University of Phoenix Material

Health Insurance Matrix

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

Include APA citations for the content you provide.

Origin: When was the model first used?
What kind of payment system is used, such as prospective, retrospective, or concurrent?
Who pays for care?
What is the access structure, such as gatekeeper, open-access, and so forth?
How does the model affect patients? Include pros and cons.
How does the model affect providers? Include pros and cons.
Health maintenance organization (HMO)
The idea and concepts of health maintenance organizations have been reported back to 1910, when the Western Clinic in Tacoma, WA offered plans to utilize their providers to lumber mills employees and owners with a premium of fifty cents a month. However, it was not until Dec. 29, 1973, that President Richard Nixon signed into law the Health Maintenance Organization Act of 1973, to provide the option of health insurance to all citizens of the United States.
Health maintenance organizations use a prospective payment system in which providers within a specific network are paid a flat rate per member on a predetermined scale regardless of if services are not utilized or over utilized. According to (“Patient Advocate Foundation” 2012), “care can be provided in a larger geographic service area than would be possible with only one physician group. This network model offers the patient choice of physicians and managed



References: EHow. (2013). Retrieved from http://www.ehow.com/about_5285846_fee_service_health_insurance.html Health Savings Account. (2013). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/health-savings-account Patient Advocate Foundation. (2012). Retrieved from http://www.patientadvocate.org/index.php?p=383 The U.S. Government Accountability Office. (2006). Retrieved from http://www.gao.gov/products/GAO-06-798

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