Health Policy Impact Paper
Introduction
Health policy is referred to as decision, plans and actions that are undertaken in order to attain certain health care objectives within the society (Kongstvedt , 2001). A precise healthcare policy helps achieve a number of goals things such as defining vision for the future, outlining priorities and the expected roles of various groups. Health policy also builds consensus and informs people. There are many categories of health policies ranging from personal health care, pharmaceutical, public health and many others that cover financing and delivery of healthcare. However this paper will compare and contrast three fore health insurance policies and these includes; free of service, HMO and PPO.
Free for service policy
Free for service health policy is a conventional healthcare policy where health insurance company pay fees for the services offered to the insured individuals covered by the policy (Miller, 2009). This health policy gives choices to doctors and hospitals. Insured persons are given a chance to choose and change doctors as they wish. The insurer is required to pay monthly premium and pay part of the doctor’s and hospital bills. One is also required to pay a given amount of money before the health insurance begins and this is known as deductable. The deductable fee applies annually after which the bills will be shared with the insurance company. Consequently, not every health cost incurred is counted towards the deductible
In order to receive health claims one has to fill out forms and send them to the insurer with all receipts of medical expenses. The policy has a coordination of benefit clause that limits benefits under two health plans to more than 100 percent of the claim(Berenson, & Rich, 2010) The policy also has a cap that is the most one can pay or medical bills in a given year. Consequently, it does not cover the monthly health insurance premium. However, the policy is limited to some health services such as immunization and well child care.
Health Maintenance Organization
Unlike free for service policy, HMO provides additional care such as preventive care, office visits, immunizations and well bay check up. To receive payment claim, does not required filling up forms for office visits or hospitals stays (Dorsey, 2002). However, members are required to present a card and one may have o wait for a longer appointment compared to free for services health insurance plan. Consequently, one is required to select one primary doctor who will monitor and provide most of the medical care and referring to other health professionals as needed. Nevertheless, one is not allowed to see other health specialist without the referral from the primary doctor.
In this health plan, members are required to pay a monthly premium in order to get comprehensive care for the family. The HMO organizes for services either directly or indirectly either through health professional or its own group of services under contract (Miller, 2009). However, the policy limits the alternative for doctors and hospital in line with the agreements of the policy unless it’s an emergency or medically vital. There may also be little co-payments for every visit and hospital emergency but the overall medical cost is relatively low compared to free for service health policy agree to any policy before acquiring enough knowledge concerning the policy.
Preferred providers Organization
This policy is n integration of HMO and Free for Services health plans. Just like HMO and individual is given opportunity to choose a primary doctor from a list of doctor in a network. When one chooses to go to one doctor, most of the cost is covered except for small co-pay (Greenberg, 2013). When an individual decides to see a doctor outside the selected network, the PPO policy will cater for the percentage of the fees. Individuals opt for PPO due to the fact that it provides more alternatives for doctors and health service providers even when they have to pay for part of the coverage to see a doctor outside the network (Moisio, 2013) Conversely, one is supposed to pay premiums that are generally higher compared to HMO and this means that one will have to pay more upfront. Although the policy has deductable, services such as preventive care are not subject to the deductable
Conclusion
Benefits of health policies vary depending of the type of the policy. However, the overall purpose of the health policies discussed above is to help control health costs. However, before an individual acquires a given health policy it’s important to learn about the various benefits and limitations of the healthcare plans in order to select the appropriate plan to cater for the individual needs. Therefore, public health professional can help in educating individuals concerning different forms of health policies so that citizen will not enter into terms of a given policy without having full information concerning the health plan. By increasing awareness of health policies to individuals through education, public health professionals will be able increase the impact of the health policies in the society.
Reference
Greenberg, J. S.(2013).Empowering Health Decisions. Jone & Barlett: New York
Moisio, M. A.(2013) A Guide to Health Insurance Billing. Cengage Learning. New York
Miller, H. D. (2009). From volume to value: better ways to pay for health care”. Health Affairs (Project Hope) 28 (5): 1418–1428.
Berenson, R. A. & Rich, E. C.(2010). US approach to physician payment: the deconstruction of primary care”. Journal of General Internal Medicine 25 (6): 613–618
Dorsey,J. L.(2002)The Health Maintenance Organization Act of 1973(P.L. 93-222)and Prepaid Group Practice Plan,” Medical Care, Vol. 13, No. 1, pp. 1–9
Kongstvedt P. R.(2001)”The Managed Health Care Handbook,” Fourth Edition, Aspen Publishers.
Miller, H. D. (2009). “From volume to value: better ways to pay for health care”. Health Affairs (Project Hope) 28 (5): 1418–1428.
