MARKET RESEARCH AND SEGMENTATION (SLP)

Running Head: HEALTH CARE AND DEIVERY SYSTEM SLP 5

Title: Health Care and Delivery System SLP

Shaneya Acker

Dr. Sharon Nazarchuk

MHA 507

Trident University International

July 28, 2018

Part one: Insurance

The health insurance is a kind of insurance that tends to cover the entire or a segment of the individual that is incurring the medical expense, through spreading the risk over a large population of individuals (Schroeder, 2014). The insurer may create a routine funding framework such as a monthly premium to be able to provide the finances to pay for the specified health care benefits outlined in the insurance agreement.

Insurance product

My health insurance plan is the HMO (Health Maintenance Organization). This kind of insurance product tends to limit the coverage care from the health providers who work or are contracted by the HMO. Basically, this insurance plan does not cover the out of network care except in times when an emergency arises. The holder of this kind of insurance plan is required to work or live in areas where the services of this insurance plan coverage (Baker, 2010). The insurance plan offers the integrated car as well as it focuses on prevention and the patient’s wellness.

Source

My employer is the source of my insurance and the company decides on the insurance plan that we as the employees need to take. The company agrees with the insurance company on how the funding structure of every employee is going to be settled based on the income of the employee (Baker, 2010). The company that I work for deducts from my salary the financing required for me to enjoy the benefits provided by my insurance provider. A particular percentage of my salary is deducted every month and also the insurance service company provides me and my fellow employees with a listing of the health facilities where we would acquire health services under the insurance plan provided.

Out-of-pocket costs

The out of pocket costs are the costs which I incur as a health insurance holder because the insurance cover does cover particular services that I might receive in the health care (Baker, 2010). As a holder of my health insurance plan from time to time, I always incur some extra cost when I visit the health facility recommended by the health organization. Some of the extra costs that I incur in my health insurance plan are buying the prescribed and seeing a specialist.

Level of coverage

The insurance plan that I use covers about 100% of my health expenses and in that case, it tends to reduce the out of pocket expense. Some of the coverage’s that my insurance plan covers are wellness, preventive, surgical as well as hospital services (Baker, 2010).

Self-pay

A self-pay patient is a term that is used to provide a description of an individual who opts to independently pay for his or her medical bill without the assistance of a health insurance (Limb, 2015). Self-pay patient avoids the monthly premium which is often paid b individuals who use insurance policies to pay for their medical expenses. Also it an individual may opt to self-pay for his or her medical expenses if his or her condition falls under the exclusion list of the insurance provider. For a self-pay patient, he or she may face difficulty choosing a primary health provider to whom he will be visiting for his or her medical checkups. Also for self-pay, the patient some most health care providers not allow them to receive treatment. The major limitation of the self-pay patient is that his or her medical bill may be higher than he or she expected.

Part 2

MEMO

To: Healthcare Lobbyist

From:

Cc:

Date:

Subject: LIMITATIONS OF SELF PAY

As a United States citizen, I have noticed that our healthcare systems do not entirely support the self-pay patients. The healthcare systems tend to be much more supportive to patients who are covered by the private or the public insurance. Most of the people who opt to use the self-pay method to settle their medical expenses mostly their health conditions are often excluded in the insurance coverage list. As a citizen of the United States, I would love for the self-pay method to be reviewed and the patients who opt to use this kind of method should be treated the same as those patients using an insurance cover to settle their bills.

The self-pay patient tends to receive medical services which are at some point escalated us a way to limit the self-pay method. Due to this most people are forced to seek other alternative treatment methods which are cheap and affordable. Some of these alternative medications may not be as effective as the treatment that the patient would have received in a health care facility and it may lead to their health condition deteriorating.

As the healthcare lobbyist, I would request you to push the health care system to come with new ways that would see the individuals opting to use the self-pay method to settle their medical expenses be provided with equal chances as those using the insurance cover. Some of the recommendations that I would provide would be the health the cost of the services it provides to it patients and also the health insurance companies to be pushed to incorporate most of the health needs in their insurance plan. By doing this health would no longer be regarded as a luxurious need but as a basic need (Schroeder, 2014).

Yours Sincere

References

Baker, L. C. (2010). HMO Coverage Reduces Variations In The Use Of Health Care Among

Patients Under Age Sixty-Five. NCBI.

Limb, M. (2015). Self pay patients are likely to increase in the UK as waiting lists lengthen and

medical insurance prices rise. BMJ.

Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General

Internal Medicine.