Preview

Health Care Delivery System

Powerful Essays
Open Document
Open Document
1163 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Health Care Delivery System
Running Head: Health Care Delivery Systems Essay

Abstract
The American health care system is designed to focus on the organizations of individuals, places, and to treat and prevent adequate health care for the target populations. The federal government conducts an immense portion of delivering health care systems in our world today. The purpose for health care delivery systems is to provide financial tangible benefits and provide health care services for the population and institutions. The results showed for the support of the hypothesis is elaborating in the importance of different health care delivery systems and the purpose
…show more content…
(http://aspe.hhs.gov/Progsys/forum/mcobib.htm). For example, Managed Care is a health care delivery system that merges payment and the delivery. It also accesses the use of treatments by engaging organization strategies creating to enhance the growth of cost-effective in the delivery of health care. Managed health care plan is a system that assimilates any management with in accordance of finance that delivers health care services of the covered population. In contrast, PPO also known Preferred Provider Organization is the delivery system that commits with medical care providers who gives discounted fees to clients. Nevertheless, clients have the opportunity to give health care to participants who are not members but can potentially become financial penalized due to any action of seeking out side providers and face consequences of not receiving discount and any deductibles of one’s health care plan and …show more content…
There goals is to obtain affordable and comprehensive health care coverage. This plan is conducted in advance by the option of a fixed fee from all members. Moreover, HMO delivers minimal cost for medical services that are needed for patients, and this health plan is responsible in conducting the deliver and finance portion of the medical health care services. They also arrange to provide the essential medical care which includes the benefit packages. Prepaid Health Plans (PHP) is known "to help make quality health care affordable for groups of people, including farmers, blue collar workers and their families” (Ahern, 2007) . In contrast, the traditional health care insurance only funds health coverage for hospital visits, and enrolled insures that receive health coverage in prepaid plans is charged a predetermined for acute and preventive health care from doctors who work in hospitals. As for PPOs, their health care philosophy originally was to create simple concepts in delivering health care services to large groups with lower rates in order to substantially gain a business development for their management. To emphasize, insures can select their own physician’s however penalties can potentially occur if they are not with the network. This form of health coverage is engaged in receiving adequate power with lower

You May Also Find These Documents Helpful

  • Good Essays

    The Health Maintenance Organization (HMO) Program will coordinate with a specified group of doctors and hospitals to provide care. Employees are limited to only the specified groups or hospitals the HMO provides. The HMO plan offers no deductible, and copayment fees from $0 to $20 for visits depending on services performed. Employee also will be offered the option to seek their own healthcare providers outside the HMO program for an additional cost. A Preferred Provided Organization Program is also available to employees who want to visit their own doctor and hospital providers. There will a yearly family deductible of $500 and $250 for individual before any medical expenses are covered. The plans will pay 80% on care provided or performed within the preferred provider list. The plan will pay only $70 on care rendered outside the preferred provider…

    • 667 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Hcr 230 Week 1 Assignment

    • 473 Words
    • 2 Pages

    PPO plans are the most popular plan that doctors, clinics, hospitals, and pharmacies contract with. One of the reasons that the PPO plans are so popular is because they pay the doctors a discounted fee for service based on their fee schedule. PPO plans offer a low premium that has a higher deductible or the other option is a high premium with a lower deductible. The patients are responsible to pay a copayment, and there is also a yearly deductible that the patient has to pay out of pocket. If a patient sees a doctor outside of the network without a referral, the plan will pay less and the patient is responsible for the remainder of the fee. Patients have their choice of providers, but if the patient goes to a out-of-network provider it will cost more. One thing to remember though is that all non-emergency services require pre-authorization.…

    • 473 Words
    • 2 Pages
    Good Essays
  • Good Essays

    Preferred provider organizations (PPOs) are a private plan which is the most popular, followed by health maintenance organizations (HMOs). PPOs sometimes pay participating providers based on a discount from their physician fee schedules which is called a discounted fee-for-service. With a PPO the patient pays annual premiums and often a deductible. The patient has two choices with the first being offered a low deductible with a higher premium and the second being a high deductible with a low premium and they always pay a copayment at the time medical services are rendered. Consumer-driven health plans (CDHPs) combine two components with the first being a high-deductible…

    • 738 Words
    • 3 Pages
    Good Essays
  • Satisfactory Essays

    The "Preferred Provider Organization" or PPO is the most popular types of plan that individual and families get for insurances. With this plan you can visit any in-network physician and/or healthcare’s providers without requiring a referral from a primary care physician. PPO is all about reducing the cost of care and claims processing, so therefore reducing the premium you to have to pay to the health insurance. The PPO can also be called” claims network”. PPO may not have copayment for doctor’s visit and prescription, and may not be for going to specific doctors and hospitals. PPO helps file out claims properly. PPO arrangement prevents, manager and/or operator approaches medical providers. Manager of the PPO fixed payments, make a contract,…

    • 217 Words
    • 1 Page
    Satisfactory Essays
  • Better Essays

    The purpose of a managed care organization is to coordinate the costs and delivery of health care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a Health Maintenance Organization (HMO). A HMO “provides medical care for all its enrollees in return for a fixed annual fee per enrollee” (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care services thereby reducing costs and controlling utilization. For example, HMO’s…

    • 1187 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    Preferred Organization Provider or PPO plans have higher costs out of organization providers that are seen. Preventative care coverage changes within the plan but is available. With this plan, a referral to another physician specialist is not required. There are some pre-authorizations required for other procedures and some fees are involved or can be discounted within this type of plan.…

    • 373 Words
    • 1 Page
    Satisfactory Essays
  • Satisfactory Essays

    There are several ways the managed care model is expressed one particular way is the Health Maintenance Organization or better known as HMO. HMOs have their own network of doctors, hospitals and other health care providers who have agreed to accept a payment plan at a certain level of services they provide. With HMO, you would have to pick a Primary Care Physician within the local approved network where that doctor can coordinate any additional care you might need. If you need a specialist, a referral would be needed within the HMO network. HMOs usually have lower monthly premiums, but out of network health care professionals are not typically covered by the insurance.…

    • 394 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Economic Issues Simulation

    • 1040 Words
    • 5 Pages

    Health Maintenance Organizations (HMOs) have an important role to their patients and their health care providers. Castor Collins Health Care Plan was found in the year of 1999, in Pantome. This particular HMO service provide health care insurance and health care services to a variety of physicians and hospitals. This company used the capitation idea for compensation to pay its health care providers. Castor Collins is currently serving 100,000 members, throughout Pantome, and is looking for ways to increase the their numbers.…

    • 1040 Words
    • 5 Pages
    Good Essays
  • Good Essays

    Based on my income, age and the frequency of doctor visits I am currently enrolled in a preferred provider organization also known as an (PPO) as stated in Siegel, R., & Yacht, C. on the subject of personal finance (p. 246). Additionally, this is covered through blue Cross/Blue Shield. Therefore, I am under a network of health care providers that provide preventive care. The advantages of carrying this type of health insurance allows me to track my health year to year and detect early sings of health issues. Moreover, covered in my insurance is by a prescription drug plan that I pay ten dollars for generic prescriptions. The disadvantage of carrying a (PPO) health insurance is that it will cost more to go out of network.…

    • 302 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    Observing from my classmates I have learned from them that there are six types of managed care models. There are the health maintenance organizations (HMOs), the preferred provider organizations (PPOs), exclusive provider organizations (EPOs), physician hospital organizations (PHOs), point-of-service (POS) plans, and provider-sponsored organizations…

    • 290 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Health Insurance Matrix

    • 3146 Words
    • 9 Pages

    Health maintenance organizations use a prospective payment system in which providers within a specific network are paid a flat rate per member on a predetermined scale regardless of if services are not utilized or over utilized. According to (“Patient Advocate Foundation” 2012), “care can be provided in a larger geographic service area than would be possible with only one physician group. This network model offers the patient choice of physicians and managed…

    • 3146 Words
    • 9 Pages
    Powerful Essays
  • Good Essays

    Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional procedures to acquire quality care (Types of Insurance, 2010).…

    • 686 Words
    • 3 Pages
    Good Essays
  • Better Essays

    Evolution of Managed Care

    • 1519 Words
    • 7 Pages

    Managed care is a type of system that was formed to help control the costs and quality to health care services; this will give access to services to specific groups of covered patients. The system was created to help the patients (customers) to receive services without having the full financial burden (University of Washington, 1998). The managed care services’ goal is to be able to help individuals and their families by providing health care services that is affordable. This type of managed care will help employees or individuals by requiring a set fee to be paid to the physician for visits, a co-pay and monthly premium to be paid to the insurance company. This will lower the amount that the patient has to pay. There have been many demands that have been needed in the managed care system; changes have had to be made to keep improving the health care services to help it to continue to grow. This paper will cover how the managed care began, in addition to how the system has grown and the changes of the system.…

    • 1519 Words
    • 7 Pages
    Better Essays
  • Good Essays

    US Health Care System

    • 683 Words
    • 5 Pages

    PPO- Preferred Provider Organization allow visits to innetwork doctors or healthcare provider with out a referral…

    • 683 Words
    • 5 Pages
    Good Essays
  • Good Essays

    As a country we are facing currently facing a problem based on health care. Every country has their own way of doing things, but which way makes the most sense? Statistics show that Canada’s health care system is working for them, but will it work for the United States? Ezekial J. Emanuel, Holly Dressel, and together, Karen Davis, Cathy Shoen, Katharine Shea, and Kristine Haran, all address possible solutions to this problem. While Emanuel feels that America’s system is sufficient, Dressel, Davis, Shoen, Shea, and Haran believe there are better options. These authors evaluate the different systems based on quality, cost, and accessibility.…

    • 793 Words
    • 4 Pages
    Good Essays