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How does health insurance differ from other kinds of insurance? What are the similarities and differences between them Answer

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 some of the issues that employers face in providing health insurance to their employees. Why has the cost of employer-sponsored health plans increased significantly over the last 5 years?

Private healthcare is funded predominantly through indemnity insurance plans such as Blue Cross Blue Shield, Aetna, and United Healthcare. The public financing of healthcare is accomplished through the Medicare and Medicaid programs. We will examine the complex reimbursement methodologies adopted by public and private payers. We’ll also look at the incentives that are inherent in each methodology and assess how these incentives may impact the operations of payers, providers, and employers. Once the payment methodologies have been identified, we’ll consider what is working and what is not working in terms of provider reimbursement and the challenges faced by employers in providing health insurance. We’ll also look at the triad of care – access, cost, and quality – to assess how reimbursement strategies drive each of these dimensions. The more we learn about the U.S. healthcare system, the more complex it becomes. Our current payment methodologies are very complicated and demonstrate another justification why healthcare reform is so important for the U.S.

Healthcare has become so expensive and the economy crashed in 2009. All employer paid benefits has risen for all employees during this time since most employers can’t afford to take on the burden of paying for full healthcare coverage for an entire family. Some offer different levels of paid benefits, if it is single the company will pay the cost per month and the employee will pay deductibles and co-pays along with co-insurance. If they want to add their family there are different levels of monthly payments coming from the employee along with deductibles, copays and co-insurance. The payment system is complicated and cumbersome for most people to even understand if they are not in involved in healthcare. Or even if they are involved in healthcare all the different payment systems are fragmented.

http://www.kff.org/insurance/snapshot/chcm110212oth.cfm

Why has the cost of employer-sponsored health plans increased significantly over the last 5 years?

First, dominant insurers are rolling over and paying powerful hospitals the rates they demand to be paid, which increase each year because they know that patients do not pay for their own healthcare directly and have no idea what their employer is paying for healthcare.

Second, is the lack of preventive care. Patients will subtle illness either fear going to the doctor for care, or do not want to pay the cost to see the doctor or they just simply do not have the coverage to pay to see a doctor and so they wait. Often times they wait until things get worse and they have no other choice but to go see a doctor, and by this time their treatment is long term and costly.

 

The compelling solution: reform the employer tax exclusion

The solution to this problem is, from a policy standpoint, simple: equalize the tax treatment of individually-purchased and employer-sponsored health insurance. If more people bought insurance for themselves, more people would understand the tradeoffs between higher prices and access to brand-name hospitals. Those “must-have” hospitals, in turn, would be more reluctant to exploit their market power to raise insurance premiums. And insurers would, in turn, have more ability to walk away from pricey hospitals, instead of rolling over and passing those costs onto their policyholders.

http://www.forbes.com/sites/aroy/2012/05/12/how-employer-sponsored-insurance-drives-up-health-costs/

 

From a health insurance perspective, what is the insurance risk and who bears the risk?   How do insurance premiums reflect this risk?

“The insurer assesses, as accurately as possible, the risk it will bear for covering an individual or a group against specified types and extents of losses (the risk assessment function of insurance)” (Barton, 2009 p. 110). Insurance companies establish the amount of risk they take on in two ways: underwriting process and experience rating. In the underwriting process, actuaries evaluate the possibilities of events happening to whatever is being insured (health, cars, property, etc) and modify as needed. Experience rating utilizes prior claims to predict the likeliness of future claims. Auto insurances utilize experience rating when they evaluate how many traffic violations you as a driver have. A violation will usually cause an increase in your premium.

Barton, P. L. (2009). Understanding the U.S. health service system. (4th ed.). Chicago, IL: Health Administration Press.

An actuary is someone who looks at the data for a population and determines their potential utilization of services which will determine insurance premiums.   What are some characteristics of a population which may drive up health insurance premiums?

 

 

 

 

 

 

An article in the New York Times in the Money & Policy section states that one reason premiums are on the rise is because of the new federal law. Actually, we are paying more for a lot less. It also stated that next year there we be competition among the carriers which will lower the premuims. The name of the article I found online is As Health Costs Soar, G.O.P. and Insurers Differ On Cause. A second reason why premiums are on the rise is because health insurance is very expensive which makes health care expensive. The last reason is the new law ObamaCare. There are many people out there believe this is the main reason.   This law does not prevent premiums from rising. I found out about this information on Reason. com. The name of the article is “Is ObamaCare causing Health Insurance Premiums To Rise?

Characteristics of a population that drive up health insurance premiums are:

1)   People who smoke cigarettes/cigars/pipes, etc.

2)   Overweight or Obese (BMI)

3)   High Blood Pressure

4)   Heart Conditions

5)   Cancer – active, remission, survivor, etc.

6)   Insurance fraud – prior, current, etc.

7)   High cholesterol

8)   Working in highly stressful or dangerous environments

9)   Depression or history of mental illness

10)   Post Traumatic Stress Syndrome (PTSD) from military service or abuse (domestic, sexual, mental, etc.)

Chronic health conditions greatly impact the health insurance premiums. “Nearly half the U.S. population has one or more chronic conditions, among them asthma, heart disease or diabetes, which drive up costs. And two-thirds of adults are either overweight or obese, which can also lead to chronic illness and additional medical spending”.

Some other factors that drive up our health care costs include:

  1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.
  2. We’re growing older, sicker and fatter.
  3. We want new drugs, technologies, services and procedures.
  4. We get tax breaks on buying health insurance — and the cost to patients of seeking care is often low.
  5. We don’t have enough information to make decisions on which medical care is best for us.
  6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.
  7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.

http://www.kaiserhealthnews.org/Stories/2012/October/25/health-care-costs.aspx

Insurance risk means that there is a possibility that the cost of treating the patient will be higher that the premiums that the patient pays. So the insurance company bears the risk that they will reimburse the hospital for more money than they expected. Insurance premiums can reflect this risk when the healthier people pay less premiums, while those who are unhealthy or engage in riskier activities like smoking cigarettes pay higher premiums.

Do you support the idea that that smokers should pay more for their health insurance as compared to non-smokers? How about individuals who exceed a specific body max index (BMI)?

I would not support the idea of higher premiums for smokers or overweight individuals. It seems as though this will be hard to regulate, especially for families were there is one individual in the family that smokes or is overweight. It wouldn’t be fair to charge the entire family at a higher rate for the behaviors of one individual. I do believe that smokers should pay more for their insurance, because there are so many programs and pills to support a person to quit smoking. Smoking also affects those around you more than obesity does. When a person is fat, it only effects how they themselves breathe, look, feel, health, etc. When a person smokes, their habit affects the air that others breathe. It also has been stated several times that 2nd hand smoke is worse than first hand. I have never understood how this could be true and still to this day, don’t really know if it is true; however, I know that smoking has an effect on others besides yourself and therefore, for the good of the masses, we should do all that we can to help people stop smoking.

I wouldn’t necessarily agree with smokers paying more for their health insurance because there are other things that people do that harm their bodies such as alcohol or drugs. Just because they smoke doesn’t mean that they will have health issues. They can pay the same premium but if they are required to have more doctor visits, then they will pay the difference.

 

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Supply base rationalism seeks to reduce the suppliers in which an organization deals directly Answer

Supply base rationalism seeks to reduce the suppliers in which an organization deals directly to a smaller number of strategic suppliers. How does this process work? What are the benefits to each of the players in this relationship? Document your sources. Respond to at least two of your fellow classmates’ postings.

Answer:

Harrison & van Hoek (2011) stated “paradoxically, the first step to managing the supply base for value through relationships is to get rid of the majority of suppliers.  The rationale for this action is the inability of a focal firm to allocate development resources to suppliers when there are simply too many of them” (p. 314).  Wheatley (1998) stated “vendor reduction brings two immediate benefits.  Typically prices improve as vendors fight to retain business.  And suppliers’ quality and delivery performance improve as a focus on things such as delivery performance or quality forces vendors to shape up – or find themselves de-listed” (para. 6).  The first step of the process is to thoroughly understanding your customer’s critical-to-success (CTQ) factors.  The best way to complete this step is to utilize the Six Sigma approach of first gathering voice-of-the-customer (VOC) and translating this information into the actual CTQs.  This step help develop the supply chain strategy.

The second step is aligning the internal organization to those CTQs.  Harrison & van Hoek (2011) stated “without that it will be hard to know exactly what to buy and what opportunities in the supply market are most valid to consider” (p. 305).  Once the internal operation understands the CTQs and strategy, it will be much easier for the organization to develop metrics to determine which suppliers meet the partnership criteria.

Then, companies can reach past their four walls.  CIO Canada (2002) stated “the best performers have already linked their operation with those of their customers, suppliers, and logistics providers.  They know their own performance metrics, and those of all the partners in the supply chain.  They have visibility from the beginning to the end of their supply chain, and can make cost and volume adjustments before it’s too late” (para. 21).

Segmenting the supply base into categories such as bottleneck items, non-critical items, and leverage items can help organize suppliers within each category.  To rate each supplier, it is best to select a cross-functional team of stakeholders, establish the rating criteria, agree on the effective weighting for each criteria, and score each supplier’s performance.  Typical criteria used to rank suppliers include quality, responsiveness, discipline, delivery, financial, management, technical capability, and facility.  Based on my direct experience on this subject, it might be very important to add a category that rates each suppliers’ continuous improvement level and ability to work together to create joint product designs.

References

CIO Canada, 10(12), 0.  (2002).  Five steps to better supply chain value. Retrieved from http://search.proquest.com/docview/217447317?accountid=32521

Harrison, A. & van Hoek, R. (2011). Logistics management and strategy: Competing through the supply chain (4th ed).  London, England: Prentice Hall Financial Times. ISBN: 978-0-273-73022-4

Wheatley, M. (1998). Seven secrets of effective supply chains. Management Today, , 78-86. Retrieved from http://search.proquest.com/docview/214774115?accountid=32521

 

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HCS 449 Week 3 Individual Personal Action Plan

Personal Action Plan

 

An action plan is a detailed, step-by-step plan for accomplishing an identified goal. Complete your personal action plan by answering the questions below. Refer to the program outcomes as a guide while answering your questions.

 

Program Outcomes

 

  1. Graduates will be able to identify the structure and role of delivery systems within the health care industry.
  2. Graduates will be able to examine the components of management and leadership within health care organizations.
  3. Graduates will be able to analyze the utilization and application of technology within a health care organization.
  4. Graduates will be able to examine the application of risk and quality management concepts in the health care industry.
  5. Graduates will be able to examine the impact of legal and regulatory requirements on the delivery of health care.
  6. Graduates will be able to explore financial and economic issues in the health care industry.

Part I

A personal action plan is a plan you develop to meet personal goals. Instead of focusing on a career goal, consider the personal goals that might help you eventually meet your career goal, or think of goals you want to accomplish for personal satisfaction. These often relate to education or professional development, aside from the focus of your chosen career. In developing a personal action plan, you will look at your personal strengths and weaknesses and your ability to think strategically, and you will identify the goals you want to achieve. Answer the following questions to help you prepare for your action plan.

Based on the program outcomes listed above, your program reflection from Week Two, and your program questionnaire from Week One, what would you identify as your greatest strengths?

One of my greatest strength is being social and very easy to get along with that is my strength I would say as a person. The reason why I would state this is because everyone that I have known or barley new told me out of everyone they have met I was the easiest and the most understanding person they have met. I like to listen to people and give good eye contact when they are talking some people tend to just move around and do different kinds of things when people are talking I stay focused on the person and listen.

Based on the program outcomes listed above, your program reflection from Week Two, and your program questionnaire from Week One, what would you identify as areas you need to improve?

One of things I should focus on is communicating and also not being shy when it comes to presentation and stuff around all of people that is what I think I need to improve because then I tend to start sweating and getting all nervous. My teachers always told me and also my mentors told me never to let them see you sweat it just the way it goes even when you are trying to be a seller of any kind you never want to see you sweat.

How do you feel you have accomplished the ability to strategize and critically think during the course of your program?

I have accomplished a lot in this time of my education I have learned many different kinds of things like learning about floor plans and managements techniques in this class. Which I think is very helpful when it comes to my work I tend to deal with a lot of people and help whatever I can and also dealing with robots so have to make sure I do understand what is going on around and also the people if they need any kind of help I would be there to give that kind of care. I also learned how to strategize the time with my education and also my work so that I don’t get caught up in school and work so I learned how to deal with the time and also work.

How have your ethical and personal perspectives evolved since you started this program?

I have learned a lot of different kinds of things from this program the way different kinds of people different kinds of things and also the way they think we are all different and we all do things a certain way this is the way we learn and how to do things better and understand the different kinds of cultures and the way we do things. Ever since I been in this education I have learned many different kinds of ways that I have learned from my classmates and the way they do things which was very interesting and amazing the way they were doing things in this education.

Based on your answers above, identify at least three areas where you can improve by setting a personal goal. Use these areas to create your goals in Part II of this worksheet.

Communication, Presentations, being shy are the three things that I need to improve on and the way to do things is to make sure that I can set goals to make sure that I can do them.
Part II

Generate your action plan by completing the table below. Identify at least three goals you would like to meet with this action plan. Research action plans on the Internet for help in completing this table.

 

  Goal How will I accomplish this goal? Who needs to be involved? When will it be done? What resources are needed? What obstacles may arise? How will I overcome these obstacles?
Example Goal I want to better understand the role technology will play in the future of health care. I will read trade journals and magazines and talk to people in different positions in health care. Myself and those I interview. It will really be ongoing, but the initial phase should be done in 6 months, by June 15, 2011. I need to join some trade organizations in order to read their articles. I also need to find people in different health care careers to interview. People may not have an opinion or their opinions may differ from the trade journals. I might have a hard time finding journals or magazines. I think developing really detailed questions and being consistent will help. Also, I might have to contact trade organizations to ask for help.
Goal 1

 

 

 

I want to understand more about communication. To learn and understand more about people and the communication Myself and also everyone that I can communication with. It would be nice to be done when I can communicate with people all better Any kind of resources that I can about communication There will be a lot of obstacles that will arise and I will be ready for whatever comes. Just don’t be shy and communicate with anyone that I can to understand more about communicating
Goal 2 Being Shy Just communication and being more open to people and just go out there Everyone needs to be involved that I can communicated with so that I can stop being shy When I get the fear of not being shy anymore Learning and understand the different kinds of ways to stop being shy. Fear of being shy and not understand Don’t be affarid
Goal 3 Presentations Don’t be scared and just go and do it People that I can presentation to. When I can presentation without sweating Watching people and learning different kinds of techniques People not understanding Go out there and just do it
Goal 4 vocabulary Learn more and also read a little more to learn more vocabulary. Books and people When I learn as much as I can know Books and reading Not understanding the words Learn and be reading a lot of books