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Health Insurance Plans

Chapter Problems

The indemnity plan that Annie has chosen will have a lot of advantages to her family. For instance, it will allow any of them to get health services from medical centers of their choice. This is unlike other insurance companies that dictate the centers that one should visit for medical services. This will present a significant disadvantage, as it is more expensive than other insurance premiums. For HMO, the employee will get services from hospitals that have signed a contract with the insurance company (Charles, 2008). In choosing this plan, Annie should first determine the health plans that are provided within the coverage of her area. This will ensure that she has access to medical services. She can then consider which health plan fits her best. This is because many insurance companies will not incorporate chronic illnesses and if they do, they have some pre-existing conditions of the exclusion period (Charles, 2008).

Third, she should have a health reform reminder, because covers keep on changing. For example, parents’ plans will cover children below a specified age. This age is 19 years old, after which the cover will no longer work. She can find out whether her doctor and other healthcare providers are in contact with the network of the health plan. Therefore, she can contact them and get confirmations before she signs a contract. She will ensure that it does not interrupt her services (Charles, 2008). The fourth step is that she can compare the cost of the premiums in the plans in order to decide on whether to take up the out-of-pocket expenses or the monthly premium. Since she is getting the cover from her employer, she will only have to pay a part of that premium. It is advisable for her to choose a cover which will favor her financially. She should compare the quality of different plans in order to make an informed choice. She should also consider the medical conditions covered by the plans and their respective restrictions (Frech, 2001).

When the government publishes data on whether hospitals operate according to acceptable clinical standards with regard to pneumonia, it will affect the decision-making process of the customers. This is because when customers receive such information, they will always evaluate it and respond accordingly (Frech, 2001). They will need to get more information and do more research. If they realize that such data indicates that the standards are not met or the quality is lower than they expected, they will evaluate alternatives and choos the best among the available ones (Somers, 1977). This is of immense importance because it will affect the turn-out of these services. In this case, if the evaluation proves a healthcare provider to be of low standard or quality, then it will experience a decline in the overall amount of patients and vice versa (Feldstein, 2005).

A population includes items or people with the same traits that a researcher attempts to understand. In this case, the population is the pediatrics (Somers, 1977). A sampling frame will be the source materials from which sample is taken. It will include all people within the population that are be sampled.  In this case, the sampling frame will include the institutions that the populations graduated from (Feldstein, 2005). They could also get some documents depicting the performance on subjects related to pediatrics.  Questions that a health group would use to target their population include the following. "Do you belong to an MCO plan?" Yes: __. No: ___. "If yes, does the MCO plan cover your child or children?" Yes: ___. No: __. "Is the town hospital in contract with your MCO plan?" Yes: __. No: ___ N/A: ____

Segmenting is dividing customer base into smaller groups with common attributes in order to easily understand the customer group. The attribute here is the salary of the group. Marketing mix is a tool that business professionals use to determine a product’s offering (Feldstein, 2005). The marketing mix to use here will be based on the pay that they get. The multispecialty medical group can ensure that the grouping based on salary will appeal to the segment and that it uses appropriate salary intervals (Korenchuk, 1994). In addition, the number of employees in every interval must be uniform. The interval should also cover the whole population and should be even.

In segmenting its market, a women’s health clinic can use age, income of the patients and employment status as the bases for segmentation. In this context, the product is the services provided by the clinic (Korenchuk, 1994). Age base would influence it in a way that it would be easier to attend to patients when children are separate with the adults. This is because children have different medical requirements from adults. Employment status base would be helpful when it comes to payment (Korenchuk, 1994). This is because most of the people who are employed will have an insurance cover. If the clinic happens to have some allowance, income base can help in determining the worthiness of a patient in relation to their ability to pay.

The PHO plan for Bethsaida hospital can be segmented on the bases of geographical location, demographics, that is family size and income, and physical or personal history. Physical or personal history involves physical disability and the current physical and/or mental health status. Geographically, it will help the PHO in establishing which hospitals its customers will be getting health services from (MacEachern, 1999). Demographically, it will help in determining the premium for each salary bracket and also for the family depending on the size. The PMO plan will also depend on the health disability and mental status of clients to be covered, since some conditions are chronic illnesses. If they happen to incorporate chronic conditions, then they have some pre-existing conditions exclusion period (MacEachern, 1999).

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