Basics of the U.S. Health Care System 2nd Edition by Nancy Niles

Exercise 3

REAL LIFE APPLICATIONS: CASE STUDY
A friend, who had been a dependent on her parents' insurance, recently graduated from college and was offered a full-time healthcare management position. When she started to complete her human resource (HR) application, the HR manager asked her what type of healthcare plan she chose. Her new employer offered several different healthcare plans: fee-for-service, HMO, PPO, and POS plans. She was very confused and asked you to explain the managed care plans to her.
ACTIVITY
(1) Describe the characteristics of these healthcare plans and (2) identify the differences between the HMO and PPO plans.
RESPONSES

CASE SCENARIO TWO
You had heard that the premiums for your health insurance plan may decrease as result of the Affordable Care Act's requirement that insurance companies spend a certain amount of their premium revenue on their plans. You were interested to find out if this was true.
ACTIVITY
Perform an Internet search on medical loss ratios. Describe the concept and why it could decrease the cost sharing of your health insurance coverage.
RESPONSES

CASE SCENARIO THREE
For years, your parents had a traditional fee-for-service health insurance. They are now required to switch to a managed care product. They are very upset because they love their physicians. However, their physicians did tell them they had contracted with certain MCOs to provide services. Your parents were still confused.
ACTIVITY
Explain the managed care principle, and which program would enable them to still use their practitioners.
RESPONSES

CASE SCENARIO FOUR
As a healthcare consumer that recently switched to a managed care health plan, you were very worried about the quality of the care provided to you. You were wondering if there were any reviews of these types of programs to determine the quality of healthcare services offered.
ACTIVITY
Discuss the different types of reviews used to assess managed care organizations.
RESPONSES