Grading Criteria For Economic Issues Simulation Paper

Grading Criteria Economic Issues Simulation Paperhcs440 Version 91gr

Evaluate and analyze a selected company's profile, including employee demographics, healthcare risk factors, premiums, and evaluation methods. Justify the selection of a specific health plan for the company, explaining reasons for choosing this plan over alternatives. Ensure your paper is between 700-1050 words, well-organized with clear introduction and conclusion, proper headings, and formatted according to APA style. Include in-text citations and a reference list with credible sources. The paper should demonstrate comprehensive understanding, critical reasoning, and adherence to academic standards in mechanics, style, and presentation.

Paper For Above instruction

The healthcare industry has undergone significant transformations over recent decades, driven by evolving economic factors, technological advancements, and changing legislative landscapes. When selecting health plans for companies, myriad considerations—including employee demographics, healthcare risk factors, financial premiums, and evaluation methodologies—must be carefully analyzed to ensure optimal benefits and cost management. This paper explores these aspects through a comprehensive profile of a chosen company, followed by an evaluation and justification of the recommended health plan based on thorough analysis.

Company Profile and Demographics

The selected company, GreenTech Manufacturing, operates in the renewable energy sector, employing approximately 1,200 workers across various departments such as research, production, maintenance, and administration. The workforce demographics indicate a diverse age distribution, with 35% aged 25-34, 40% aged 35-49, 15% aged 50-64, and 10% over 65. The gender composition is roughly 60% male and 40% female, with approximately 20% minority representation. The majority of employees are full-time, with a smaller contingent engaged in seasonal or part-time roles.

Health Care Risk Factors and High Usage Areas

Given the demographics, specific healthcare risk factors are notable. The prevalence of chronic conditions such as hypertension, diabetes, and obesity is higher than industry averages, especially among employees over 50. Historically, high utilization rates occur in emergency services, primary care visits, and prescription medication usage, primarily for managing chronic illnesses. Mental health issues, including stress and anxiety, are increasingly common, reflecting workforce pressures and balancing work-life demands. These factors influence healthcare costs substantially and necessitate tailored plan options.

Premiums Offered by the Company

GreenTech Manufacturing is willing to allocate approximately $8,000 annually per employee for healthcare premiums. The company's financial strategy emphasizes balancing premium affordability with comprehensive coverage, aiming to attract and retain skilled workers. This premium budget shapes the plan options available, favoring tiered plans or those with specific wellness incentives.

Evaluation Methodology for Employees and Healthcare Risk Factors

The evaluation process involves actuarial analysis, epidemiological assessment, and cost-benefit analysis. Actuaries utilize historical claims data to project future costs, adjusting for demographic shifts. Epidemiologists assess risk factors related to chronic diseases prevalent in the workforce. Combined, these evaluations facilitate selecting health plans that optimize coverage and cost-efficiency, emphasizing preventative services to reduce high-cost premium claims.

Plan Selection Justification

After comparative analysis, the Preferred Provider Organization (PPO) plan emerges as the optimal choice for GreenTech. The reasons for this selection include its flexibility in provider choice, which is valued by employees, and its comprehensive coverage features, which are crucial given the chronic health issues prevalent in the workforce. Additionally, PPO plans often include wellness incentives, aligning with the company's goal to encourage healthy behaviors and potentially reduce long-term costs.

Reasons for Choosing the PPO Plan

• Flexibility in Provider Choice: Employees can access a broad network without referral requirements, supporting employee satisfaction and choice.
• Enhanced Coverage for Chronic Conditions: The plan offers extensive chronic disease management programs, crucial for managing prevalent health risks.

Reasons for Not Selecting Other Plans

The Health Maintenance Organization (HMO) plan was considered but deemed less suitable due to its restrictive network and referral requirements, which could hinder employees with specific provider preferences or needs for specialty care. The High Deductible Health Plan (HDHP) was also less favored because, although it can reduce premiums, it may impose financial burdens on employees facing frequent healthcare utilization, especially those managing chronic illnesses.

Conclusion

In conclusion, selecting an appropriate health plan requires balancing employee needs, health risk factors, and budget constraints. For GreenTech Manufacturing, the PPO plan offers the best combination of flexibility, comprehensive coverage, and supportive services aligned with workforce health risks. This strategic decision promotes health management, employee satisfaction, and economic efficiency, illustrating how analytical evaluation supports sound healthcare coverage choices in corporate settings.

References

• Baker, L. C., & Chua, J. (2020). "Health Insurance Planning and Policy." Journal of Health Economics, 69, 102314.
• Kaiser Family Foundation. (2022). "Employer Health Benefits Survey." Retrieved from https://www.kff.org
• Liu, J., & O'Neill, B. (2019). "Healthcare Cost Management and Employee Wellness." Health Policy and Management Journal, 12(3), 156-165.
• Milliman. (2021). "Understanding Health Plan Options in Corporate Settings." Milliman Reports.
• National Institute for Health Care Management Foundation. (2020). "Healthcare Utilization and Risk Factors." NIHE Policy Briefs.
• Schneider, M., & Somers, M. R. (2018). "Evaluating Employee Benefit Plans." Benefits Quarterly, 34(1), 14-21.
• Thomas, K., & Hwang, K. (2021). "Chronic Disease Management in the Workplace." American Journal of Managed Care, 27(10), 468-474.
• U.S. Department of Health and Human Services. (2022). "Workplace Wellness and Health Promotion Strategies." HHS Reports.
• Woolf, S. H., & Aron, L. (2020). "The Impact of Cost and Coverage on Healthcare Choices." Journal of Healthcare Management, 65(4), 265-272.
• Zhang, Y., & Wang, J. (2019). "Economic Evaluation of Health Insurance Plans." Journal of Public Health Policy, 40(2), 245-259.