RMI 2101 Lecture 10: Topic 11-healthcare benefits
26 Dec 2016
School
Department
Course
Professor
Document Summary
Third party payment for healthcare goods + services (hcgs: 3 parties, sellers (aka providers) Patients, insured person / party: payer, incentives. No incentive to act like a traditional consumer. Individuals with health insurance tend to use more (hcgs) than those without health insurance: providers (sellers) Payment system in a 3rd party indemnity plan. Every service, a separate fee is paid. Incentive: max # of services: patients with insurance + providers are paid ffs. 3 types of healthcare plans: traditional indemnity plans, general characteristics. Basic plan- hospital care + major medical. Insurer(cid:495)s role is to indemnify the insured for covered losses: reimbursement example. Out of pocket max once reached coinsurance reduces to. Out of pocket max ,500: insurer had no control. Bill payer only: managed care plans, hmo payer of health care goods + services, provide health care directly or arrange for providing of care, typical hmo. Referral to see a specialist: hmo pays pcp by capitation.
