As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix.
Each box must contain responses between 50 and 100 words using complete sentences. Include APA citations for the content you provide. | |Origin: When was the |What kind of payment |Who pays for care? |What is the access |How does the model affect patients? |How does the model affect providers? | | |model first used? |system is used, such | |structure, such as |Include pros and cons. |Include pros and cons. | | | |as prospective, | |gatekeeper, open-access, | | | | | |retrospective, or | |and so forth? | | | | | |concurrent?
Indemnity | |Indemnity insurance |With traditional | |Indemnity plans give patients control| | | | |often runs on a |Indemnity insurance | |of their healthcare. They are allowed| | | | |retrospective payment |plans, patients commit | |to see any provider and do not | | | | |system, which is |to paying physicians | |require referrals to visit a | | | | |basically, a case by |and hospitals for each | |specialist. The down-side to having | | | | |case method of |individual service | |an indemnity plan is the longer, or | | | | |payment.
Reviews for |rendered. Once a | |more frequently a service is | | | | |payment may only be |patient has received | |utilized, the higher the cost. This | | | | |submitted once the |care, an itemized bill | |may seem like an incentive for | | | | |service has been |will be submitted to | |providers, yet is a disincentive for | | | | |provided to the |the insurance company | |patients paying upfront | | | | |patients (Austin & |and reimbursement is | |(Barsukiewicz, Raffel, & Raffel, | | | | |Wetle, 2012).
Payments|made to the member | |2010). | | | | |are made based on the |directly. Indemnity | | | | | | |frequency and quantity|insurance pays for | | | | | | |of services used, and |services at a | | | | | | |not a penny more. |predetermined rate. At | | | | | | | |times, the insurance | | | | | | | |company may reimburse | | | | | | | |the provider directly. | | | | | | | | | | | | | | | |(Austin & Wetle, 2012).
| | | | |Consumer-directed | | | | | | | |health plan | | | | | | | |Point-of-service | | | | | | | |Preferred provider |PPO plans began to | | |PPO’s have the most | | | |organizations |emerge somewhere | | |freedom of all the | | | | |around the late 1970’s| | |insurance types. Patients | | | | |into the early 1980’s. | | |are not required to obtain| | | | |They were developed as| | |referrals from a primary | | | | |an alternative to | | |care physician (PCP) when | | | | |HMO’s in an effort to | | |specialty care is needed, | | | | |grant patients a bit | | |or wanted.
Plan members | | | | |more freedom when | | |may see both in-network | | | | |choosing a provider | | |and out-of-network | | | | |and allowing them to | | |providers, however seeing | | | | |obtain services at a | | |an out-of network provided| | | | |lower, fixed rate in | | |leaves patients liable for| | | | |turn, containing the | | |the balance after the PPO | | | | |cost of service | | |has paid the provider | | | | |(Barsukiewicz, Raffel,| | |(Barsukiewicz, Raffel, & | | | | |& Raffel, 2010).| | |Raffel, 2010). | | | |Health savings account | | | | | | |
References Austin, A. , & Wetle, V. (2012). The United States health care system, combining business, health, and delivery. (2nd ed. ). Upper Saddle River, NJ: Pearson Education. Barsukiewicz, C. K. , Raffel, M. W. , & Raffel, N. K. (2010). The U. S. health system: Origins and functions. (6th ed. ). Mason, OH: Cengage Learning.