The pitfalls of health planning are the difficulties experienced by
different methods of health planning. In a bit to highlight the pitfalls of
various health Planning methods, a detailed definition of health planning
itself will be helpful. Health Planning can be referred to as planning
concerned with improving health, whether undertaken comprehensively for a whole
community or for a particular population, type of health service, institution,
or health program. The components of health
different methods of health planning. In a bit to highlight the pitfalls of
various health Planning methods, a detailed definition of health planning
itself will be helpful. Health Planning can be referred to as planning
concerned with improving health, whether undertaken comprehensively for a whole
community or for a particular population, type of health service, institution,
or health program. The components of health
planning include: data assembly and
analysis, goal determination, action recommendation, and implementation
strategy.
Types of Health Planning
Health planning can be categorized into four different types. They are;
the fee for service, health maintenance organization (HMO), point of service
plan (POS) and preferred provider organization (PPO).
the fee for service, health maintenance organization (HMO), point of service
plan (POS) and preferred provider organization (PPO).
The Fee-for-Service Plan
The fee-for-service plan or the indemnity plan is the most expensive
option. In this planning method, the individual chooses the hospital or who the
doctor who carries out health care services. The individual is at liberty to
terminate of change who carries out this services. In the real sense, the
individual can hire or fire who attend to his health care services. In this
plan, the individual sign up for a year plan by paying a premium for the
services expected. After meeting that deductible the plan pays a percentage of
your doctor or hospital bill. The typical percentage arrangement is 80/20. The
plan pays 80 percent of the bill while you pay the remaining 20 percent.
Because this tends to be the most expensive arrangement for families, it is the
least popular selection for most people.
option. In this planning method, the individual chooses the hospital or who the
doctor who carries out health care services. The individual is at liberty to
terminate of change who carries out this services. In the real sense, the
individual can hire or fire who attend to his health care services. In this
plan, the individual sign up for a year plan by paying a premium for the
services expected. After meeting that deductible the plan pays a percentage of
your doctor or hospital bill. The typical percentage arrangement is 80/20. The
plan pays 80 percent of the bill while you pay the remaining 20 percent.
Because this tends to be the most expensive arrangement for families, it is the
least popular selection for most people.
Health Maintenance Organization (HMO)
The HMO is another type of health planning in
which the health care services is rationed among a given organisation for the
purpose of saving cost of medical cost of services rendered to the employees of
the organisation or members of the family. It is in the interest of the HMO to
ensure the health and safety of you and your family, so it covers all necessary
treatments. The HMO provides you coverage with no deductibles for a fixed fee.
You are a member of the HMO and typically are asked to choose a doctor in the
plan, who will be your primary care provider. Your primary care provider will
refer you to specialists or other doctors within the HMO network as needed.
Preferred Provider Organization (PPO)
The
PPO has a network of doctors it has contracted with to provide care at specific
fees, and if you seek care within this network, your costs will be less than if
you choose a doctor outside the plan. A PPO is a managed care plan, where health
care is rationed but to a lesser degree. Unlike the HMO, you have the choice to
select the doctors and specialists you’d like to see, but you are encouraged to
select doctors within the PPO.
Point of Service Plan (POS)
The
POS is a combination of an HMO and PPO. Your primary care provider will refer
you to specialists, just like in an HMO. Just like the PPO, if you decide to go
to a doctor outside the plan, your bill will be higher than if you choose a
specialist within the network. These plans are typically not as expensive as a
PPO plan but are more expensive than an HMO.
Advantages of HMOs
According
to the American Heart Association (AHA), HMOs usually offer the broadest range
of services for the lowest out-of-pocket cost. Also, according to a Consumer
Reports National Research Center survey of over 37,000 people, HMO members were
more satisfied with their providers’ customer support and reimbursement
policies than were PPO members.
Disadvantages of HMOs Compared to PPO
HMO
plans are more restrictive than PPO plans in that members must choose from a
limited pool of health care providers, according to the AHA. Also, in order to
see a specialist under an HMO plan, patients must first get a referral from their
primary care physician.
plans are more restrictive than PPO plans in that members must choose from a
limited pool of health care providers, according to the AHA. Also, in order to
see a specialist under an HMO plan, patients must first get a referral from their
primary care physician.
Disadvantages of PPOs Compared to HMOs
PPO
plans are less restrictive than HMOs with regard to choice of health care
provider, and PPO members are not typically required to obtain a referral from
their family doctor in order to see a specialist, according to the AHA. Also,
unlike HMO plans, which normally only reimburse for medical services rendered
by providers belonging to the HMO network, PPO plans reimburse for some health
services procured from out-of-network providers, albeit for a higher cost to
the patient than is paid for in-network services.
plans are less restrictive than HMOs with regard to choice of health care
provider, and PPO members are not typically required to obtain a referral from
their family doctor in order to see a specialist, according to the AHA. Also,
unlike HMO plans, which normally only reimburse for medical services rendered
by providers belonging to the HMO network, PPO plans reimburse for some health
services procured from out-of-network providers, albeit for a higher cost to
the patient than is paid for in-network services.
Disadvantages of PPOs Compared to HMOs
According
to Consumer Reports, PPO members not only pay more for their health care; they
also experience greater difficulty receiving reimbursements owed to them. Among
seriously ill individuals surveyed by Consumer Reports, 32 percent of PPO
members reported having billing hassles compared to only 13 percent of HMO
members.
to Consumer Reports, PPO members not only pay more for their health care; they
also experience greater difficulty receiving reimbursements owed to them. Among
seriously ill individuals surveyed by Consumer Reports, 32 percent of PPO
members reported having billing hassles compared to only 13 percent of HMO
members.
