Health Care Financing
Gail M. Biggers
Grand Canyon University: HCA 515 – O102
March 24, 2013
There are two broad approaches to financing health care: a market-based approach and a government-financed approach. For each approach, answer the following questions:
1. Who is provided access?
Most government financed systems are inclined to make available for every person living in the nation with treatment which proposes access to some fundamental level of care. Majority of people pay for coverage through taxes and additional charges. In government financed health care the government may provide care itself such as the United Kingdom or they may contact other providers to do ...view middle of the document...
3. How are the services paid for?
Services are paid for through Fee for service which drives up the cost of health care. This rewards quantity over quality. Fee for service does nothing to promote low cost, high value services, such as preventive care or patient education even if they could considerably enhance patients’ physical condition and reduce health care costs through the system. 78% of employer sponsored health insurance is was fee for service. Reimbursement is the form of payment for services provided. The most common practice is the insurance company pays to the provider directly. Under the MCO when receiving care the patient is usually required to pay a small amount out of pocket such as 15 or 20 dollars and the rest is picked up by the managed care plan.
4. How does reimbursement apply? Reimbursement is the determination how much to pay for certain services.
Reimbursement is costs or repayment for health care benefits. In the United States health benefits are often provided before the payment is made. End result physicians, clinics, hospitals, and other health care contributor establishment request reimbursement for health services provided in addition to expenses incurred. Presently reimbursement of claims for healthcare service depends on the appointment of medical codes to explain the diagnosis.
5. Are there limitations on care?
Government financed health care typically has more control to place limitations on care offered to patients and doctors in order to keep costs down. Since payers must try to deliver the most care for the greatest number of people at the least cost health care systems themselves may accidently cause access problems for individual people these problems maybe result of well meaning efforts to make care more affordable, or desire to have care for an individual align with what seems to work best for most people. Language and education can also cause limitations in care especially immigrant populations. Financial barriers can prevent low income people from accessing care thus they do not see the doctor as often as they should or when they should. Patient or providers value system. In some cultures using modern medicine is the last recourse after exhausting traditional and spiritual methods.
6. What guides care decisions for patients?
What guides care decisions for patients is accessibility. Health literacy which involves the ability to understand, each evaluate use of health information. Low health literacy is associated with health inequalities. Providing patients with written information that is tailored to an individual needs can be helpful in reinforcing professionals’ explanations of health problems. Access to the internet and researching on medical websites such as Web MD helps in providing patients with information that can be used when discussing medical issues with their provider.
7. What is the quality of services?
The quality of services consists of achieving safe effective,...