Explain the three different types of health insurance.
The three basic insurance plans are point of service (POS), health maintenance organizations (HMOs), and preferred provider organizations (PPOs) plans. The PPO is a fee-for-service health plan that enables a beneficiary to make use of a wide array of providers, which have entered into an agreement to provide the purchaser with discounts on normal fees. The health plan makes use of its high purchasing influence to negotiate for discounts from providers. In return, the providers anticipate members to select plans frequently since they appear on the preference list of the plan provider (Williams & Torrens, p. 124). The HMO plans are based on the premise that the providers of the plan enter into an agreement with a group of practicing physicians. In this case, the physicians will manage health care for a group of enrolled patients. This plan depends on a person’s choice to register with a certain group of doctors and to access all forms of medical services through groups of physicians by referral or directly (Williams & Torrens, p. 125). On the other hand, POS offers some flexibility that the HMO plan fails to provide, and they are also termed as open-ended plans. Within this plan, an enlisted individual can make use of medical services that are not covered by the plan subject to coinsurance payments and deductibles. This plan addresses the shortcomings of the HMO program (Williams & Torrens, p. 126).
Describe the principles of insurance and apply them in evaluating health insurance plans.
In insurance circles, the possibility of a loss is referred to as risk. The risk drives individuals to take insurance covers. Insurance is a process of managing exposure to financial risks through two major principles: transferring of risk from a person to a group and sharing costs on some equitable basis by all individuals in the group. In each health insurance plan, the risk of foregoing financial risks is passed or transferred to the group. This cushions individuals from huge losses that they would incur if they were to source health services individually. Low income earners can share their costs with other members or individuals in the group (Williams & Torrens, p. 110).
What roles does the private sector play in public health?
In the minds of most individuals, the role played by the private sectors, and specifically by the doctors in private service, is progressively vital in creating the significant lifestyle changes that are perceived to be meaningful to the prevention of diseases in the long run. Most deaths in America are attributed to behavior and lifestyles of individuals. Most of these behaviors and changes in lifestyle can only be addressed by practicing physicians. Research has revealed that individuals are likely to change their bad lifestyles and behavior if they are advised by their personal medical practitioners. The pivotal role of the practicing doctor in encouraging and promoting improved personal behavior has been recognized. Therefore, this should be the core of any future state or federal plans of health care development and disease prevention (Williams & Torrens, p. 154).
What are the positive characteristics usually associated with a solo practice?
It has been observed that physicians are concerned and conversant in issues related to treatment and curative procedures. This is in relation to the physician interests and capability to practice health development and disease prevention activities. This is in contrast to matters associated with prevention of disease and health promotion. This can be attributed to their medical health training (Williams & Torrens, p. 155)..
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