Insurance And Effective Care

Case Scenario

A patient is confused about how to make payments for a recent visit to urgent care and hospital stay. Her employer-based insurance provider’s website allows her to use her HSA account to make a payment online. She uses her HSA debit card to make the payment, but her insurance provider sends her a check instead of sending it to the Tri-City HealthCare Agency. After contacting her insurance help desk via the website, she is told to send the check to Tri-City HealthCare Agency herself. The patient asks the insurance provider’s help desk representative why they cannot just make the payments for her. She is told about the various payment types and payers in the health care industry and how the market influences the integrated delivery systems in the industry.

Case Questions

Describe the payer systems mentioned in the case study.

Explain how the market forces have influenced the need for integrated delivery systems.

How might the insurance provider explain the payment system it utilizes for its clients? Explain if this method is effective or not for the insurance provider’s clients.

What has been the most significant legal and regulatory effect on managed care organizations?

1. How would this case study have differed if the patient was using public or social insurance?
2. The response to each question should be a minimum of 200 words. Formal essay structure is not required; differentiated responses to each question are acceptable. 
3. Integrate two to four scholarly sources in the collective assignment.
4. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 
5. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Essentials of Health Economics

Dewar, D. M. (2017). Essentials of health economics (2nd ed.). Burlington, MA: Jones and Bartlett Learning. ISBN-13: 9781284054620

Government and Policy for U.S. Health Leaders

Higbea, R., & Cline, G. (2021). Government and policy for U.S. health leaders (2nd ed.). Burlington, MA: Jones and Bartlett Learning. ISBN-13: 9781284207767 (Available as a custom eBook – includes only Chapter 6