HSM-541 Week 3 Discussion Question 1: Private Insurance (GRADED A)
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Course
HSM 541
Institution
DeVry University
HSM-541 Week 3 Discussion Question 1: Private Insurance
Week 3 Discussion:
Week 3: Private Insurance
Let’s consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them?
Next, let’s con...
Week 3: Private Insurance
Let’s consider the general concept of insurance. How does health insurance differ from
other kinds of insurance? What are the similarities and differences between them?
Next, let’s consider what might happen if value-based reimbursement completely
replaces volume-based (i.e., fee-for-service) reimbursement. What are the implications
for providers? For patients? For healthcare managers and administrators?
- How does health insurance differ from other kinds of insurance? What are the
similarities and differences between them?
When you compare health insurance to another kind of insurance, like life insurance,
there are similarities and differences between them. Life insurance is a voluntary
benefit a person pays a premium for in order for the identified beneficiaries to receive a
death payout. This payout is used to cover funeral expenses and to give some
monetary relief due to the loss of income resulting from the death (Kurt, 2020). Other
than the monthly premium, there are no other out-of-pocket costs.
Health or medical insurance is a voluntary benefit a person pays a premium for in order
for the insurance to cover medical services for preventative or curative reasons. Along
with the weekly or monthly premium, there are other out-of-pocket costs such as co-
pays for provider visits or pharmaceutical costs. If health/medical insurance is provided
through an employer as part of a PPO plan, any out-of-network costs for services
provided from a physician outside of the designated network would be the responsibility
of the patient.
What might happen if value-based reimbursement completely replaces volume-based
reimbursement?
Though fee-for-service has been the historical reimbursement model for the United
States, there has been traction around a move to a value-based reimbursement model.
The fee-for-service model is a costly model by encouraging physicians/providers to bill
for every billable service. This model is also not sustainable in the economy today.
Therefore, there has been a push to value-based model. This model would contain
costs by tying reimbursement to quality outcomes of the patient. This places the
responsibility of ensuring treatments and procedures are not done unnecessarily.
Additionally, it ensures the procedures/treatments that are performed are done with the
highest quality. Those providers who meet the quality metrics have additional
reimbursement, but those who perform badly can be financially penalized by withholding
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, additional reimbursements. Patients would benefit ultimately from the value-based
model.
Kristi Melton
Reference:
Kurt, D. (2020). Life vs. Health Insurance: Choosing What to Buy.
Investopedia. https://www.investopedia.com/articles/personal-finance/100115/life-vs-
health-insurance-choosing-what-buy.asp (Links to an external site.).
- Good morning,
Having insurance means you have a contract that is meant to protect you from financial
lose, it is a policy that that people that have it receive financial protections or are
reimbursed for losses. Insurance works by pooling together many people that have the
same thing to lose, they all pay a premium and all in a sense cover each other. Say a
company covers 100 people that own a home, everyone pays home insurance every
month and at the end of the year one house floods, well the insurance has the money to
give that house to get fixed properly. It is pretty much an "in case" thing to have, and we
all have it on our homes, cars and lives. Health insurance is a little different
"because the losses it attempts to cover are not limited. Everyone inhabits a body that is
subject to illness and injury with the potential for losses far beyond one’s ability to pay.
Only the truly wealthy, and here we are talking about the billionaires, can afford to self-
insure (Crisp 2018). I did not have health insurance for a few years after I turned 26 and
was no longer on my dads, luckily I did not get sick at all, I remember having an ear
ache and going to see my family doctor. He charged me a very small amount for
the visit and prescribed me a generic medication and I was fine thankfully. I could
not imagine having something very serious happen and stress even more because
of knowing once the bill came I was not going to be able to pay it. I know have a better
job that offers health insurance but it is still so expensive. I see doctors
more frequently because I am a bit older and want to make sure I am healthy but I still
have to pay monthly, a copay and the 10% of the visit that my insurance does not cover.
Which is just crazy to me, I understand it is a business at the end of the day but it really
makes me believe that you just have to be rich in order to receive the best quality
healthcare in the U.S.
Crisp, J. (Feb 19, 2018). Here's why Health Insurance is Different from other
Insurance. Kevin MD. https://www.kevinmd.com/blog/2018/02/heres-health-insurance-
different-insurance.html (Links to an external site.)
This study source was downloaded by 100000829957125 from CourseHero.com on 03 -03-2022 18:16:33 GMT -06:00
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