Question

Understanding Health Policy with A Clinical Approach explaining Paying for Health Care?

Answer 1

*Payment of healthcare services in the united states is derived from:

a.Out of pocket payments

b.Health insurance plans

c.Public/government funding

d.Health savings accounts

*The parties who were providing health care are:

The provider, the patient, and the fiscal intermediary such as the health insurance company or the government

Health insurance is developed to provide protection should a covered individual experience an event that required health care.

*Two forms of payment available in the health insurance are:

-Fee-for-service: A person purchases coverage for certain benefits, using health insurance coverage for the benefits, and paying the provider for services provided.

-Prepayment: The individual pays a fixed, predetermined amount for the services rendered.

*Cost-sharing is a contribution required by insurance policies from the covered individual in the form of a copayment, deductible or coinsurance.

-Co-payment: Costs must pay at the time they receive the services

-Co-insurance: The patient pays a percentage of the cost of the services

-Deductible: Payments that are required prior to the insurance paying for services rendered in a fee-for-service plan

*Two types of insurance plans:

-Indemnity Plan: Fee-for-service plan; contracts between a beneficiary and a health plan, but there is no contract between the health plan and provider

-Managed care Plans: Includes health maintenance organizations, preferred provider organizations, and point-of-service plans; focuses on cost containment of health services

*Medicare: Provides medical care for individuals who are 65 years and older, disabled individuals who are entitled to social security benefits, and people who have end-stage renal disease.

*Medicaid: Provides health insurance to the medically indigent; a welfare program government level.