Imagine you are sharing Sunday dinner with your extended family. Over dinner, the discussion turns to health care….
Managed Care and Integrated Organizations
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Write My Essay For Me!1. Grandpa has heard about this new-fangled expression, managed
care. Explain managed care to him in terms that he can understand.
2. Grandpa also wants to know if the military is a managed care system.
Give him two reasons why it could be, and two reasons it may not be.
3. Grandma, overhearing the conversation, says that managed care is too
complicated for her. She simply wants to know two key differences
between her traditional health insurance and managed care.
4. Grandma is intrigued. Now, she wants to know why she should opt for
managed care over her current insurance. Give her two reasons why this
may be so.
5. During your conversation, the concepts of utilization monitoring and
control come up. Explain two methods used to monitor and control the
utilization of services under managed care.
Long-Term Care
6. Aunt Jeanne has been listening quietly and recognizes you’re an
expert in health care administration. She wants to know the difference
between Medicare and Medicaid. Define each.
7. Aunt Jeanne wants to know how many of her older seemingly (financially) comfortable friends ended up using Medicaid for nursing home care. Give her two potential explanations of circumstances under which they may have decided to use Medicaid.
8. Aunt Jeanne then says, “There’s no way in heck I’m going to a nursing
home!” Rather, she’d prefer some alternatives to staying in a nursing
home. List two alternatives for her (from the text) and describe
briefly.
Health Services for Special Populations
9. Aunt Jeanne says that she’s a long way from needing long-term
care. She’s more interested in the new Women’s Center at Central Hospital, but can’t understand why they need a special clinic
just for women. She thinks it has something to do with interior
decorating. Identify four health concerns women face, which could be
why the hospital has an interest in providing specialized services for
women.
10. Uncle Rodger pipes up, “We live out there in the boonies. We have
our own health challenges, and they’re different for us than for the
city slickers.” Identify two challenges of rural health that he may be referencing.
11. Uncle Rodger doesn’t think they need a Women’s Center; rather, they
need to deal with real health problems. He’s inferring that the
challenges of rural
health constitute more immediate problems associated with health care.
You know that there are many differences between the two populations.
Provide two examples of measures that have been taken to improve access
to care in rural areas.
Cost, Access, and Quality
12. Aunt Marjorie then says that she’s fed up with the whole business
and is moving to Canada. Identify two reasons why she might want to
move to Canada for healthcare, but then you tell her that there are
reasons why she may want to reconsider (list two as well).
13. Aunt Marjorie listens intently to the ongoing discussion. She’s
convinced that managed care is about making money. You know it’s a
matter of perspective. Identify four key stakeholders that may benefit
from providing healthcare in a managed care environment.
14. Describe briefly how each stakeholder listed above (Question 13) would view the issue of cost.
15. Aunt Marjorie has a new job in real estate and will be enrolling in
her company’s managed care plan. Explain to her four ways in which she
might assess her plan using measures of cost, access, or quality.
16. Aunt Marjorie doesn’t understand the terms premium or co-pay. Define each term using an explanation she can understand.
Health Policy
17. Cousin Greg, a student at the local community college, is more
interested in how these issues relate to the next Presidential election.
He wants to know how social issues become government policy.
Just having finished an outstanding health systems class at Wayland
Baptist, you provide a short outline of the policy cycle, to include the
general steps.
18. Cousin Greg wants to know how the government has gotten involved in
healthcare over the years. You provide him with four (4) examples from
your U.S. Health Care Systems class (list only).
19. You learn that Cousin Greg is writing a paper for his introductory
health class. He’s confused about the term “political will”. Explain
the meaning of political will.
20. Cousin Greg’s last question has to do with national health
insurance and socialized health insurance. He wants to know what the
difference is and who is using these models. Provide one explanation and one example for each.
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Solution Preview
Hi
Below are the questions with suggestions on how to address them. Some of
them have comments in parenthesis that need to be addressed.
—————————–
1)Grandpa has heard about this new-fangled expression, managed care.
Explain managed care to him in terms that he can understand.
Managed care just means that the insurance has a contract with doctors,
laboratories and other places that provide health services that allows
you to receive the best possible care controlling what those services
costs. That doesn’t mean you will receive the attention you need. Part
of being managed care is that they make sure you receive the care you
need for high blood pressure including care that prevents complications.
2)Grandpa also wants to know if the military is a managed care
system. Give him two reasons why it could be, and two reasons it may
not be.
The military run their own managed care system with services in house
and a health insurance that allows them to seek health care outside the
system. **(You may be able to find the specific reasons under the
managed care materials describing VA health care system.)**
3)Grandma, overhearing the conversation, says that managed care is
too complicated for her. She simply wants to know two key differences
between her traditional health insurance and managed care.
Well, Grandma, your traditional health insurance is what is called a fee
for services. You only pay when you see your doctors and you can see
any doctor you choose. With the managed care you may have to pay a
monthly fee, see the doctors that have contracts with the insurance and
pay a small fee every time you see them.
4)Grandma is intrigued. Now, she wants to know why she should opt for
managed care over her current insurance. Give her two reasons why this
may be so.
You know grandma, manage care is really good for you because they make
sure you keep up with your regular check-up, screening test on time and
are doing everything you need to keep your sugar under control. They do
this because they have a system in place that monitors and controls what
services you use.
5)During your conversation, the concepts of utilization monitoring and control come up. Explain two methods used to monitor and control the utilization of services under managed care.
Manage care can monitor and control the services you use and you need through your primary care physician or PCP. S/he is responsible to coordinate all the services you need like preventive care, routine physicals including your referrals to specialist. They can also do it through a utilization review process, in which the insurance has a system in place that makes sure you are using the services you need according to the information to your age, gender or illness.
Long-Term Care
6)Aunt Jeanne has been listening quietly and recognizes you’re an
expert in health care administration. She wants to know the difference
between Medicare and Medicaid. Define each.
That is very easy Aunt Jeanne. Medicare is health insurance for people …
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