Hcs 490 Week 4 Case Study Comparison Paper
Team B Case Study Comparison
Amanda McClanahan, Natasha Martinez, & Tammy Thompson
HCS/490
March 15, 2015
Ann Fairchild
Case Study Comparison
In reviewing the case study of a thirty-year-old mother with four young children we can expect her annual costs for health care services to be exponential, and unfortunately health care costs are continually rising. Although this mother does not have any special health problems or any special health concerns for her children, there are many variables to account for on a yearly basis. It is important that she chooses the best health care option for her, and her family that isn 't going to become an imposition. This family has many options to consider, and many benefits that they can consider, in order to assure that health care does not become a burden, rather than an asset to keeping her family healthy.
Expected Annual Health Care Expenses …show more content…
According to Health Care Costs Institute, Inc.
(2015) "The government estimates that the average family will spend an extra $15,630 until the child is 18". Annual checkups are important at any age, especially now that health care is more geared towards preventative care and has increased the frequency of being checked up on by your physician. A list of necessary tests and examinations for adolescents include, but are not limited to; scheduled immunizations, growth evaluations, cognitive and physical development, eye exams, hearing exams, dental exams, and the need to have labs ordered to check for anemia, cholesterol, lead, and tuberculosis. "A child is recommended to receive a checkup as a newborn, 3-5 days old, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30, 36 months, and every year after that until they are at least 21 years old" (KidsHealth,1995-2015). The average office visit for children under the age of twelve is between $88 - $557, immunizations $94-$1255, and up to $50 for screenings annually (American Academy of Pediatrics,
2011).
For this middle-aged mother, it is important at the age of thirty to make sure she is continuing her annual well-woman exams. She should start receiving breast exams (mammograms) annually, make sure her overall health is accounted for and manageable, that she has her vision checked, skin checked and is up to date on her vaccinations. The mother needs to account for any unexpected expenses, such as emergency room visits, any outpatient procedures, and the cost of prescriptions and/or over the counter medications, for both her and her children.
Health Care Costs
The average annual health care cost for a family of five (with four being children under the age of 12), according to the Health Insurance Marketplace Calculator, is estimated at $7,878, or $657 per month. These calculations were based off of an average income (roughly $52,000 annually), the amount of people in the household (including adults and children under the age of 12), and whether anybody in the household uses tobacco. This calculation shows what the health care costs will be for a family of five without an insurance premium/ plan and this only accounts for doctor appointments and medications. There are usually many other occasions where a family with four young children will visit the hospital for accidental occurrences where more medications are likely to raise this estimate.
Considering all four children are under the age of 12, the emergency room visits are usually higher considering their many uncertainties. Not only are their immune systems still developing, they are also still learning their allergies. Children are also more likely to go to the emergency room for stomach pains, toothaches sprains/ broken bones, upper respiratory infections, fevers, and even for swallowing something that they should not have (money/change, buttons, magnets, etc.). Whether they eat a lot of candies or ate something that did not settle well with them, this is can result in an emergency room visit.
This calculation can never be truly accurate considering that children (especially those under 12 years old) are not as immune to many illnesses as teens and adults are. Children are more energetic and insist on playing where there is a very good possibility for cuts and scrapes. Emergency room visits are not planned yet this is where parents take their children if their children (or they themselves) get sick or hurt. However, if we were to go off of a basic calculation, where there are no emergencies, only routine doctor visits, and only occasional emergency room visits, then the calculation stated earlier would suffice.
Different Health Plans
HMO, PPO, CDHP are various types of health plans consumers can choose for their health care needs. Many employers offer several different plans to their employees. The differences between the three types of plans range from low to high costs and how to seek medical care. Health Maintenance Organizations (or HMO 's) are low-cost plans, but access to medical care is limited to a particular group of providers who are considered to be "in-network". In-Network refers to providers that are contracted with a health insurance company, to accept and provide care to patients with that particular insurance. A Primary Care Physician (PCP) is a requirement of an HMO plan that would refer patients to specialists. Preferred Provider Organization (or PPO 's) on the other hand, allow consumers to schedule direct medical care within a larger network of providers and cover more out-of-network care (HDHP.org). The costs associated with PPOs can be pretty high when looking at co-pays, co-insurance, deductibles and out-of-pocket maximums (HDHP.org). Another plan to consider is Consumer-Driven Health Plans (CDHP). This plan allows members to use Health Savings Accounts (HSA 's), Flexible Savings Accounts (FSA 's) or Health Reimbursement Accounts (HRA 's) to pay for the more routine medical expenses, while the high-deductible health plan (HDHP) protects from catastrophic medical expenses.
Conclusion
For a single mother of four children under the age of twelve who only seeks medical care for minor ailments or injuries would probably do well with an HMO. The family would develop a trusted relationship with a physician who will take care of the preventative care for the whole family, and has the ability refer them to the proper specialist, if they feel it is needed. Many of the medical expenses this family would incur would be covered under the HMO plan, provided they stayed within the designated network, and the mother can use an HSA to be able to use or invest a significant amount of money in future care for her family, and those unexpected medical expenses that may not be covered entirely by the insurance company she chooses. It is easy to be able to prepare for the health care that is expected and needed for her family, but is equally important to be knowledgeable about what to expect annually and be able afford the care that her family needs.
References
American Academy of Pediatrics. (2011). Estimated Pediatric Preventive Care Cost for Not-at-Risk* Patients through Age 21, 2011. Retrieved from https://www.aap.org/en-us/professional-resources/practice-support/practice-management/Documents/Bright-Futures-Cost-Estimates.pdf
HDHP.org. (n.d.). Retrieved from http://www.hdhp.org/hdhphealth-insurance/compare-ppo-vs-hmo/ on 3/14/2015.
Health Care Cost Institute Inc. (2015). Press Release: Children 's Health Care Spending Report 2007-2010. Retrieved from http://www.healthcostinstitute.org/news-and-events/press-release-childrens-health-care-spending-report-2007-2010
KidsHealth. (1995-2015). Your Child 's Checkups. Retrieved from http://kidshealth.org/parent/growth/medical/checkups.html
The Henry Kaiser Family Foundation (2015) Health Insurance Marketplace Calculator. Retrieved from kff.org/interactive/subsidy-calculator/#state=&zip=&income-type=dollars&income=51939&employer-coverage=5&alternate-plan-family=individual&adult-count=1&adults%5B0%sD%5Bage%5D=30&adults%5B0%5D%5Btobacco%5D=0&child-tobacco=0
Amanda McClanahan, Natasha Martinez, & Tammy Thompson
HCS/490
March 15, 2015
Ann Fairchild
Case Study Comparison
In reviewing the case study of a thirty-year-old mother with four young children we can expect her annual costs for health care services to be exponential, and unfortunately health care costs are continually rising. Although this mother does not have any special health problems or any special health concerns for her children, there are many variables to account for on a yearly basis. It is important that she chooses the best health care option for her, and her family that isn 't going to become an imposition. This family has many options to consider, and many benefits that they can consider, in order to assure that health care does not become a burden, rather than an asset to keeping her family healthy.
Expected Annual Health Care Expenses …show more content…
According to Health Care Costs Institute, Inc.
(2015) "The government estimates that the average family will spend an extra $15,630 until the child is 18". Annual checkups are important at any age, especially now that health care is more geared towards preventative care and has increased the frequency of being checked up on by your physician. A list of necessary tests and examinations for adolescents include, but are not limited to; scheduled immunizations, growth evaluations, cognitive and physical development, eye exams, hearing exams, dental exams, and the need to have labs ordered to check for anemia, cholesterol, lead, and tuberculosis. "A child is recommended to receive a checkup as a newborn, 3-5 days old, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30, 36 months, and every year after that until they are at least 21 years old" (KidsHealth,1995-2015). The average office visit for children under the age of twelve is between $88 - $557, immunizations $94-$1255, and up to $50 for screenings annually (American Academy of Pediatrics,
2011).
For this middle-aged mother, it is important at the age of thirty to make sure she is continuing her annual well-woman exams. She should start receiving breast exams (mammograms) annually, make sure her overall health is accounted for and manageable, that she has her vision checked, skin checked and is up to date on her vaccinations. The mother needs to account for any unexpected expenses, such as emergency room visits, any outpatient procedures, and the cost of prescriptions and/or over the counter medications, for both her and her children.
Health Care Costs
The average annual health care cost for a family of five (with four being children under the age of 12), according to the Health Insurance Marketplace Calculator, is estimated at $7,878, or $657 per month. These calculations were based off of an average income (roughly $52,000 annually), the amount of people in the household (including adults and children under the age of 12), and whether anybody in the household uses tobacco. This calculation shows what the health care costs will be for a family of five without an insurance premium/ plan and this only accounts for doctor appointments and medications. There are usually many other occasions where a family with four young children will visit the hospital for accidental occurrences where more medications are likely to raise this estimate.
Considering all four children are under the age of 12, the emergency room visits are usually higher considering their many uncertainties. Not only are their immune systems still developing, they are also still learning their allergies. Children are also more likely to go to the emergency room for stomach pains, toothaches sprains/ broken bones, upper respiratory infections, fevers, and even for swallowing something that they should not have (money/change, buttons, magnets, etc.). Whether they eat a lot of candies or ate something that did not settle well with them, this is can result in an emergency room visit.
This calculation can never be truly accurate considering that children (especially those under 12 years old) are not as immune to many illnesses as teens and adults are. Children are more energetic and insist on playing where there is a very good possibility for cuts and scrapes. Emergency room visits are not planned yet this is where parents take their children if their children (or they themselves) get sick or hurt. However, if we were to go off of a basic calculation, where there are no emergencies, only routine doctor visits, and only occasional emergency room visits, then the calculation stated earlier would suffice.
Different Health Plans
HMO, PPO, CDHP are various types of health plans consumers can choose for their health care needs. Many employers offer several different plans to their employees. The differences between the three types of plans range from low to high costs and how to seek medical care. Health Maintenance Organizations (or HMO 's) are low-cost plans, but access to medical care is limited to a particular group of providers who are considered to be "in-network". In-Network refers to providers that are contracted with a health insurance company, to accept and provide care to patients with that particular insurance. A Primary Care Physician (PCP) is a requirement of an HMO plan that would refer patients to specialists. Preferred Provider Organization (or PPO 's) on the other hand, allow consumers to schedule direct medical care within a larger network of providers and cover more out-of-network care (HDHP.org). The costs associated with PPOs can be pretty high when looking at co-pays, co-insurance, deductibles and out-of-pocket maximums (HDHP.org). Another plan to consider is Consumer-Driven Health Plans (CDHP). This plan allows members to use Health Savings Accounts (HSA 's), Flexible Savings Accounts (FSA 's) or Health Reimbursement Accounts (HRA 's) to pay for the more routine medical expenses, while the high-deductible health plan (HDHP) protects from catastrophic medical expenses.
Conclusion
For a single mother of four children under the age of twelve who only seeks medical care for minor ailments or injuries would probably do well with an HMO. The family would develop a trusted relationship with a physician who will take care of the preventative care for the whole family, and has the ability refer them to the proper specialist, if they feel it is needed. Many of the medical expenses this family would incur would be covered under the HMO plan, provided they stayed within the designated network, and the mother can use an HSA to be able to use or invest a significant amount of money in future care for her family, and those unexpected medical expenses that may not be covered entirely by the insurance company she chooses. It is easy to be able to prepare for the health care that is expected and needed for her family, but is equally important to be knowledgeable about what to expect annually and be able afford the care that her family needs.
References
American Academy of Pediatrics. (2011). Estimated Pediatric Preventive Care Cost for Not-at-Risk* Patients through Age 21, 2011. Retrieved from https://www.aap.org/en-us/professional-resources/practice-support/practice-management/Documents/Bright-Futures-Cost-Estimates.pdf
HDHP.org. (n.d.). Retrieved from http://www.hdhp.org/hdhphealth-insurance/compare-ppo-vs-hmo/ on 3/14/2015.
Health Care Cost Institute Inc. (2015). Press Release: Children 's Health Care Spending Report 2007-2010. Retrieved from http://www.healthcostinstitute.org/news-and-events/press-release-childrens-health-care-spending-report-2007-2010
KidsHealth. (1995-2015). Your Child 's Checkups. Retrieved from http://kidshealth.org/parent/growth/medical/checkups.html
The Henry Kaiser Family Foundation (2015) Health Insurance Marketplace Calculator. Retrieved from kff.org/interactive/subsidy-calculator/#state=&zip=&income-type=dollars&income=51939&employer-coverage=5&alternate-plan-family=individual&adult-count=1&adults%5B0%sD%5Bage%5D=30&adults%5B0%5D%5Btobacco%5D=0&child-tobacco=0