Question & Answer: ONLINE COURSE HM-210: HEALTH CARE ISSUES & ORGANIZATION Comprehension…..

ONLINE COURSE HM-210: HEALTH CARE ISSUES & ORGANIZATION Comprehension Questions Week 2 Answer 5 questions Submit response to instructor Chapter 6 1. What is meant by health care financing in its broad sense? What impact does financing have on the health care delivery system? 2. Discuss the general concepts of insurance. Describe the various types of private health insurance options, pointing out the differences among them . Discuss how the concepts of premium, covered services, and cost sharing apply to health insurance. 4. What is Medicare Part A? Discuss the financing and cost-sharing features of Medicare Part A. What benefits does Part A cover? What benefits are not covered? 4. What is Medicare Part B? Discuss the financing and cost- sharing features of Medicare Part B. What main benefits are covered under Part B? What services are not covered? 6. Briefly describe the Medicare Advantage program. 7. Briefly explain the prescription drug program under Medicare Part D 8. Discuss the financing, eligibility, and covered benefits for the Medicaid program. 9. What are the major methods of reimbursement for outpatient services? 10. What are the differences between the retrospective and prospective methods of reimbursements? 11. Discuss the prospective payment system under DRGs 12. Distinguish between national health expenditures and personal health expenditures. 13. Explain how the fee-for- service practice of medicine led to increased health care costs.

Expert Answer


Q1) Healthcare financing is the concept of payment of the expenses incurrent by a patient by providing coverage through health insurance. The individuals who are covered under insurance(public or private) will get their expenses reimbursed as per the policy of the insurance and healthcare provider. Financing enables patients who are covered under public healthcare schemes like Medicare, Medicaid etc. to get health checkups and treatments done at free or at minimal costs.

Financing eases out the payment process through cashless system, reimbursement process etc. without putting much pressure on the patients at times of emergency. Demand for healthcare increases as financing increases. Financing also affects the total healthcare costs and services in a healthcare delivery system.

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Q3) Premium is the amount that an individual pays to purchase a healthcare insurance covered for a specific period of time. It needs to be paid on a periodic basis to avail the insurance. Premiums are subsidized and are offered free as a part of benefits by many employers to their employees.

Covered services highlights the scope of the coverage of insurance for a period. Covered services are determined and are included as a part of package depending on various factors like frequency of the health issues, cost of treatment, availability of treatment facilities in the network hospitals etc.

Cost sharing refers to the sharing of healthcare costs between the insurance and the individual depending on what is covered under insurance. It helps in sharing of expenses incurred by a patient for a treatment.

Q6) Medicare Advantage Program includes the plans offered by private insurance providers over and above the Original Medicare which is offered by Government. It is also referred as “Part C” or “MA Plans”. Medicare pays to the private insurance firms to cover the benefits they offer.

Medicare Advantage Plans are of various types as highlighted below –

Health Maintenance Organization(HMO) plans – Getting a referral from the primary doctor to visit other hospitals or doctors out of the network.

Preferred Provider Organization(PPO) plans – Incurs less expenses within network providers and more expenses if out of network hospitals are vistied.

Fee For Service(FFS) plans – Fee for the service offered by the hospitals or healthcare providers.

Special Needs (SNP) plans – Provide focused or specialized healthcare for specific groups of people.

Q10) Prospective reimbursement method is the determination of amount of payment ot reimbursement before rendering the services based on a predetermined set of factors like place of treatement, kind of servcies or treatment rendered etc.

Retrospective method of reimbursement or payment is the reimbursement provided post the treatement of rendering of services based on the actual costs incurred for the services.

Q12) National health expenditures are the agreegate amount of the health care expenditures incurred by a nation which include healthcare research, administrative costs, healthcare services and medical expenses incurred, investment in equipment and structures etc.

Personal health expenditures are a component of national health expenditures which just include individual level healthcare costs incurred and are directly related to the goods and services associated to patient care.

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