Question:

This module discussed how the health care system is financed. As the costs of care have been increasing, so have efforts to contain them including implementing strategies such as managed care, gate keeping, and developing integrated health systems. One of the key elements of this system, especially as we move forward, is the changing interactions between patients, third-party payors, employers, and health care providers, and the role of cost sharing in decision-making. Keep this in mind when answering the assignment.

Interview two people you know (not a family member or “significant other”) that have insurance through different sources (i.e., Medicare/Medicaid, Tricare, Employer, Self-pay). Ask them about the type of insurance they have, the type of plan they have (POS, HMO, PPO, etc.), any eligibility criteria they needed to meet for obtaining the insurance, what it costs them to have it/use it, and how those costs impact when/how they use care.

For this discussion, in at least 350 words, using the information you gathered from the interviews:

Explain the experiences the two people have had with their health care.
Describe how the individuals interact with their health care providers, employer and insurance companies to receive care (i.e., gatekeeping, employer incentives, personal health records, etc.).
How would you change the cost structure of insurance so people would get the best benefit from their insurance? Specifically, how would the cost of these changes be paid?

For this discussion, you will need to post your initial thread before you will be able to see the posts of other students.