Financing and Structuring

Financing and Structuring Health Care

Health Services Organization Management – BUS 500

January 30, 2011

Identify and describe the three main types of health care insurances in the U.S.

Managed care consists of three types of insurances that are similar in nature but the programs are different. The three main types of managed care are HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organization), and POS (Point of Service Plans). The similarity that these plans share is that they all have an agreement with the insurer and a network of selected health care providers. The insurance holders are offered financial incentives for using the providers in their network but there are specific guidelines when selecting a provider and there are formal procedures that must be followed. ("Heath insurance types,")

HMOs function on a prepaid treatment basis where regardless of the medical care the members of HMOs will pay a set monthly fee. HMOs also require a person to have a primary care physician who serves as your doctor for all basic health care services. A person enrolled in an HMO will have to receive most of their medical treatments from providers within the network. In order to receive services from a physician specialist, a referral is needed from the primary care physician.

A preferred provider organization (PPO) is a plan which contracts with a network of preferred providers for the beneficiary to choose from. These doctors and hospitals on serve a specific association or group. With a PPO plan, the beneficiary is not limited to certain providers and do not need to select a primary care physician or need a referral to see a doctor in the network.

A POS (point of service) health care plan is a unique plan because it combines some of the same features of HMOs and PPOs. Point of service plans provides access to a large network of doctors, hospitals, clinics, specialist, and other health care professionals. A POS plan is similar to...