Quiz 2: Understanding Health Care Systems

Ambulatory care refers to the health care facility that is provided by any health care institution without the requirement of overnight admission into a hospital. The facilities that are being provided include diagnosis, observation, treatment and rehabilitation. Following are the different circumstances under which ambulatory care might be preferred: 1. When emergency care is to be provided in a remote areas or rural areas, ambulatory care becomes mandatory. 2. Unnecessary hospitalization associated with diseases like hypertension, asthma, chronic pain, dental conditions, diabetes and several can be avoided by means of ambulatory care. 3. In case of consultation, diagnosis and intervention ambulatory care might be preferred instead of admitting patient for observation purposes. 4. Ambulatory care also proves to be beneficial for the individuals on rehabilitation program. Ambulatory care is necessary because it helps in avoiding extra rush at the health care institutions. In regard to the people, who are poor, can easily avail this facility as it is comparatively less costly and do not compromise with the quality of the service. Ambulatory care programs can be easily set up even in a small area without the requirement of building whole health care institution.

The client of the insurance company has to pay by three ways that include co-pay, co-insurance and deductible. The total amount paid by client is the sum of these amounts. In the given case, amount of co-pay is $30 and the deductible amount is $325. Amount to be paid as co-insurance can be calculated as follows: The total amount paid by the client is calculated as follows: Therefore, the total amount paid by the patient is .

A managed care plan is a health insurance providing scheme that provides high-quality health care benefits at the lowest cost possible to the enrolled individual or employee. In managed care plans, doctors from different specialties are always present at the service. The health care providers of the enrolled person are scrutinized before they are recruited for a medical care plan. It provides cost-effective quality care to the person enrolled under the managed care plan. Disadvantages of managed care plans are as follows: 1. Rules are not flexible regarding the choice of doctors. Sometimes members enrolled under the plan do not feel comfortable with allotted-healthcare provider or doctor available in the network. 2. In order to save money, sometimes the managed health care providers contact/ recruit inexperienced health care. In few other situations health care professional with an aim makes extra money and conduct unnecessary medical tests. Types of managed care plans are as follows: 1. HMOs (health maintenance organizations) - Here the person receives all kinds of healthcare from the network provider, except in case of emergency. It requires a referral from the primary care physician (present in the network). 2. Preferred provider organizations (PPOs) - A person can choose a physician from a preferred list of physician present in the network, so no referral is required in PPOs. 3. Point-of-service plans (POS) - It requires a primary care physician, but if a person wishes to go outside the network, then referral from primary care physician is not mandatory. Some tips for the improvement of medical care plans are as follows: 1. A person must be allowed to seek medical aid out-side the network and medical care plans must pay at least more than 50% of the medical bills. Strict scrutiny of the physicians must be conducted at regular intervals by the panel of medical care providers. 2. Approval from the insurance providers must be swift to avoid long waiting periods. Confidentiality must be strictly maintained by the insurance providers regarding the diseased condition of the enrolled person.