Health Care Finance and Risk Management

Chapter 1

The four components of U.S health care are providers, payers, consumers, and insurers. Why does the system need payers separately from consumers?

Payers need to be separate from consumers as the American health care system requires a professional body like employers, insurance companies or government to take care of the payment responsibility in a professional manner and follow the laws and legislations.

2. The government, employers, and insurance companies pay much of the cost of U.S health care. Which one is the most important?

The most important health care provider in any health care system is the hospital as it provides consumer with all the possible range of services, have all the latest equipment, resources and qualified staff to deal with each and every type of disease, injury, ailment etc. The least important provider is urgent care facility since it does not offer continuous services and the emergency department of hospitals can deal with emergency cases in a better manner and open 24/7.

3. Do you think physicians care about incentives for them to prescribe low cost drugs and treatments? Explain your reasoning.

Most of the physicians do care for the financial incentives that they get as a result of prescribing certain drugs therefore the incentives must not be financial and it is important that the physician do not compromise on the quality of care and treatment that is being given to the patient just for the reduction of cost and receiving of incentive.

4. Assume that you work for a medical insurer. You have been asked to develop a strategy to encourage physicians and hospitals to hold down medical costs. What are your recommendations? Be specific.

The best way for the physicians to keep the cost down would be to provide the provider with incentives so that it monitors and cut down the unnecessary usage of medications or treatments without compromising on the quality.

5. With respects to hospitals, clinics and nursing homes, which one do you think is likely to provide the best service in a non emergency treatment? Explain your reasoning.

Hospitals are expected and have the necessary resources both human and equipment, tools that are needed to provide care for non emergent cases. Every facility is present under one roof, in a controlled environment with enough occupancy space to accommodate large number of patients at one time.

6. An emergency room received a burn victim. The individual had no health insurance. The doctor had to choose to send him to either an urgent care facility or a trauma center. How should she make that decision?

Urgent care facilities deal with patients on emergent basis and provide low cost treatment. Trauma centers on the other hand have the necessary skilled and qualified staff but the cost of treatments is very high due to involvement and usage of expensive and highly sophisticated equipment. Therefore, it will be more advisable that she send the person to an urgent care facility since the patient will not be able to afford expensive ...