A Community Of Learners’ 6 Healthcare Finance Models Market ✓ Solved

A COMMUNITY OF LEARNERS’ 6 Health Care Finance Models Market-based

Market-based healthcare finance provides access to all consumers. It acts as a private health insurance and anyone who can afford its cover can access it. Also, this financial cover suits different health preferences and people preferring them can access this finance provided that they can afford the costs associated with it. Government-financed healthcare services targets all citizens regardless of their income levels. Some particular health services in this context are totally free while others require some contribution which is also affordable for low-income earners (Barr, 2016). Also, this health finance is more accessible than its market-based counterpart.

Market-based health is not as accessible as its Government-financed counterpart since it is more expensive (Barr, 2016). However, subscriptions to this cover differ with packages such as premium ones. Consumers with high subscription have more accessibility than those who subscribe to lower packages. Government-finance is more accessible. Also, there is no levels of subscriptions for consumers. Hence, the accessibility is similar for all citizens who are eligible for coverage.

The services for market-based healthcare financial services differ with the healthcare provider. Some providers accept insurance covers while others may not. Also, the level of insurance that one subscribes to determine the extent of health services that they receive. The services in Government-financed healthcare is paid by the government. However, some services are only subsidized for the consumers and may need to contribute something for their services. All citizens access equal services under this package.

The service provider are paid based on two key factors: Firstly, the diagnosis that a patient seeks determines the cost and, secondly, the level of insurance that one subscribes to determine the reimbursement (Cleverley & Cleverley, 2018). The level of income also plays a role in how a patient pays the health service provider under market-based financed provision. The service provider under government-finance is paid based on diagnosis. Even though the income of a patient does not play a role, high income earners tend to pay more than their low income counterparts. The government subsidizes the costs of health provision but it ensures that every citizen gets equal access to healthcare.

Market-based financed healthcare do not have any limitations of care. However, when the consumers’ packages may not cater for the services that they get, then they will be required to top up for further provisions of services. Government-financed healthcare system has some limitations to care. For instance, some diagnoses are not covered by the government and the patients are required to reimburse them themselves. Also, inaccessibility to healthcare is a limitation to some consumers at different geographic levels.

The patients are the ones to guide care decisions in this system. These decisions are based on the medical services that they choose to reimburse in a given situation. However, the FDA plays a key role in the decisions that patients make. On the other hand, the guide care decisions in government-financed system are made by the healthcare providers. The diagnosis of the patient determines this decision (Cleverley & Cleverley, 2018). However, like market-based system, FDA also play a key role in making guide decisions for care in this context.

The quality of service in market-based finance as assessed based on HEDIS shows the following: Accessibility and effectiveness of care. Unlike government-financed system, this financial plan is effective and accessible especially considering that the patient is the one to decide on the care guide. Conversely, this system is not as accessible and effective as market-based. The evaluation based on HEDIS indicates that government-financed healthcare is ineffective since patients do not have a right to make decisions on their care guide.

The competitive opinions for market-based financed healthcare system are unlimited. For instance, patients can choose the healthcare provider of their choice based on numerous ones in the market (Cleverley & Cleverley, 2018). Also, the mode of reimbursement differs with specific healthcare providers and the consumers can choose the option of their preference. There are no competitive opinions for the government-financed healthcare systems. The key reason for this case is that patients are diagnosed under the decision of the healthcare providers because of subsidization which restricts them from making any choice other than what healthcare provider has granted.

Prevention and wellness are the primary features of market-based financed healthcare providers. HEDIS indicates that openness for competitive opinions is one factor that improves prevention and wellbeing in this context. Also, the reimbursement that patients make for services plays a vital role in the improved prevention and wellbeing. Prevention and wellbeing are also focused on by the government-financed healthcare providers. However, other factors such as governance determine the effectiveness of this system as they strive to achieve this goal (Cleverley & Cleverley, 2018). Hence, there is no certainty of prevention and wellbeing despite an effort to promote it.

The healthcare costs are managed and controlled by the management of the respective healthcare providers in this context. It is expected that all healthcare services at a given time can be catered for without waiting for the patients to make reimbursement. Hence, the management of the healthcare organization controls how healthcare costs are managed. The government manages and controls healthcare costs. Hence, the economic stimulus of the country determines these costs at a given time. However, the government is responsible to ensure affordability and accessibility of healthcare services in this context.

The procedure for generating medical advances is determined by two key factors: the roles played by the policies in the healthcare industry and a particular healthcare provider in the market-based financed context decides when and how to generate medical advances. The ministry concerned with healthcare in the country decides when and how to generate medical advances. However, the lowest level requests through protocol when there is a need to generate those advances. The management of healthcare facilities do not play any role in this case like their market-based counterparts.

The healthcare reforms are established by the FDA and other government regulations. However, internal reforms in any healthcare facility under this context can establish their reforms provided that they comply with the overall policies by the FDA (Cleverley & Cleverley, 2018). Hence, unlike the government-financed system, market-based financed system has some freedom of making healthcare reforms internally. Like the market-based financed system, healthcare reforms are established by the FDA (Cleverley & Cleverley, 2018). Any reforms that need to be made are forwarded to this association for approval before implementation. However, unlike the market-based financed settings, government-financed system cannot make internal reforms since a lot of procedures may be involved to approve them.

References

• Barr, D. A. (2016). Introduction to US health policy: The organization, financing, and delivery of health care in America. JHU Press.
• Cleverley, W. O., & Cleverley, J. O. (2018). Essentials of health care finance NVA with navigate 2 scenario for health care finance. Jones & Bartlett Publishers.
• HCUP. (2022). Statistical Briefs. Healthcare Cost and Utilization Project (HCUP).
• HEDIS. (2022). HEDIS Measures. National Committee for Quality Assurance.
• The Kaiser Family Foundation. (2023). Health Insurance Coverage of the Total Population.
• Medicare Payment Advisory Commission. (2023). Report to Congress: Medicare and the Health Care Delivery System.
• National Health Policy Forum. (2021). Understanding the Economics of Health Care.
• Centers for Medicare & Medicaid Services. (2023). National Health Expenditures Summary.
• Institute of Medicine. (2019). The Future of Health Care: Reforming the Great Plan.
• World Health Organization. (2020). Health Systems Financing: The Path to Universal Coverage.