Economic Issues Simulation Paper Christi L. Baker HCS 440 March 5, 2012 Steven Miracle Abstract Castor Collins Health Plans, a regional health maintenance organization (HMO), in the state of Pantome provides HMO health insurance and health care services to enrollees through its statewide network of physicians and hospitals. E-Editors, a company with 1600 employees has asked Castor Collins to find an employee health insurance plan that accepts preexisting conditions at a maximum premium of $4,500 per person. Caster has two plans, which may fit the client’s demands. This paper converses the selection method including risk factors as compared to premiums that the company is willing to pay. In addition, the paper also considers the …show more content…
Thus, this plan covers preexisting conditions, but risks under this plan are lower than under Caster Enhanced, because this plan covers fewer services (University of Phoenix, 2011). For E-Editors, the premium charged for this plan is $4,491, and earnings are $7.19 million (University of Phoenix, 2011). For E-Editors, the premium charged for Castor Standard is $3,485 and earnings are $5.58 million (University of Phoenix, 2011). The risks and returns in this plan are low (University of Phoenix, 2011). A comparison of the expected utilization and the returns from providing Castor Standard to this group shows that the risks are quite high, and earnings from this plan are not sufficient to cover them (University of Phoenix, 2011). This plan is not the best choice of plan for E-Editors because one could mitigate risks by providing a different plan or by not insuring the group (University of Phoenix, 2011). Risk adverse customers buy health insurance to avoid losing income or wealth when indisposed (University of Phoenix, 2011). The insurance company in this case Castor Collins bears the risk in return for the premium and takes care of enrollees’ medical expenses (in part or full) when indisposed (University of Phoenix, 2011). The premium that Castor Collins receives is a source of revenue (University of Phoenix, 2011). It is
The purpose of this paper is to summarize the International Trade Simulation, explain the basic concept of International Trade, emphasize the four key points from the reading assignments in the simulation, and apply these concepts to my workplace.
Employers are beginning to incorporate telemedicine into the benefits package for their employees. Recognizing e-visits are beneficial to the employer, because the employee will not need as much time away from work to have non-emergent health conditions treated. In addition, the service is a cost savings to both the employer and employee. There are some employer groups covering these services at 100 percent for their employees’. E-visits are cheaper than clinic, and office visits.
Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many
In America, we not only have the problem of the non-insured but the under insured which causes just about as much problem as the underinsured. Each group has contributed to the vast growing cost of healthcare. Over the last decade or two, the amount of uninsured has risen due to the job market in the economy and the fact that most insurances are tied to employment, which is also a problem as the unemployment rate rises. The purpose of this paper is to explore this issue.
Many people are concerned about rising health care costs. In reaction to this, some individuals and companies are gravitating toward the assumed lower prices of Health Maintenance Organization (HMO) health plans. HMOs spend billions of dollars each year advertising their low cost services. While these savings look good on paper, there are many pages of small print. The explanation after the asterisk indicates that not only do the HMOs lack lower costs, but they also short-change the patient in quality care. Much of the money spent on premiums goes directly into the pockets of stockholders and less is then available for
Administrative expenses have been seen through time not spent finding, filing, and retrieving patient charts. A reduction in employee time equals less money spent by the employer. Budget savings a seen through elimination of transcription, transferring, and transporting of patient charts. Billing components within EMR packages can provide cost savings through generation of direct billing and reimbursement; this process shows great potential for reduction in billing errors. Errors made during the billing/reimbursement process result in dollars lost or not recovered for the organization, which in turn drives up the cost of healthcare. The Centers for Medicare and Medicaid Services reported (in 2003) that a 10% error rate, regarding payments,
This paper will discuss the preexisting condition Insurance Plan Program and its effects on the healthcare and health insurance market as well as the Segway into the elimination of Pre-existing condition clauses for insurances as found in section 2704 of the public health service Act. The remainder of this paper is organized as follows: Section 1 discusses Why the policy was enacted, section 2 discusses the economic environment previous to the PCIPP, section 3 Evidence supporting a market failure in the insurance industry, section 4 discusses how the plan was accepted and how it is working, section 5 discusses future implications, and section 6 discusses the conclusion
As a “comprehensive major medical insurance policy,” the Dumonts’ coverage includes basic health insurance for hospital, surgical, and physician expense needs, as well as major medical expense coverage. The latter is very important to extend the basic coverage to protect the Dumonts from the financial effects of a catastrophic illness or accident. The policy has a very adequate lifetime cap of $3,000,000 per insured. The Dumonts should continually analyze the health plans from both employers to determine which offers the best overall plan. But, the annual coinsurance, stop-loss amount, and family
Healthcare today is a big issue for a lot of individuals, and families. Because it’s not affordable and some plans are lacking the necessary coverage people need these days. There are many ways to make healthcare more affordable, adequate, efficient, and patient-centered. That being said there are also various healthcare plans that are suited for many different people such as HMO’s, PPO’s, POS’s, Medicaid, and Medicare. This is why government should develop a reform plan that focus on all of the above issues and much more.
Many employees must designate a health plan through their employer. These days, as HMOs (health maintenance organizations) and managed care plans continue to proliferate, that means a choice between bad and worse. As employees line up in the lunch-room for a process called open enrollment, they may be surprised to learn that managed care rates have gone up — again. The mirage that managed care is cheaper care is finally fading. And, for the first time in years, employees may also have the promise of free choice in medicine in the form of a new method of financing health care. Consumers are already aware of horror stories involving HMOs, but cheap rates persuaded many that managed care is less expensive. Recent
While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of
The RAND Health Insurance Experiment is a forty year old study that examined the amount people spent on health services (Morrisey, 2014). The experiment also studied the results of various of health insurance coverage (Welch, Hay, Miller, Olsen, Rippey & Welch, 1987). RAND HIE is still known to be one of the best studies because it helped with the adverse selection issues, price sensitivity, and the health services provided to consumers (Morrisey, 2014). Morrisey researched explained, “The experiment was very useful, and it helped with refraining adverse selection by casually selecting families to different health plans .” The main reason for
Individuals who are sick are more likely to purchase health insurance than healthy people. This “sicker population” might utilize a significant amount of healthcare services. In order to cater to this demand insurance companies will resort to raising the premiums, dissuading healthy people from buying insurance. As the pool of people covered by insurance becomes sicker it continues to drive up costs leading to a vicious cycle where each year fewer and fewer healthy individuals obtain insurance. This process is called adverse selection.
The current economy has hurt many retail businesses. Every month another retail giant closes its doors. Retail stores which we never would have imagined have gone bankrupt. Retail sales have declined greatly. Major cause of this declination is because many people are unemployed and cannot afford to purchase anything. Retailers are forced to discount prices to increase sales, but discounting still hurts margins. Retailers are assuming a very
The Federal Employee Health benefit program is the largest employer health insurance program in the United States, insuring about 3 percent of all Americans. There are 133 plans, offering 188 coverage options that are participating in the FEHBP as of 2003. Preferred provider organization (PPO), fee-for-service plans, and Health Maintenance Organization (HMO) all offer options. The government’s contribution toward the cost of the beneficiary’s premium is “lesser of 72 percent of the average FEHBP plan premium, weighted by enrollment, or 75 percent of the premium for the plan chosen” (Karen Davis) .