Health Care Resources

HEALTH CARE RESOURCES

Textbook for Reference: Getzen, T. E. (2013). Health Care Economics and Financing (5th Ed). Hoboken, NJ: John Wiley & Sons.

1. RMF- What is happening in the general economy? What is the predicted pricing for hospital days and physician visits? Are there any new medications or treatments on the horizon we did not fund this year? If so, will they make the overall costs more or less? What are our competitors offering? How much increase can the market place bear? 200 words

2. C3- How much is too much to spend to save someone’s life? Is one life worth more than another? Is the effort expended to save one more life a total, average, or marginal cost? Is it more beneficial to screen high-risk or low-risk people for disease? Which are better measures of the value of care: patient choices or professional judgments? Is there necessarily a trade-off between health and money? Why do decisions based on the average benefit from treatment lead to too much medical care? 200 words

3. How much does it cost someone with a preexisting condition to buy health insurance? Is the problem rising costs or the distribution of costs? How long does it take to determine if a policy has met its objectives? Did the changes in Obamacare prior to passage make it stronger or weaker? Which companies stand to benefit from PPACA? Which companies are likely

to lose? Will insurance profits be increased, decreased, or stabilized under the act? Does a rise in costs make the difference between mean and median household incomes more or less important? 200 words

4. Review the Public Health Economics and Tools section in the CDC website and discuss your thoughts in 150 words. http://www.cdc.gov/stltpublichealth/pheconomics/

5. Should individuals with preexisting conditions be able to purchase health insurance at the same cost as those without such conditions? Why or why not? Your response should be 200-300 words.  Please ensure to substantiate your response with scholarly sources or a personal account of your own experience in the work place.

6. Scenario: Jennifer believes that individuals with preexisting conditions should be able to purchase health insurance at the same cost as those without conditions. I do not think that just because an individual has preexisting conditions, they should be charged more just to purchase insurance over an individual with no conditions. All individuals should be able to purchase insurance at the same rate, no exceptions. I understand that individuals with no preexisting conditions are less likely to need services or create a risk for the insurance company; but I do not think it would be fair to charge those with preexisting conditions more. According to Fisman (2012), "As recently as 2009, one in seven applicants were rejected by the four largest insurance companies, who refused to sell them insurance at any price." (p.1) This is not fair in any shape or form. Why do individuals with preexisting conditions deserve to pay more to insurance companies or outright be refused to have insurance? I take for example my father who served in the Vietnam War. He was exposed to Agent Orange during that time. After he served, he went on to work with the state and has had insurance with Blue Cross ever since, even after retiring. But if Blue Cross actually accessed my father today, they would more than likely drop his insurance. The effects of Agent Orange have been prominent over the last 10 years. My father developed diabetes, has had a light stroke and most recently, been diagnosed with dementia. Veteran's Affairs associates all of these problems with his exposure to Agent Orange. Would it be fair to let someone who served our country not have insurance because of the conditions he has? What about those who were born with preexisting conditions? 

In no way shape or form do I think it is fair to pick and choose who receives insurance coverage or what rate they will receive their coverage. Individuals with preexisting conditions are more likely to need medications and special services to help with their conditions and instead of insurance companies taking extra out to cover them, these individuals could be using those funds for those other purposes. 

Fisman, Ray. 2012. The real reason why health insurers won't cover people with preexisting conditions. The Wisdom of the Ailing. Retrieved fromhttp://www.slate.com/articles/business/the_dismal_science/2012/03/pre_existing_conditions_the_real_reason_wont_cover_people_who_are_already_sick_.html

Should individuals with preexisting conditions be able to purchase health insurance at the same cost as those without such conditions? Why or why not? Do you agree or disagree with Jennifer’s answer? Why or why not? 150 words

7. Scenario: Alissa believe that people with preexisting conditions should be able to have ample coverage, but if you provide it at the same cost that's where we start to have the debate over rising costs of insurance. We already know that when there are people who utilize insurance extensively it jacks up the pricing for the members in that group. Usually, age is a factor in insurance that is how it is set up, but what if you're a "young, old" person that has the above average expenses? Or a young person with high medical needs? In particular I'm thinking of mental health. Now it is possible to overcome those kinds of obstacles in life, but should you be segregated to the "high risk" premiums? Perhaps. I must say that if someone is needing a lot of care due to whatever condition or disease, it is them that is actually taking the resources for themselves. With the number of people needing to visit the hospital and doctor's offices, maybe we should cap those services if we aren't suggesting higher premiums. Another idea would be to have the higher costs for high needs until that need recesses for a number of years and revert back to the normal pricing system.  For instance, say a type II diabetic is no longer needing insulin/supplies...after a certain number of years in "remission" they would revert back to the average pricing. Do you agree or disagree with Alissa’s answer? Why or why not? 150 words

8. Pauletta: When we talk about preexisting conditions, we have to take into consideration that some people have preexisting conditions to no fault of their own. Many people have the misfortune of inheriting certain medical conditions from genetics. Now is this far? People with preexisting conditions that were brought on by poor health care due to their own faults and reasons should be subject to higher insurance premiums, for several reasons: money that is used to treat the hesitatingly conditions will cost more than treating a patient that develops a condition while under the doctors care, secondly a patient eighth a preexisting conditions is considerer high risk, while insurance complained normally don't like covering patients with preexisting condition for financial reasons, it is against the law leave a individual uninsured if they are eligible. It is the responsibility of the health care provider to educate the consumer on how to increase their life span through healthy living and to maintain the medical attention required to ensure that each patient is treated with medical attention that is covered under insurance and self pay guidelines. Preexisting conditions will cost an insurance company more money than they willing to pay, not insuring those with these conditions is the safe zone for insurance companies, however, it is bad for the individual because they have to find a way to receive treatment at a higher out of pocket expense. Do you agree or disagree with Pauletta’s answer? Why or why not? 150 words

9. How does the physician affect the cost of health care for insurance? Does the physician affect more than the cost of his or her services? If so, how? Your response should be 200-300 words.  Please ensure to substantiate your response with scholarly sources or a personal account of your own experience in the work place.

10. Cindy: As for physician who affect more than cost of services, these individuals affect how services are provided to individuals in need of service. Here is how we as patients are affected; can anyone remember the last time a physician took more than fifteen minutes with you and listen to your concerns without feeling like you're on an assembly line. Well in the past patients were treated like people and not cattle being processed for market; that personal one on one with your physician days has past us by for profit and overhead for the health provider's organizations. Do you agree or disagree with Cindy’s answer? Why or why not? 150 w

11. Alissa: Yes, considering the amount of debt a primary physician graduates with and the fact that they will probably be paying those debts off till their 50's. During my readings I came across the (Zhu, 2012) article which brings to the surface the thought that many specialty physicians median salary is quite more than a general practitioner.  A physician graduates with good intentions but quickly realizes that healthcare is a business not a compassionate humanitarian outreach that perhaps it once was. With business at the forefront and providing for their family ringing it can be maybe even unintentionally that relatively healthier people become swept under the rug and the focus placed on Medicare reimbursements. Medicare is the largest governmentally funded insurance for the elderly/disabled and the one with the largest budget. In the conclusion of another article it finds "that financial incentives significantly influence physicians' supply of health care (Clemens, 2014)." It further explains that "physicians disproportionately adjust their provision of relatively intensive and elective treatments as reimbursements rise, and they appear to invest in new technologies in order to do so (Clemens, 2014)." Do you agree or disagree with Alissa’s answer? Why or why not? 150 words

12. Jennifer: Physicians can have a great impact on the cost of health care for insurance. It depends if it is a physician's private practice or if it is a physician working for a health care organization. In a private practice setting, a physician can affect the cost of health care for insurance purposes by having patients pay out more for services or by providing services that are not necessary. Patients are usually very trusting of their physicians and in some cases, physicians may take advantage of that. Physicians in private settings may require patients to have services done that are not needed. This in turn is calculated with the bill that is sent to the insurance company and the facility will receive a bigger reimbursement. Physicians in health care organizations can also do the same. Physicians that are overlooking patients in hospitals may perform unnecessary services just to help the organization get a bigger reimbursement. This is not to be said that all physicians are involved with doing so, but there are physicians out there that do this. If the physician is one that is honest, then the physician will only charge for services needed and that are rendered and it does not affect health care for insurance.  A physician does affect more than just the cost of his or her services. According to Rodberg (2013). "The price of medical care is seldom discussed before being undertaken, and there is no effective countervailing force to the entrepreneurial drive, by all providers, to raise their incomes as high as they are able." (p.1) By physicians doing this, it does affect more than just the services they provide. It affects health care as a whole because it is driving prices up. Physicians are able to charge what they want and it is driving health care services up through price gouging. Through price gouging, it is not only affecting insurance companies paying more out in reimbursements, it is driving services up. Do you agree or disagree with Alissa’s answer? Why or why not? 150 words

13. Please see attached----Health Economic Simulation Paper

Review the Health Care Economics Issues HMO Simulation (Health Economic Simulation Paper)

Select either Constructit or E-editor to analyze for your paper.

Prepare a 700- to 1,050-word paper in which you present a profile of the chosen company, including the demographics of the employees, the health care risk factors or potential areas of high utilization, and the premiums the company is willing to pay.

As a representative of Castor Insurance, your job is to maximize profit and minimize risk for the company. Based on your analysis of potential utilization, provide at least two reasons why each plan could be selected. Then state which plan you would select to sell to your chosen company. What are the reasons for this decision? Why did you not select the other plans offered?

14. Public Health Tools and Methods Study Guide

Complete the following table in which you identify 2 tools or methods used to address financial and economic challenges in the health care industry. An example has been provided. Cite and Reference a must!

Resources: The Economic Tools in the Public Health Economics and Tools section on the CDC website, the Department of Health and Human Services website, and other resources as needed that are available through additional research.

Tool/method	Identify the purpose and use of the tool or method	Identify the payment source and mechanism used with the tool or method
Return-on-Investment Forecasting Calculator (ROI Calculator)	This tool evaluates the net financial benefits of initiatives designed to improve health care quality and reduce costs. Two modules allow Medicaid stakeholders to develop ROI forecasts for initiatives designed to improve health care quality and reduce costs.	Medicaid
Decision and transmission modeling	1. 2.	1. 2.
Regulatory impact analysis	1. 2.	1. 2.