Discussion questions

1. Choose a government plan and describe the benefits and drawbacks of it. Does it meet the goals set for it? Provide examples that illustrate and support your response.

2.Discuss your thoughts on the government plan you chose and how it has dealt with the issue of rising costs and reduced reimbursement to providers. Has the plan been successful in both of these areas? In what ways has it been successful? In what ways has it failed?

3.In your opinion, what does the future hold for payment systems in the United States? Do these payment systems favor payers, providers, patients, or employers? Explain your answer.

4.Using the discussion in the text beginning on p. 459, answer the following question. If an HMO covered 150,000 lives, expected 25 myocardial infractions (MI) to occur each year within the covered lives, would expect a length of stay of 4.5 days for each MI, and had to pay an average of $950 per day for each day the MI patient was in the hospital, what would the PMPM cost to the HMO be? What would have to be charged to the patient/employer if the HMO had administrative costs equaling 10% of its costs and it wanted a profit margin of 7%?

5. Have you personally experienced the rising health care costs in your care, your family’s care, or the care of a friend or acquaintance? If yes, and if you are comfortable sharing, describe the situation and how it was resolved, if at all. If you have not experienced it or are not comfortable talking about it, do some Internet research to find an article about someone who could not pay for health care due to the rising costs or due to not having insurance. Discuss the article.

In both instances, discuss whether the rising health care costs can be corrected through the cost containment strategies described above or in this unit’s readings. If so, which one? Why or why not?

6. In your opinion, what is the main reason for the development of Managed Care in America? Was it needed? If so, why? If not, why not? Did it accomplish its objectives? Why or why not?


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