Health Insurance in the U.S.:
Health insurance has become an important part in the modern health care system even before the American government started to discuss the issue of compulsory medical insurance. Actually health insurance has asserted itself through the ever-increasing number of customers seeking for these services as well as through advertisements. The new customers tend to share information on the benefits of health insurance with their friends. This in turn results in the increase in the number of customers seeking for health insurance as the shared information continues to shape public opinion.

Types of Health Insurance in the U.S.:

The various types of health insurance available in the United States are classified into several categories. The three main types of these insurance plans are fee-for-service or indemnity plans, Health Maintenance Organizations, and Preferred Provider Organizations. In addition to being the traditional type of health insurance, the fee-for-service or indemnity plans permits…...

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References:

Ahmad, M. (n.d). 3 Main Types of Health Insurance: The Benefits. Retrieved April 25, 2012,

from http://www.insuranceagents.com/main-health-types.html

"Basic Types of Managed Care -- HMO, PPO, POS." (2009, March 17). GoInsuranceRates.com.

Retrieved April 24, 2012, from http://www.goinsurancerates.com/health-insurance/basic-types-of-managed-care/

Health Insurance Portability and Accountability Act (HIPAA)
Discuss whether there has been a violation of Health Insurance Portability and Accountability Act (HIPAA)?

There are no court rulings that can shed light on the issue. However going by the given facts, it is as follows: "Dr. Williams shows Joan's medical records to a friend for advice. His friend tells Dr. Williams to contact his medical malpractice insurance carrier." The problem here is if the friend is also a medical practitioner, attorney or some person exempted under the act for disclosure. The issue is not clear. It is assumed that the friend is also a medical practitioner. In that case Williams can take a stand that there has been no violation of the act if the doctor passed on the information for consultation purposes, and this is very clear from section 45 CF 160.103 according to which a business associate could be" legal; actuarial;…...

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References

Chaikind, Hinda R. (2004) "The Health Insurance Portability and Accountability ACT

(Hipaa): Overview and Analyses" Nova Publishers.

Krause, Joan H. (2012) "Kickbacks, Honest Services, and Health Care Fraud after Skilling"

Annals of Health Law, vol. 21, no. 1, 2012, pp: 41-43.

What this in essence means is that the patient would not be able to choose his own brands of medication; he must only buy what the committee has recommended, otherwise, he would lose out on his health insurance payments.
A woman who faced a problem similar to that mentioned above talks about her experience as a diabetic. She said that when the health insurance company stated that they would be able to pay for a higher priced drug to control diabetes, than the one that the committee recommended, she argued and fought it out with the company, until, eventually, they agreed, albeit reluctantly, to pay for the higher priced drug 'Glucophage.' Her experience was that as soon as she started on hits drug, she found to her amazement that her sugar levels had started to drop considerably, and that her vision, which had been deteriorating for quite some time, gradually…...

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References

ADA and Georgetown University Health Insurance Research" Retrieved at   24 July, 2006http://www.diabetes.org/advocacy-and-legalresources/healthcare/insurance-research.jspAccessed 

Ask the diabetes Team" Retrieved at   Accessed 24 July, 2006http://www.childrenwithdiabetes.com/dteam/2005-12/d_0d_di8.htm .

Children with diabetes, insurance costs, ask the diabetes team" (January, 2006)

Retrieved at   Accessed 24 July, 2006http://www.childrenwithdiabetes.com/dteam/2006-01/d_0d_dlz.htm .

However, third-party payer systems became more popular with the increased bureaucratization of healthcare, particularly with the spread of HMOs and their complex paperwork for referrals. The use of third-party payers means "the processing of payments for insurance and other duties are handled" by another agency that is responsible for collecting premium payments and issuing reimbursements (Easey 2009).
It has been alleged that the use of such third parties means that individuals not well-versed in medical needs are making decisions about when reimbursements are valid regarding treatment and care, and are often looking for reasons not to pay for care, rather than to provide customers with the medical services they require as patients. It also creates another level of red tape between the patient and his or her doctor and insurance provider. An example of such an abuse might be an individual denied coverage because of forgetting to disclose a relatively…...

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References

Easey, Cameron. (2009, April 2). Define third-party health insurance. Retrieved May 9, 2010 at http://www.ehow.com/about_5301200_define-thirdparty-health-insurance.html

Healthcare: How much does the federal government spend? (2009). The Brookings Institution.

Retrieved May 9, 2010 at  http://www.taxpolicycenter.org/briefing-book/key-elements/health-insurance/spending.cfm 

The Health Insurance Portability Act of 1996. Full text retrieved May 9, 2010 at  http://www.dhhs.gov/ocr/privacy/hipaa/administrative/statute/hipaastatutepdf.pdf

Healthy Connections Kids (HCK) is a non-Medicaid administered care program for children up to age nineteen in South Carolina, who do not have other insurance coverage and whose family unit earnings is less than two hundred percent of the federal poverty limit. HCK benefits are founded on the state health plan benefits. Kids covered under this program must be enrolled in one of the Managed Care Organizations (MCO's) who provide HCK coverage. Dental care is billed to Medicaid, but claims for all other HCK services must be filed with the MCO (SC Healthy Connections Kids (SCHIP), n.d.).

Healthy Connections Kids is for uninsured kids up to age nineteen with family wages larger than one hundred and fifty percent but less than or equal to two hundred percent of the Federal Poverty Level. They must have possessions valued at or below thirty thousand dollars. The insurance is founded on the health insurance…...

Health Insurance Costs
Perhaps it is simply that we all need a few good villains in our life, and with the Cold War firmly over we must look closer to home to find our bad guys. Or perhaps it is simply that there is a great deal of villainy in society, that in fact society is nothing more than an evolutionary process of ever-more sophisticated forms of villainy.

Either explanation might do to explain the rise of the health maintenance organization as a pervasive element of American society as a primary reason that the quality of health care continues to decline even as health care costs continue to rise in this country. This paper examines the relationship between HMOs and other forms of health insurance and the rising cost of American healthcare, using the area of organ donation as a means of illustrating the complexities of the issue and the ways in…...

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References

Florman, S. etal. "Organ Procurement."

ACS Surgery: Principles & Practice, 02/28/2003.

Dobson, R. "Scientists produce genetically engineered, cloned pigs for xenotransplantation." British Medical Journal 2002, 12 January: 324-76.  http://www.ncpa.org/studies/s168/s168b.html 

Martin, P. (1999, 22 December). "Bioethics and the whole: pluralism, consensus, and the transmutation of bioethical methods into gold." Journal of Law, Medicine & Ethics 27 (10): 316.

Some of the other benefits of the NHI include the fact that contributions are payroll - related and, of course, as previously mentioned, the fact that the contributions are shared between the three main actors: the employer, the employee and the government. If we look at the proportions we have previously described, it seems that working in the private sector is more beneficial from this point-of-view, since the employee will only contribute with 30%. However, we should also mention that this should be related to the level of salaries in the public and private sectors.

Obviously, the salary package is almost always determined by the motivating elements that the employee is likely to include in the package. In the case of Taiwan, first of all, all employees offer access to the national insurance system, which means that each employee visiting the doctor will generally pay less than $5 for the services…...

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Bibliography

1. Andrew T. Huang, Chih-Hung Jason Wang, and Chih-Liang Yaung. Insuring Taiwan's health. 2001 Special Edition: Emerging markets. The McKinsey Quarterly.

2. Lu, Rachel. Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan. HEALTH AF FA IRS ~ Vo l u m e 2-2, Nu m b e r 3. 2003.

3. Gross, Ames. Taiwan's New Universal Health Insurance Program. Pacific Bridge Medical - Taiwan Medical Publications. May 1998. On the Internet at  http://www.pacificbridgemedical.com/publications/html/TaiwanMay98.htm 

Andrew T. Huang, Chih-Hung Jason Wang, and Chih-Liang Yaung. Insuring Taiwan's health. 2001 Special Edition: Emerging markets. The McKinsey Quarterly.

Health Insurance
There are many good reasons to have health insurance, and among those reasons is the fact that there is a tremendous financial risk that is linked to "unanticipated adverse health events," according to an article in the Journal of Health Economics (McLaughlin, et al., 2002). Health insurance not only helps the person that is ill or has been in an accident to get healthy again, it prevents -- at least in many cases it prevents -- financial calamity. The U.S. Department of Health and Human Services (HHS) has come out with a report that shows most families that cannot afford health insurance do not have the "financial assets to pay the hospital bills they would incur if a family member were to be hospitalized" (Glied, 2011, p. 1). In fact the HHS report reflects the fact that the majority of uninsured families have "virtually no savings or investments" so…...

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Works Cited

Glied, Sherry. (2011). The Value of Health Insurance. U.S. Office of Health and Human Services

Retrieved February 3, 2012, from  http://www.healthcare.gov/blog/2011/05/valueofinsurance051011.html .

McLaughlin, C.G., and Chernew, M.E. (2002). Health Insurance: Economic and Risk Aspects.

Journal of Health Economics, 11(3), 353-356.

Health Insurance Plans
There seem to be three basic health insurance categories. They are generally called Fee-for-Service, anaged Care or Health Saving plans, though some call them by other names. The fee-for-service plan is what many people consider the traditional type of insurance. Like automobile insurance, people choose the cover they want and pay the price for those services. Often health care providers just take this insurance and the company pays after a deductible or co-pay, which are amounts to be paid at the time of service (usually a relatively small amount).

anaged Care is a newer type that essentially relies on the insurance companies having some type of agreement with doctors, hospitals and other care providers. Those who join a managed care program have choices from these services and negotiated amounts are paid to the provider for very specific services or types of treatment. In some cases, there are restrictions on…...

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MANAGED CARE TYPES: There are three kinds of Managed Care plans: HMOs, PPOs and POSs. Health Maintenance Organizations are popular because they save money by having large numbers of people who share costs. Their focus is often on preventive care, trying to keep health problems from developing or getting worse. Doctors and hospitals agree to accept certain fees and co-pays. They often restrict the procedures. Cost savings is very important with HMOs.

Preferred Provider Organizations are similar to HMOs but usually cost more but offer more flexibility, at least within the network of doctors and hospitals they arrange. These types of programs usually allow people to go outside of the network if needed but it can cost higher service fees to do this. Sometimes specialist services can be included if someone needs a particular type of care. Point of Sale options are a final type. They are a hybrid of HMOs and PPOs. A primary doctor has to be identified and he or she determines what care can be received and where. With his or her authorization, the patient can go to other caregivers as needed though fees may again be higher. It seems that this option was a way to confirm that medical treatment, not just cost management was still important.

MEDICARE AND MEDICAID: Medicare and Medicaid are government options for care for poor and elderly people. They have care that is offered like regular insurance and some managed care options. The managed care elements were added with the growth of this option for others. Though it is hard to tell yet as to whether care is better, early results suggest people like this option. A Kaiser (2010) study shows that interest in this element has been great. The number of Medicaid users in a managed care program doubled to 33 million by 2008. However, the costs rose dramatically too so it isn't clear if this is good for savings. Other studies indicate that beneficiaries had better access to services and liked the care they received more. Some research shows that the type of care a patient gets is different too. In a study on heart procedures, patients received more sophisticated treatments and had less need for repeat procedures. In-patient procedures seem to be reduced as more people get less intensive care. Pharmacy costs seem to have been reduced as well.

Employee insurance costs may at the outset look as an unimportant and dispensable expenditure, but in reality it is far from true. Research has shown that health insurance can increase overall productivity by reducing the costs associated with "Employee Absenteeism," reducing the costs of turnover, and thereby contributing to optimising the output. (Ellen O'rien). Most people lacking insurance are from the lower economic layer of the society and more than two thirds of this group are full time workers. The lack of insurance coverage implies that these poor people are putting off their medical attention until an emergency situation arises. In majority of the cases such medical emergencies could have been averted with timely medical intervention. "Many people simply put off medical care until they end up in the ER - much sicker and requiring more care than they would have had they been visiting a doctor on a…...

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Bibliography

David a. Fahrenthold, "Mass. Bill Requires Health Coverage: State Set to Use Auto Insurance as a Model," Accessed May 28th 2007, available at  http://www.washingtonpost.com/wp-dyn/content/article/2006/04/04/AR2006040401937.html 

Pam Belluck, "Massachusetts Set to Offer Universal Health Insurance,"

Accessed May 28th 2007, available at  http://www.nytimes.com/2006/04/04/us/04cnd-mass.html?ex=1180584000&en=cb0ddd48a623b68e&ei=5070 

Ellen O'Brien, 'Employers' Benefits from Workers' Health Insurance', the Milbank Quarterly, Volume 81 Number 1, 2003, Available Online at,  http://www.milbank.org/810101.html

Health Information Portability Accounting Act (HIPAA, went into effect the first quarter of 2003. Indeed, HIPAA creates federally mandated requirements regarding protected health information (PHI) that can impact any employer, regardless of its size, location or industry. Government estimates place the price tag for compliance within the public and private sectors at an estimated $22 billion. While the Privacy Rules were not aimed at regulating non-medical employers, employers who sponsor group health plans are affected, de-pending on whether the employer: (1) is fully insured or self-insured; and (2) creates or receives Protected Health Information. Protected Health Information (PHI) is defined to include all individually identifiable health information held or transmitted by a covered entity or business associate electronically or in other forms (Amatayakul, 2000). There are some exceptions. One important PHI exception is that the Privacy Rules do not apply to employment records, including medical information employers use to comply…...

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Bibliography

Amatayakul, M. (2000). HIPAA update. Achieving compliance with the new standards. MD Comput, 17(3), 54-56.

Lax, J.R. (2002). An outline for HIPAA compliance. Health Insurance Portability and Accountability Act. Optometry, 73(11), 711-717.

LePar, K. (2004). Quality consciousness...auditing for HIPAA Privacy Compliance. J Nurs Care Qual, 19(2), 105-113; quiz 114-105.

("Protecting the Privacy of Patients' Health Information," n. d.) the variations HIPAA necessitates would be sufficient and the changes would be accompanied by remarkable uneasiness in several respects. Functioning in the type of high-security setting visualized by the proposed HIPAA security regulations would imply functioning under regular surveillance and with concentration to making medical record information as being secure. hether in relation to paper or electronic form, information relating to medical record could not be any longer be left unprotected, wherein a normal observer, a thief or a snoop, could have reach to it. ("History: HIPAA General Information. Health Insurance Portability and Accountability Act," n.d.)
The Health Insurance Portability and Accountability Act -- HIPAA indicate to be one of the most confronting functional initiatives most radiologists would confront in their careers. The anticipations of HIPAA are very large and the results of failure to agree continue beyond the related financial…...

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Works Cited

Feigenbaum, Jonathan. (2007, May) "Health Insurance Portability and Accountability Act: The Impact of HIPAA on Pharmacy and Emerging Compliant Pharmacy Information Technology." Retrieved 30 September, 2007 at http://citebm.business.uiuc.edu/TWC%20Class/Project_reports_Spring2007/HIPAA/feigenba/feigenba.pdf

Kroken, Patricia. (2002, Dec) "HIPAA and the Radiology Practice" Retrieved 30 September, 2007 at http://www.imagingeconomics.com/issues/articles/2002-12_07.asp

N.A. (n. d.) "Health Insurance Portability and Accountability Act (HIPAA): Comprehensive self-study guide" Harbor-UCLA Medical Center and Coastal Cluster Health Centers. Retrieved 30 September, 2007 at http://www.harboruclasurgery.labiomed.org/users/HIPAASelf-StudyGuide.pdf

N.A. (n. d.) "HIPAA FAQ's" Retrieved 30 September, 2007 at http://www.hipaacomply.com/faqs.htm#What%20exactly%20is%20HIPAA?

Health Insurance and Managed Care
The purpose of this paper is to develop a game that will make it much easier and fun to not only understand, but also remember the major types of managed care plans together with their characteristics. The game is quite simple and can be played by pretty much every individual as it is applicable in understanding other concepts. The game requires two individuals or more to play, however, if one is alone, it is still applicable.

To begin with, one of the essential requirements of the game includes having paper slots in which the content being discussed is written. In this case, taking into account that there are four types of managed care plans, there will be four main slots. This will include, Health Maintenance Organization (HMO), Point of service (POS), Preferred Provider Organization (PPO), and High Deductible Plans (HDP) (ASD, 1992). The other requirement will be…...

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References

AAP, ((2015), Types of Managed Care Plans, Healthy Children,   (Retrieved; 12/14/2015)https://www.healthychildren.org/English/family-life/health-management/health-insurance/Pages/Types-of-Managed-Care-Plans.aspx 

ASD, (1992), Types of Managed Care Plans, American Society of Dermatology,   (Retrieved; 12/14/2015)http://www.asd.org/types.html 

High Insurance Portability
Health Insurance Portability & Accountability Act

Some hope was given for the current legal environment to become better defined for health-care providers when Health Insurance Portability & Accountability Act (HIPAA) was passed by the in 1996. As previously mentioned, HIPAA is a monumental act that attempts to address and incorporate all three issues-- privacy, confidentiality, and security within one law. When HIPAA was passed, many applauded the portability aspects of HIPAA that allowed for continuing healthcare coverage for individuals who lost their jobs and attendant healthcare insurance. But few back in 1996 anticipated the dramatic impact that HIPAA would have later on the privacy and security of patient's health information in the United States.

HIPAA Legislation History

HIPAA legislation was passed in the year 1996. Title I of the regulation dealt with the health insurance coverage of the public and their immediate family when they lost their jobs. Title II of…...

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References

Allison, Tom L. & Clark, John H. (2001). Making Correctional Health Care Smarter Magazine Corrections Today, Vol. 63.

Buckovich, Suzy A. (2000). Patient Privacy, Confidentiality and Security. Magazine Title: Drug Topics. Volume: 144. Issue: 4. Page Number: 77.

Conn, J. (2006) HIPAA, 10 years after. Modern Healthcare, 36(31), 26.

Erikson, J.I., & Miller, S (2005). Caring for patients while respecting their privacy; renewing our commitment. Online Journal of Issues in Nursing, 10(2).

Misconceptions and Confusion in Healthcare Coverage Among Elderly Populations
A small podiatry practice in Northeastern Missouri becomes the scene of a tragedy which takes place in plain sight, as there is not a day that goes by where at least one or more patients will be charged for their office visit despite mistakenly believing they would be covered. Unanticipated medical costs can be devastating even for adults in their prime of their working lives, but for the elderly and infirm living on a fixed income and attending multiple physicians simply to survive, the burden of health insurance failing to cover their medical bills can be overwhelming to say the least. Approximately 75% of patients who are examined in this particular Missouri podiatry practice are over the age of 65, putting them well within the segment of society which is ostensibly enjoying their retirement years while managing a fixed income. Another thing…...

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References

ConsumerReports.org. (2014, February 11). Managing medicare: Get the most from this comprehensive health insurance option for seniors. Retrieved from  http://www.consumerreports.org/cro/2012/09/managing-medicare/index.htm 

Detering K.M., Hancock A.D., Reade M.C., & Silvester W. (2010). The impact of advance care planning on end of life care in elderly patients: Randomized controlled trial. BMJ,

340:c1345 (1-9). Retrieved from  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844949/pdf/bmj.c1345.pdf 

Loewenstein, G., Friedman, J.Y., McGill, B., Ahmad, S., Linck, S., Sinkula, S. & Volpp, K.G.

....

As health care’s share of gross domestic product (GDP) grows, people are struggling with how to estimate the value of the health care industry in the economy.  While it might seem like a straightforward answer, simply looking at the total amount paid for healthcare in proportion to the total GDP, that valuation would be a gross oversimplification. Generally, GDP is viewed as a proxy for standard of living, but in the United States standard of living might actually drop for many people as the percentage of GDP attributable to healthcare grows.  It is important to keep in....

It is difficult to address the issue of lack of mental health funding for first responders without first acknowledging the general lack of appropriate thoughts about mental health.  While physical illness is treated as a legitimate illness and self-care to help avoid that illness is supported, mental illness is oftentimes still treated like a character defect.  People who seek assistance for mental health not only have to face a lack of funding, but often have to worry about whether the stigma that attaches to seeking such help will work against them in their future professional lives. For....

A Health Care Informatics Risk Assessment is one of the tools used in healthcare management.  They examine workflow issues that have the ability of positively or negatively impacting several important factors, such as the quality of care, overhead costs, and overall efficiency.  One of the areas of health care that can benefit from a Health Care Informatics Risk Assessment program is telemedicine.   Another area of health care that could benefit from a Health Care Informatics Risk Assessment program is vaccine administration in large groups.

If the COVID-19 pandemic has any lasting impact on the provision of....