HCM 620 California Intercontinental University Managing Risks in Healthcare Setting Paper

The course textbook states that “healthcare is one of the most important factors impacting the economic security of individuals and families today” (p. 308). Despite healthcare’s impact on the economy, the healthcare system (including issues related to insurance) is often referred to as ‘broken,’ or ‘defective.’ This week’s assignment asks you to think critically about the relationship between healthcare policy and the economy.

To begin, complete the following exercise which you will use in your analysis:

After reading about long-term care insurance (p. 323), figure out if you already have it (possibly through an employer) or if not, how you would get it in your state.

What triggers make you eligible for benefits? What is covered and what is excluded?

How easy is it for you to access this type of insurance?

What are your costs? How is this protected from inflation?

After completing this exercise, write a paper discussing long-term care insurance. Use the Internet Resources provided by your textbook (p. 335) and other peer-reviewed sources to aid your research.

Begin with defining its origins and relationship to the economy. Explain the characteristics of long-term care insurance, including, but not limited to the types of long-term care policies, triggers to become eligible for benefits, exclusions, and protection against inflation. Address any burdens you think it is attempting to relieve and how it benefits society and individuals. Discuss the role and motivations of insurance companies, as well as the ease in which individuals can access this insurance. Conclude with how well you think long-term care insurance will meet the needs of society and the economy in the coming future, including any alternative or additional recommendations you think should be adopted.

Your paper should be a minimum of 2000 words, not including the title page or reference pages. Draw upon insights from your course textbook, industry-related websites, and peer-reviewed sources to include a minimum of 4 references.

Question 2

Max, age 28, is insured under an individual medical expense policy that is part of a preferred provider organization (PPO) network. The policy has a calendar-year deductible of $1,000, 75/25 percent coinsurance, and an annual out-of-pocket limit of $2,000. Max recently had outpatient arthroscopic surgery on his knee, from a skiing accident. The surgery was performed in an outpatient surgical center. Max could not work for two weeks and lost $2,000 in earnings.

Max incurred the following medical expenses: (Assume that the charges shown are the charges approved by Max’s insurer and that all providers are in the PPO network.)

Outpatient X-rays and diagnostic tests: $800

Covered charges in the surgical center: $12,000

Surgeon’s fee: $3,000

Outpatient prescription drugs: $400

Physical therapy expenses: $1,200

In your discussion, answer the following questions and briefly explain how you arrived at your calculations:

How much of the expenses will be paid by the Insurance company?

How much of the expenses will Max pay?

If the surgeon was not in Max’s PPO network, would his policy cover this fee? Why or why not?

After calculating these answers, imagine if a member of Max’s family wanted to understand the values but they have little understanding of medical insurance and its terminology. Describe Max’s costs as if you were explaining it to this member of Max’s family as clearly and simply as possible, including the out-of-network surgeon.

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