Care Act with a health care delivery and reimbursement model that is based on quality metrics. ACOs are responsible for providing quality care and reducing the total cost of care and account for their services to patients and the payers of health care services. The focus of this essay is the benefits and the unintended consequences of ACOs.

Benefits of ACOs

ACOs function on a delivery model of individual health providers and organizations coming together to coordinate care delivery. An immediate benefit of ACOs is ...

Within the United States of America, the appeal of managed care has increased sufficiently as a method of healthcare administration. The development of managed health care is an attributed backlash to the traditional U.S. health care system (Sekhri 2000). The managed care organization is employer-based offering indemnity insurance and fee-for-service conditioned for both the providers’ and patients’ expectation of the unlimited resources and unrestricted choice (Sekhri 2000). The system is enforced by both user and provider satisfaction through adequate compensation and consumers through unrationed medical care. Methods used in the managed health care organization are consumer oriented for equal benefit. ...

Following the American Psychological Association’s Guidelines

((Cover Page))

Reg No

Designation Health Care Delivery Systems 1. Accessibility is cited as the major reason for the poorest outcome of the US Health Care system. Health care in the US follows the market justice model. The patients pay for the health care service. The service varies according to the pay. Hence people with good financial resource can get outstanding health care services in US. People with poor economic resources are neglected of quality health care in US. Lucas Kawa, 2013 discusses the increasing mortality rates and poor health care measures in United States. The life expectancy of ...

THE HEALTH CARE MARKET

Qn 1 Access to health care services varies from state to state. In the U.S, healthcare services have tremendously evolved from a predominantly volunteer or charitable system where patients paid little or no money at all to business entities (Ameringer, 2008). The healthcare industry is now one of the largest industry employing over 13 million workers with a projection to increase by 5 million by 2015. According to Ameringer, its very unfortunate that the health system problems lie with delivery system that drives low quality and inefficient care in a country filled with latest technological advancements and skilled health care professionals. ...

Introduction

According to Peter R (2001), managed care contracts that are a process of negotiation between a physician or health care professionals and a well-managed health care facility for them to provide prospective services. These health contracts should be provided by well-established health professional or physicians. In the United States, there are well local well-established insurance companies dealing with managed care contracts. These companies include Wellcare Health plans, Humana, Coventry Health Care and Amerigroup.

Wellcare Health Plans

Wellcare Health Plans is one of the largest insurance companies in the United States. Being established in 1985, it has about 2.2 million members with about 91,000 ...

Introduction

- Summary - Medicaid - Medicare Analysis of challenges to Medicaid in terms of improving access to care, quality of care, and reducing the cost of care. Analysis of challenges to Medicare in terms of improving access to care, quality of care, and reducing the cost of care.

Conclusion

• Conclusions about the future of managed care in each program - Will it grow or decline? - What will be the challenges for success? Introduction This research encompasses a study of managed care in United States of America as perceived under Medicaid and Medicaid ...

Managed care in the healthcare delivery is an approach that puts the scarce resources in a healthcare system into maximum use. Due to this, the healthcare system improves the services provided through utilization of the scarce resources available. Optimal resource utilization ensures that there is little investment with maximum output that benefits the citizens. In addition, the managed healthcare system responds to the social economic needs of the society. In this case, the economic abilities of the society are not stretched beyond their capabilities while offering the best healthcare services. In addition, managed healthcare approach defines in details the ...

<Put your name here> <Put the name of your school / University here> Health Insurance comes where there is a chance of bringing oneself to paying medical bills that are incurred by individuals. Health Insurance companies develop a system by determining the expenses incurred in the health care system, where they develop a standard financial structure, where they decide the premiums or such related payments. This is to ensure that the money is available to pay for the health care benefits as mentioned in the insurance agreements. The earliest health insurance plans were for accidents incurred from ...

Introduction

Human resource management has been used for the last fifteen years. Before that, human resource management was known as personnel administration. Personnel administration is the main aspects of evaluating, training, hiring, and compensating the employees of a company. One of the main reasons that human resource management was implemented into organizations was to help to increase competitive pressures of the business organizations in the United States. The competitive pressures came from globalization and rapid changes in technology. All of these pressures enhanced the concern when firms engaged in strategic planning. Therefore, human resource management is all of the activities ...

Pharmacists are one of the important medical staff in different settings in order to provide adequate medical assistance to their clients. There are various pharmacy settings in which pharmacists themselves must be aware of the roles they need to play so as to prevent medical errors.

Pharmacists’ Role and Different Settings

Retail Pharmacy One of the pharmacy settings is the Retail Pharmacy. This setting is an independent pharmacy, which includes, but not limited to supermarket and chain pharmacy. Retail pharmacies have the license to dispense medicines to the general customers. However, this type of setting does not involve dispensing prescription medications either through ...

Highlighting the differences between the Medicare Advantage Plan and the Medicaid care plan is of great significance. The most convenient and affordable plan can be identified by stating its advantages over the latter plan and citing valid examples. The paper attempts to highlight the most recommendable plan by stating reasons supporting the proposal. A Medicare advantage plan involves a Medicare health insurance provided by a private company. A Medicare Advantage plan was developed to offer prescription of drugs (Medicare.gov, 2014). Various types of Medicare Advantage Plans include Health Maintenance Organization (HMO), Private Free-For-Service (PFFC), Special Needs Plans (SNPS) and Preferred ...

Managed health care is a comprehensive term describing the system integrating delivery of health care services with resourcing and financing. It’s also an approach under which the healthcare services can be delivered with the best possible scarce resources allocation in order to optimize the patients’ outcomes (Navarro, Cahill). In a properly functioning managed care system, people get healthcare services that are appropriate and necessary, within set efficiency criteria, within defined timeframe, complying with the highest quality standards, and with “anticipated and measurable outcomes” (Linsley, Morton, 2014). Managed healthcare differs from so-called “liberal medical practice,” allowing physicians to choose methods of ...

An Overview of Health Economics

Economics has generally been defined a social science of scarcity, and its application in health is a reflection of the need to achieve maximum value from resources used through improving cost and clinical effectiveness. Economic principles are applied in numerous disciplines and health is among the disciplines where the principles are applied. Health economics involves an application of economic theories and principles such as consumer and producer theories, as well as understanding of the social choices. It aims at understanding the behaviors portrayed by health care providers, individuals, public and private institutions. It has been imperative in the improvement of care, ...

Question One:

Managed care plans have become an issue especially in the context of the controversial Affordable Health Care Act otherwise known as Obamacare. However, the tirades of opposition notwithstanding, my experience in electing the MCO plan to belong to was good. I settled for the Health Maintenance Organization (HMOs) which I found satisfactory and efficient. Some of the advantages associated with the HMO include the fact that one is attached to a physician and can access inpatient and outpatient medication within the package at hospitals within the HMO. In addition, the HMO system eliminates out of pocket expenditure and ensures ...

Health maintenance organization is a kind of managed health insurance or healthcare whereby the insured individuals only doctors, physicians and specialists who are part of a network. This paper seeks to focus issues that arise because of managing health maintenance organizations (Ehealthinsurance.com, 2014). The need to read this paper is to have a clearer idea of what the program concerns. Health maintenance organizations have participated in a major role of maintaining a higher standard of healthy living for the society. We will embark on their benefits and demerits, the challenges associated, and their recommendations. - Benefits of Health Maintenance Organizations: - Healthcare ...

Despite the healthy benefits of inoculating children, parents still ask, “Is this right for my baby?” Since the heightened rate of autism among children, many parents have wondered if vaccines are to blame. Out of fear or the thought of saving their children, parents skip vaccines that protect children from harmful diseases such as tuberculosis, measles, mumps, and several others. Other parents simply believe that vaccines are unnatural and that if the child eats clean and lives healthy their body will naturally resist these diseases. This is all, of course, preposterous. Scientifically speaking, no amount of clean eating can ...

Part 1:- What do you envision as the future of Public Health?

Introduction Public health across the world has emerged from merely investigating sewage disposal systems when cholera and dysentery outbreaks occurred in Britain to sophisticated health promotion programs for diabetics; persons affected with HIV/AIDS as well as specific maternal and child health interventions (Johnson, 2006). This essay will briefly offer insights into what I envision as the future of public health in America and across the globe.

Besides, the discipline has reached the level whereby it is being classified that science of preventing disease; prolonging life by providing informed services to communities that will empower them to take better ...

Conflict and Interactionism

Introduction Discussion of health care institution Discussion of theories Theoretical applications Conclusion Abstract In this research presentation sociological theories functionalism, conflict and interactionism with applications in the health care institution particularly in United States of America will be explored. Health care institutions across the world embrace interpretations of sickness, wellness, disease, medicine, nurse, nursing, healing, well-being and many other issues, which analysts find difficulty to classify within the science. Many irregularities are occurring within health care institutions across American under managed care typology producing immense conflict and citizens are taking an Interactionist approach ...