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What is the key difference between a fee-for-service healthcare system and a system based on health maintenance organizations?

Short Answer

Expert verified

The main distinction between the two systems is that one is based on payment based on the services supplied, while the other is based on a fixed payment for all services provided.

Step by step solution

01

Concept of HMO.

A health maintenance association (HMO) could be a health coverage company that has healthcare for a hard and fast yearly cost within the USA. it's a corporation that gives and manages healthcare facilities for medical insurance, self-funded health care benefits packages, consumers, and other groups on a paid basis by serving as a contact between health care providers.

02

Explanation of solution.

Moral hazards may be a major concern for insurance companies. financial loss is reduced by employing a fee-for-service healthcare system or a health-maintenance organization system.

In a fee-for-service healthcare system, healthcare service providers are compensated for the services they provide or are permitted to supply, and they are compensated more for any extra services they provide.

Service providers, on the opposite hand, will receive a hard and fast sum per person irrespective of the number of services they perform under a health maintenance organization. The policyholder has the choice of requesting additional services without incurring from now on costs.

However, in recent years, all healthcare providers should adhere to the HMO framework.

As a result, fee-for-service depends on the number of services delivered, whereas HMO relies on one payment per individual for all treatments.

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Most popular questions from this chapter

Why might it be difficult for a buyer and seller to

agree on a price when imperfect information exists?

In an insurance system, would you expect each person to receive in benefits pretty much what they pay in premiums, or is it just that the average benefits paid will equal the average premiums paid?

Imagine that you can divide 50-year-old men into two groups: those who have a family history of cancer and those who do not. For the purposes of this example, say that 20% of a group of 1,000 men have a family history of cancer, and these men have one chance in 50 of dying in the next year, while the other 80% of men have one chance in 200 of dying in the next year. The insurance company is selling a policy that will pay $100,000 to the estate of anyone who dies in the next year.

(a) If the insurance company were selling life insurance separately to each group, what would be the actuarially fair premium for each group?

(b) If an insurance company were offering life insurance to the entire group, but could not find out about family cancer histories, what would be the actuarially fair premium for the group as a whole?

(c) What will happen to the insurance company if it tries to charge the actuarially fair premium to the group as a whole rather than to each group separately?

What do economists (and used-car dealers) mean by a 鈥渓emon鈥?

For each of the following purchases, say whether you would expect the degree of imperfect information to be relatively high or relatively low:

a. Buying apples at a roadside stand

b. Buying dinner at the neighborhood restaurant around the corner

c. Buying a used laptop computer at a garage sale

d. Ordering flowers over the internet for your friend in a different city

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