ch1.docx - Broad description of the System A multiplicity...

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Broad description of the System - A multiplicity of financial arrangements that enable individuals to pay for health care services. Numerous insurance agencies or MCOs that employ varied mechanisms for insuring against risk.Multiple payers that make their own determinations regarding how much to pay for each type of service.A large array of setting where medical services are delivered; Numerous consulting firms offering expertise in planning, cost containment, electronic systems, quality, and restructuring of resources Quad-function model - Financing Insurance Delivery Payment Financing - Employment based: employers finance health care Public programs: Government is the financer Insurance - It's either private or public Delivery - Provision of health care by various providers Hospitals, clinics... Provider - Any entity that delivers health care services and can either independently bill for those services or is tax supported. Payment - Deals with reimbursement to providers for services delivered. Medicare - Program for the elderly and certain disabled individuals Medicaid - Program for the indigent Children's Health Insurance Program (CHIP) - Program for children of low income families Reasons for not having insurance - Employers are not mandated to offer health insurance to their employees Work settings, participation in health insurance programs are voluntary. Employees opted not to enroll because they cannot afford Premium cost sharing - Employees pay a portion of the cost Health Care Reform (Obama Care, ACA) - Refers to the expansion of health insurance

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