Healthcare Insurance Report: Payment Methods and Risk Mitigation

This report examines various healthcare insurance payment methods, focusing on Medicare, Medicaid, and private insurance models. The report outlines the different payment methods associated with each insurance type, including cash and credit, and the specific populations they serve. It also includes a table detailing the incidence of diseases across different age groups and their corresponding 5-year relative survival rates. Furthermore, the report identifies potential risks associated with these insurance programs, particularly the collapse of the Medicaid program, and proposes mitigation strategies to address these challenges. The report concludes with a discussion on the metrics used to evaluate the success of these insurance programs, such as coverage, quality of care, and ease of payment.

Running head: HEALTHCARE
Healthcare
Name:
Institution:
Date:

HEALTHCARE
Introduction
In insurance payment for healthcare, there are four basic modes of payments. They
include; individual private insurance, out-of –pocket payment, employment based private
insurance method and government financing. For Medicare, the insurer pays the health
provider directly with the remaining 20% of the cost being paid by the patient. If and when
the provider does not accept the claim assignment, Medicare will pay for the care received to
the patient who will then pay the provider (Klemm, et al, 2016)
For Medicaid, the insurance program offers free and low-cost health coverage to the
low-income earners, children’s, pregnant women and the elderly. For this program, the best
billing method is cash, since it required little or no money involved. Hospitals should be paid
in cash or credit depending on the level of insurance needed. Private insurance programs
should pay using credit to the care giver. Private insurance programs usually use credit cards
to pay care givers.
Dependencies
Type of
insurance
Dependencies / Age Groups Type of billing/
method of billing
Medicare General population( 1-90yrs) Credit or cash
Medicaid Low income earners and the vulnerable( 1-70
yrs)
Cash
Out-of-pocket Vulnerable members of the society( 1-90yrs) Cash
Hospitals General population( 1-90yrs) Cash
Private
insurance firms
Employees in corporations and the interested
peoples( 25-65 yrs employed)
Credit cards

HEALTHCARE
Metric representing for success
The metrics representing success for the insurance programs are represented by the
number of people it covers, the quality of care it gives and the ease of paying for the coverage
and billings(Klemm.et al, 2017)
Incidence of disease according to age groups
<30 30-39 40-49 50-
59
60-69 70+
Incidence(%of total) 0.6 5.9 18.6 26.3 21.9 26.7
5 yrsrelative survival% 72.4 79.8 85.8 85.7 86.1 *
Significant risks with recommended mitigation actions:
The significant risks and mitigation factors in this policies are their collapse. For Medicaid,
the insurance program offers free and low-cost health coverage to the low-income earners,
children’s, pregnant women and the elderly.

HEALTHCARE
References
Klemm, H. T., Naumann, A., Hofmann, G., & Spahn, G. (2016). Prognostic assessment in
private healthcare insurance part 1: Risk of osteoarthritis. Der Unfallchirurg, 119(12),
1057-1060.
Klemm, H. T., Naumann, A., Hofmann, G., & Spahn, G. (2017). Prognostic assessment in
private healthcare insurance part 2: Risk supplement for accidental
endoprostheses. Der Unfallchirurg, 120(1), 81-84.