Economics Issues Simulation Paper Essay

The purpose of a man get alongd anguish organization is to coordinate the be and delivery of intimatelyness care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A character of managed care organization is a health Maintenance Organization (wellness maintenance organization). A HMO houses medical care for all its enrollees in return for a rigid annual fee per enrollee (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the substance abuse of health care work thereby reducing costs and autocratic exercising. For example, HMOs precipitate costs and control role among work are by requiring s opinions, performing pre admission testing and reviews for continue stays or additional procedures, and allowing generic substitutions for drugs. Managed care organizations can merely money by providing lower prices through contracting large volumes of operate and redu cing the union of hospitalizations (Getzen & Allen, 2011).This essay presents a scenario in which I am a representative of top hat Collins Health schemes responsible for maximising profits and minimizing risks. Within my job description, I am advised to mount a comprehensive health insurance plan for two entities ConstructIt and E Editors. This essay explains the companys employee demographics, health risk factors, premium make out the company is impulsive to pay, and what company I chose to offer a health insurance plan. Based upon my analysis of potential utilization, I will provide two reasons for wherefore each plan could be selected as well as explain my reasoning for choosing the plan. Last, I will explain why I did non offer the company a different plan.ConstructIt Employee inditeConstructIt is a construction company composed of 1,000 employees. ConstructIt is Avoid it is, etc. comprised of 550 men and 450 women amidst the ages of 26 42 with 60% having spouses. C onstructIt employeeswork profile consist of 32% groovy physical activity, 25% moderate physical activity, and 43% sedentary activities. The age and gender profile of ConstructIt is as follows Almost half of the population is amid the ages of 26 30 years maven third of the population is between the ages of 31 35 years Approximately 20% of the population is between the ages of 36 40 years Less than 10% ages 41 45 years. (University of Phoenix, 2010, Health Profile Section)The health profile of major risk factors among ConstructIt employees is depicted within the following tableObesity39%High cholesterol19.6%High Blood Pressure19.3%Allergies17.7%Migraines16.8%Respiratory Diseases13.5%Digestive Disorders8.4%Thirty eight percent of the population is diagnosed as having no major health risks. frugal Issues SimulationIn addition, a combined 18% of the population smokes (University of Phoenix, 2010, study Health Risks Section). ConstrucIt has a game number of peck diagnosed a s not having any major health risks. This is good because it means fewer people will seek health care services resulting in pitch money for opera hat Collins Health Plans. However, ConstructIt does feature a utmost incidence of obesity rates 39% of the multitude. Obesity predisposes a individual to developing other serious chronic ailments such as high blood pressure, high cholesterol, and diabetes. The high rate of obese individuals may enlarge the risks involved whenever offering health insurance to ConstructIt.Chosen Company and PlanConstructIt is will to pay a maximum premium payout of $4000 per enrollee and E Editors is willing to pay $4500 per enrollee. However, E Editors has 600 more employees than ConstructIt, which in turn increases costs and utilization rates. Based upon the health profile of ConstructIt versus E Editor I guide a bun in the oven decided to offer ConstructIt the Castor banner insurance plan because they have lower utilization rates in many areas . I have decided not to offer E Editor any type of insurance plan through Castor Collins Health Plans because E Editor has high utilization rates. In addition, E Editors employee age groups ply from 35 54 years where as ConstructIt employee age groups range from the ages of 36 to 45 years (University of Phoenix, 2010, Health Profile Section). As a mortal ages, he or she is much more likely to increase the amount of health care goods and services required to maintain ones health. In turn, this also increases the expected utilization rates.Two Reasons For Why from each one Plan Can Be SelectedCastor Collins Health Plans brook certain factors affecting the pricing of services. These factors include limitations and exclusions for what Castor Collins is willing to pay. Castor exemplification health plan does not cover pre animated conditions where as Castor intensify does provide coverage for enrollees with pre existing conditions. unmatchable reason for why I can offer Cas tor Standard health plans to ConstrucIt is that the majority of ConstructIt employees are younger in age and virtually half the population is free from major health risks. A second reason for why I can offer Castor Standard amends plans to ConstructIt is that it costs less while covering more conditions. One reason for why I can offer Castor Enhanced health plans to both ConstructIt and E Editors is because both companies have employees with pre existing conditions. A second reason for why I can offer Castor Enhanced health plans is E Editors contains a larger amount of kernel aged individuals requiring specialized services. Many pre existing conditions require specialized services that may be added or customized to the Castor Enhanced health plan. destructionIn summary, an HMO works in connection with a group of hospitals, physicians, and providers to offer health care services for a fixed annual fee. HMOs tightly oversee the use of health care services to reduce costs and control utilization. I evaluated the employee work and health profiles of two companies ConstructIt and E Editors. ConstructIt contains 1000 employees willing to pay out $4000 in premiums per enrollee each year. E Editors contain1600 employees willing to pay out $4500 in premiums per enrollee each year. E Editors health profile revealed a higher utilization rate among services than ConstructIt. scotch Issues SimulationThis prompted me not to offer any health plans to E Editors at a time whenever Castor Collins Health Plans is trying to maximise profits and minimize risks. However, if E Editors was willing to pay higher premiums Castor Collins Health Plans may have been able to customize a health plan. I did offer a Castor Standard Insurance plan to ConstructIt because their health profile revealed a lower rate of utilization among services. It is important one evaluates the exclusions and limitations listed within health insurance plans to ensure tolerable and correct amount of coverage is available.ReferencesGetzen, T. E., & Allen, B. H. (2007). Health Care Economics. Hoboken, NJ flush toilet Wiley & Sons. University of Phoenix. (2010). The Financing of Health Care Simulation Computer Software. Retrieved from University of Phoenix, Simulation, HCS440 Economics The Financing of Health Care website.