Essay on "Economic Pressures Do Employers"

Essay 3 pages (877 words) Sources: 1

[EXCERPT] . . . .

All of these insurance options have cost containment as their prime importance. In other words, if a plan seems great but it costs too much the employer will not be using it (Rosenbloom, 2011). Plans have to be affordable for the employers to use them, and if they are not affordable they will have to be changed or done away with altogether. That can stop a company from having a good advantage when attempting to recruit new employees, and can also cause current employees to look for a new company with which to work (Rosenbloom, 2011). While frustrating for the company, it is completely understandable for the employee. By keeping costs lower for the company, though, more of the employees of that company will be able to have health insurance (Rosenbloom, 2011).

3. What are the high level characteristics of Managed Care?

There are several high level characteristics of managed care that are important to address. The plans that are offered are designed to have incentives and disincentives that are intended to redirect the delivery of medical care (Rosenbloom, 2011). Some of the options offered under these plans are access restricted and only specific groups can receive them. Additionally, there are preselected providers that must be used in order to ensure that the coverage "kicks in" properly (Rosenbloom, 2011). If the correct providers are not used, the insurance may not cover the appointment or the procedure, and that could be highly detrimental to the financial health of the patient (Rosenbloom, 2011). The way the healthcare plans are utilized is also something that has to be considered, since there may be incentives and other perks to specific types of utilization (Rosenbloom,

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2011).

When individuals who are insured under many of these types of plans need medical care from a specialist, they will generally need to receive a preauthorization from their insurance company and/or from their primary doctor in order to have their specialist's treatments and procedures covered (Rosenbloom, 2011). That is due to the fact that HMOs, PPOs, and other managed care organizations generally monitor treatment costs and plans very carefully. They do not permit those who are insured by them to just go to any doctor at any time. There is much more control to the process than that, but there are generally exceptions for legitimate emergencies (Rosenbloom, 2011). Even with those exceptions, however, it is very important that anyone insured in this manner is aware of the requirements so he or she can get the… READ MORE

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Quoted Instructions for "Economic Pressures Do Employers" Assignment:

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Answer the three questions below ..MS Word format, double spaced, font 11...one page for each question (3 pages total). I have some information to use in the paper below each question that was discussed in class. The book we use for class is The Handbook of Employee Benefits, Seventh Edition by Jerry S. Rosenbloom.

1. What types of economic pressures do employers face that impact healthcare plan design and selection?

?Shift in Medicare and Medicaid costs to states ?Increased taxes ?Global competition ?Requiring employers to reduce operating costs ?Foreign companies may have benefit of national health plans with very little premiums ?Talent management ?Attract and retain top talent ?Costs ?Disproportionate ?Healthcare expenses outpacing CPI

2. What types of health insurance programs have been developed to address these economic pressures? What do these programs have as their prime importance?

Types of plans include: ?Managed Care Plans ?Health Maintenance Organizations (HMO) ?Preferred Provider Organizations (PPO) ?Point of Service (POS) ?Consumer Driven Health Plans The prime importance is cost containment

3. What are the high level characteristics of Managed Care?

Plan designs have incentives and disincentives intended to redirect delivery of medical care Access restricted Specific groups Preselected providers Utilization management/utilization review Preauthorization for medical care Monitoring of treatment costs and plans

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