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Hcs 235 Week 4 Assignment

Hcs 235 Health Care Utilization Paper

1451 WordsFeb 18th, 20136 Pages

Health Care Utilization HCS235

Health Care Utilization

HCS 235
October 30, 2012

Health Care Utilization
The Affordable Care Act was signed into law March 23, 2010 by President Barack Obama; however, the constitutionality of the law remained in question. In a controversial 5-to-4 ruling, The U.S. Supreme Court upheld the law on June 28, 2012. The ACA is thought by some as the United States health care rescue, and as its downfall by others.
It is estimated that the ACA will provide new services to 64 million Americans, providing health care coverage to 32 million previously uninsured. In addition to providing new health insurance coverage, the ACA implemented several components that can expand access to health care. One policy…show more content…

The aim of the ACA is to provide affordable health care to all Americans, but it still leaves some issues unaddressed that will impact the access to health care. Covino (n.d.), “Though the intentions of the legislation are good, the Affordable Care Act does little to improve the actual health care delivery system” (para.1, page 2). According to the American Medical Association, we are facing an increasing Physician shortage. As of 2010 we faced a shortfall of 13,700 physicians, the estimate is that number will increase to 62,900 by 2015, 91,500 by 2020, and 130,600 by 2025 (Krupa, n.d.), with primary care taking the largest impact. Health Care coverage will be of no benefit if there are no doctors to treat the patients. An example of this occurred in 2002 when Thailand’s’ “30 Bhat Scheme” added (CNN n.d.) “14 million people to the country’s health care system, resulting in long waits and subpar service” (Your health is covered, but who is going to treat you?) Several factors contribute to the physician shortage. Many physicians are reaching the age of retirement, the Association of American Medical Colleges estimates nearly 15 million physicians will be eligible for Medicare in the coming years (CNN n.d.). The increasing cost of malpractice insurance also deters many from pursuing a career in medicine, and is forcing some doctors to retire. Also contributing to the physician shortage is a lack of spots in residency programs. “In 2011, more than 7,000 were left

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HEALTH INSURANCE MATRIX1Health Insurance MatrixModelDescribe the modelHow is the care paid or financed when this model is used?What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?What are the benefits for providers in using this model?What are the challenges for providers in using this model?Health MaintenanceOrganization (HMO)HMO is a managed care insurance plans that offer provisions of health care services on the capitated or prepaid basis to its members for a fixed amount of fees (Clack, Renfroe, and Rimmer, 2015). There are several models for HMOs. First is staff model HMO includes salaried employees e.g. physicians and others thatprovide care to only HMO-enrolled members. The second is group HMO model involves a large number of doctors that are under contract to provide care to its The members of the HMO pay a fixed monthly fee to receive health care. Further, they also pay a small co-payment for each time they visit a doctor. Further, different reimbursement plan exists in the differentorganizational structure. For example in staff, HMO model physicians are usually salaried and receive incentive or bonuses related to planning The HMOs can employ open-endedor close-ended or the combination of both. The open-ended form is opento private physicians who form a contract with the HMOs for providing care to its members. Therefore, they rely on the private physicians in providing care. In contrast close-ended structure employs a doctor or single medical group to provide Following are the benefits for providers including receiving salaries in an advance for care those required by HMO enrollees. The HMO model fosters preventive measures meaning that if the medical expense is less then higher will be the provider income. Further, the PCPs can build a long-term relationship with their patients. Moreover, if the HMO provider offers care to fewer The challenges associated with this model include sharing of the financial risks with some physicians or the entire network of doctors. Further, especially in a closed-ended HMO plan, the physicians have more restriction with whom they can work on an exclusive basis forservices and are not allowed to see those patients that belong to another

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