Grantham University Managed Health Questions

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Health Medical

Grantham University

Description

Do you understand the workings of health insurance in the United States? This assignment will give you an opportunity to demonstrate the knowledge acquired so far. Please respond to all of the questions below in a word document. Each correct and complete response is worth 20 points. Make sure to type the questions and the answers in order. 

  1. Why were the first health insurance organizations formed in America? What were the original driving factors? Describe the early growth of health insurance in the US.
  2. Explain the theory of insurance, by specifically addressing the degree of risk aversion, the size of the potential loss, and the "wealth effect".
  3. What is meant by the "HMO Effect" versus "Favorable Selection" in managed care? Describe the evidence of an HMO Effect, and the evidence of Favorable Selection.
  4. What are deductibles? Why are they so important in US health insurance models? How do changes in deductibles impact utilization and clinical decision-making.
  5. Discuss the Utilization Management function in managed care, including Preadmission Certification and Concurrent Review of services.
  6. Discuss the emerging role of Disease Management (DM) and Intensive Case Management in American managed care. How does DM actually work?
  7. A key concept of health insurance is premium sensitivity. Describe the general process for premium computations in US healthcare insurance. Briefly explain employee premium sensitivity and how do employees typically respond to changes in health insurance premiums?
  8. Describe the commonly used approaches to "underwriting" for healthcare services.
  9. Do hospitals actually have "monopoly power" today? Why or why not?
  10. Explain risk adjustment in the Affordable Care Act. How well does this approach work in your view?

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Explanation & Answer

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Running head: Complete Managed Health Task

Complete Managed Health Task
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1

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1.
Health insurance organizations were formed in the US in early 1920 since most of the
people used to get treated at home due to the cost of health care. It was offered as a benefit to
compensate for limited wages and also as a recruiting tool in those job categories which had high
demand and limited supply. There was an increase in demand for medical care and even the rise
in medical care cost, which lead to the introduction of medical insurance.
Accident insurance was the first form of insurance offered in the united states. It insured
against any injuries arising from the railroad and steamboat accidents. Franklin Health Assurance
Company of Massachusetts was the company offering this cover; it was founded in 1850; by
1866, about sixty organizations were offering the same type of insurance. In 1911, the first
employer-sponsored group disability policy was issued; this was mainly to replace the wages lost
due to the inability of the worker to report to work but not specifically for medical expenses. In
around the late 20th century the disability insurance was evolved into the current health
insurance programs. As it was not always the case, the new insurance also covers the
comprehensive health insurance covers routine costs, preventive and emergency health care
procedures.
2.
The theory of insurance is com...


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