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Healthcare Trends Ethics And Compliance

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Running head: HEALTHCARE TRENDS, ETHICS AND COMPLIANCE 1
Healthcare Trends Ethics and Compliance
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HEALTHCARE TRENDS, ETHICS, AND COMPLIANCE 2
Healthcare Trends Ethics and Compliance
Economic Trends of the Health Care Payment System.
Healthcare services constitute a substantial proportion of consumer spending, a factor that
has accelerated the payment trends within the industry. Health Maintenance Organization (HMO) is
among the most prevalent forms of managed care health insurance plans (Green, 2014). A HMO
falls under a health insurance plans that puts limit on care coverage to only healthcare providers
working or contracting with the HMO. A HMO provides varied comprehensive care to members for
fixed periodic payments (Green, 2014). Participants in this payment system choose a primary care
physician among an approved list who acts as a gatekeeper for coordinating care. The implication is
reduced costs by restricting care to a geographic region. Another trend, Medicare Program, focuses
on people aged above 65 years, with disabilities and all demographics with End-Stage Renal
Disease. Medicare covers Part A Hospital Insurance, Part B Medical Insurance and Prescription
drugs (Green, 2014). Medicaid is created through joint efforts from the state and federal
administrations to assist low income and resources individuals with medical costs. Medicaid differs
from Medicare in the variety of benefits like personal care and nursing care services. Eligibility for
Medicaid differs among states, for instance, the spend-down process instituted in some states allows
individuals with income exceeding Medicaid levels to be eligible for the program as medically needy
(Green, 2014). Considering the soaring costs of healthcare expenditure, payment options are
developing to address the phenomenon and shift care from a for-profit to giving emphasis to patient
needs.
Role of Ethics and Compliance in the Health Care Finance Environment.

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Running head: HEALTHCARE TRENDS, ETHICS AND COMPLIANCE Healthcare Trends Ethics and Compliance Name Institutional Affiliation 1 HEALTHCARE TRENDS, ETHICS, AND COMPLIANCE 2 Healthcare Trends Ethics and Compliance Economic Trends of the Health Care Payment System. Healthcare services constitute a substantial proportion of consumer spending, a factor that has accelerated the payment trends within the industry. Health Maintenance Organization (HMO) is among the most prevalent forms of managed care health insurance plans (Green, 2014). A HMO falls under a health insurance plans that puts limit on care coverage to only healthcare providers working or contracting with the HMO. A HMO provides varied comprehensive care to members for fixed periodic payments (Green, 2014). Participants in this payment system choose a primary care physician among an approved list who acts as a gatekeeper for coordinating care. The implication is reduced costs by restricting care to a geographic region. Another trend, Medicare Program, focuses on people aged above 65 years, with disabilities and all demographics with End-Stage Renal Disease. Medicare covers Part A Hospital Insurance, Part B Medical Insurance and Prescription drugs (Green, 2014). Medicaid is created through joint efforts from the state and federal administrations to assist low income and resources individuals with medical costs. Medicaid differs from Medicare in the variety of benefits like personal care and nursing care services. ...
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