HSA3109 2022 December Module 6 Discussion Latest

HSA3109 Foundations of Managed Care

Module 6 Discussion

Healthcare Coverage Models

In a traditional fee-for-service model of healthcare coverage, healthcare providers are reimbursed based on each service rendered. In a fee-for-service model, patients are not restricted or limited to receiving care from a specific healthcare network and instead are free to move from provider to provider, as long as the provider accepts their health coverage plan. In a managed care model, providers are reimbursed based on an agreed upon amount (capitated) that is received periodically (usually monthly). In this model, patients are part of an affiliated network of providers and facilities that work together to address patient’s needs. Based on your readings and/or experience, which of these models do you think is best for patients and why? Share a brief example of a healthcare encounter, in either model, (patient financial responsibility and outcome) and how it supports your decision.