Professor instructions and requirments are below:
No plagisirms and please follow direction under each discussion thread
Discusison post 1 Behavioral Health 150 words
Take one of the topics we covered in Week 1 which include mental health providers, the DSM-5 and also discussions about the opioid crisis and explain what you learned from the materials.
Let us know your thoughts about what you learned, further questions, etc.
You MUST include
(i) a discussion of the item reviews so I know you read it and
(ii) a SECOND article or web page ABOUT the same topic so that I can see that you learned additional material about the topic.
Watch youtube: Addicted: America’s Opioid crisis
Discussion post 2 Health policy and politics 150 words
We are reading Chapter 8 this week about health insurance. Please go to Box 8.3 in Chapter 8 on page 159.
Read the different schools of thought about what insurance should or should not cover. Answer the list of questions at the end of the discussion questions beginning with Which theory do you support (there are a total of 3 questions at the end of the case scenario.
Chapter 8.3 on page 159 Read please:
How Health Insurance Operates
This section provides an overview of the purpose and structure of health insurance. It begins with a review of basic health insurance terminology, considers the role of uncertainty and risk in insurance, and concludes with a discussion of how insurance companies set their premium rates.
Basic Terminology
As you read earlier, the health insurance industry first developed when the FFS system was standard. Under this system, not only do providers have incentive to conduct more and more expensive services, but patients are unbridled in their use of the healthcare system because FFS does not limit the use of services or accessibility to providers. As we will discuss later in this chapter, managed care developed as a response to the incentives created by the FFS system. However, even though there are numerous differences between FFS and managed care, many of the fundamental principles of how insurance operates are applicable to any type of health insurance contract. The following discussion reviews how health insurance works generally, regardless of the type of insurance arrangement.
The health insurance consumer (also known as the beneficiary or insured) buys health insurance in advance for an annual fee, usually paid in monthly installments, called a premium. In return, the health insurance carrier (or company) pays for all or part of the beneficiary’s healthcare costs if they become ill or injured and have a covered medical need. (A covered need is a medical good or service that the insurer is obligated to pay for because it is covered based on the terms of the insurance contract or policy. As discussed in detail elsewhere, the ACA requires many plans to cover all “essential health benefits.”) Insurance contracts cannot identify every conceivable healthcare need of beneficiaries, so they are generally structured to include categories of care (e.g., outpatient, inpatient, vision, maternity) to be provided if deemed medically necessary (see Box 8.3). Definitions of the term medically necessary vary by contract and are important when determining whether a procedure is covered.
Read Please
Even if the beneficiary never needs healthcare services covered by the insurance policy, they still pay for the policy through premiums. The consumer benefits by having financial security in case of illness or injury, and the insurance company benefits by making money selling health insurance.
In addition to premiums, the beneficiary typically pays other costs under most health insurance policies. Many policies have deductibles, which is the amount of money the beneficiary must pay on their own for healthcare needs each year before the insurance carrier starts to help with the costs. For example, if a policyholder has a $500 deductible, the beneficiary must pay 100% of the first $500 of healthcare costs each year. The insurance carrier is not liable to cover any costs until the individual’s healthcare bill reaches $501 in a given year. If the individual does not need more than $500 worth of health care in a specific year, the insurance carrier generally will not help that individual pay their healthcare costs.
Furthermore, a beneficiary generally continues to incur some costs in addition to the premiums even after the deductible has been met. Insurance carriers often impose cost sharing on the beneficiary through copayment or coinsurance requirements. A copayment is a set dollar amount the beneficiary pays when receiving a service from a provider. For example, many HMOs charge their beneficiaries $15 every time a beneficiary sees a primary care provider. Coinsurance refers to a percentage of the healthcare cost the individual must cover. For example, 20% is a common coinsurance amount. This arrangement means the beneficiary pays 20% of all healthcare costs after the deductible has been met, with the insurance carrier paying the other 80%.
Uncertainty
From a traditional economic perspective, insurance exists because of two basic concepts—risk and uncertainty. The world is full of risks—auto theft, house fires, physical disabilities—and uncertainty about whether any such events might affect a particular individual. As a result, people buy various forms of insurance (e.g., automobile insurance, home insurance, life or disability insurance) to protect themselves and their families against the financial consequences of these unfortunate and unforeseen events.
Although genetic predisposition or behavioral choices such as smoking or working a high-risk job may increase the chances that an individual will suffer from a health-related problem, in general there is a high level of uncertainty regarding whether a particular person will become sick or injured and need medical assistance. Health insurance protects the consumer from medical costs associated with both expensive and unforeseen events. Even if the consumer does not experience a negative event, a benefit exists from the peace of mind and reduced uncertainty of financial exposure that insurance provides.
In terms of health status and wise use of resources, when insurance allows consumers to purchase necessary services they would not otherwise be able to afford, it functions in a positive manner. Conversely, when insurance leads consumers to purchase unnecessary healthcare goods or services of low value because the consumer is not paying full cost, it works in a negative manner. The difficult task is trying to figure out how to set the consumer’s share of the burden at just the right point to encourage and make available the proper use of health care, while discouraging improper usage.
Risk
Risk is a central concern in insurance. Consumers buy insurance to protect themselves against the risk of unforeseen and costly events. But health insurers are also concerned about risk—the risk that their beneficiaries will experience a covered medical event.
Individuals purchase health insurance to protect themselves against the risk of financial consequences of healthcare needs. Because of differences in risk level, individuals who are generally healthy or otherwise do not anticipate having health expenses may place a lower value on insurance than individuals who are unhealthy or those who are healthy but expect to have medical expenses, such as pregnant women. Therefore, healthy individuals tend to seek out lower-cost insurance plans or refrain from obtaining insurance altogether if it is not, in their view, cost effective. Unhealthy individuals or healthy individuals who often use the healthcare system would obviously prefer a low-cost insurance plan (with comprehensive benefits) but are generally more willing to pay higher premiums because of the value they place on having insurance.
Health insurance carriers are businesses that need to cover their expenditures, including the cost of accessing capital needed to run their company, to stay in the market. b They earn money by collecting premiums from their beneficiaries, and they pay out money to cover their beneficiaries’ healthcare costs above the deductible amount and to cover the costs of running a business (e.g., overhead, marketing, taxes). One way health insurance companies survive is to make sure the premiums charged to beneficiaries cover these costs. From the insurance carrier’s perspective, it would be ideal to be able to charge lower premiums to attract healthy individuals who are less likely to use their benefits, and higher premiums to unhealthy individuals who are more likely to need medical care.
8.3 Answer Discussion Questions
As a general matter, all types of insurance under traditional economic models cover expensive and unforeseen events, not events that have small financial risk or little uncertainty (Council of Economic Advisors, 2004, p. 195). For example, auto insurance does not cover regular maintenance, such as an oil change, and home insurance does not protect against normal wear and tear, such as the need to replace an old carpet. Accordingly, many economists argue that health insurance should not cover regular, foreseeable events such as physical exams or low-cost occurrences such as vaccinations. Other economists support a different school of thought. An alternative economic view is that health insurance should insure one’s health, not just offer protection against the financial consequences of major adverse health events. Because people without health insurance are less likely to obtain preventive care such as physical exams or vaccinations, these economists believe that it is in everyone’s best interest, ethically and financially, to promote preventive care. Therefore, it is appropriate for insurance to cover both unpredictable and expensive events as well as predictable and less expensive events.
8.3 Answer Discussion Questions
Which theory do you support? What do you think is the best use of insurance? If insurance does not cover low-cost and predictable events, should another resource be available to assist individuals, or should people pay out of their own pockets for these healthcare needs?
Discussion post 3 Health Service Fiance 150 words:
Developing a strong business plan means developing realistic estimates of revenue and expenses in order to develop a credible operating budget.
What is a credible resource? A credible resource is one that is considered trustworthy, reliable, and authoritative in providing accurate and unbiased information. You can easily identify sources that are more likely to be credible if the websites end in .gov, .edu, or .org. You can also identify credible resources by referencing information on the websites of professional organizations such as HFMA, ACHE, AHIMA, and MGMA.
The discussion questions below are asking you to be very specific about identifying sources of credible information. As an example, if you were talking about finding salary information, statements like, “I would find salary information in a database” is not sufficient. In this example, you would need to say something specific like, “I would find the average salary by job type in the Bureau of Labor Statistics database”.
For your original post:
1. Identify a small healthcare-related business that you might like to start. Very briefly (2-3 sentences) describe this business.
2. Describe how you might go about estimating the revenue for the first year of operations. What method(s) would you use? What specific sources would you use to support your assumptions about volume and revenue per unit (e.g., visit, service, product)? Be specific about the credible source(s) of information that you would use to determine your volume and your revenue per unit/visit/etc.
3. Describe how you might go about estimating the expenses for the first year of operations. What method(s) would you use? What specific, credible sources would you use to support your assumptions about key expenses. Provide at least 2 specific examples of expense estimates for your new business (e.g., labor, supply, equipment, space, overhead). Be specific about the credible source(s) of information.
