Voluntary Health Insurance in Healthcare.pptx

It describes the Voluntary Health Insurance in Healthcare

1. Voluntary Health Insurance UTHRA. D MHA 2 nd Year

2. Introduction   A voluntary health insurance wherein people can enroll and purchase the insurance product of their liking, paying a risk- rated premium. Private insurance tends to play a different role depending on a country's wealth and institutional development. In many lower- and middle-income countries, private insurance may be the only form of risk pooling available and it usually provides principal coverage to those in the formal sector.

3. How it works

4. Private health care plans Indemnity plan: Health insurance that reimburses individuals for part or all of the expenses they incur from health care providers. Individuals are free to decide whether to seek care from a primary care physician or a specialist.

5. Managed health care plan: A health insurance policy under which individuals receive services from specific doctors or hospitals that are part of the plan. Under managed health care plan we have few plans: Health maintenance organization (HMO) Preferred provider organization (PPO) Health maintenance organization (HMO): A health insurance plan that covers health care services approved by doctors. A primary care physician provided general health services and refers patients to a specialist as necessary

6. Types of HMO: Staff model- In which all doctors are employed and/or contracted directly by the HMO; Group model- In which the HMO contracts with an independent group to provide services; Network model- In which more than one independent group is contracted to provide services; Independent practice association- In which the HMO contracts several doctors in independent practice Preferred provider organization (PPO): A health insurance plan that allows individuals to select a health care provider and covers most of the fees for services. Discount on charge arrangement : an arrangement in which the preferred provider organization agrees to pay a specific percentage of the health care provider’s charges Per diem rate arrangement : an arrangement in which the preferred provider organization pays the provider a specific sum per day a patient is hospitalized

7. Challenges faced by Private Health Insurance Moral hazard: Relates to potential changes in attitude of both consumers and providers under insurance arrangements, which may result in excess demand for health care. With full reimbursement of bills through insurance, neither the consumer nor the provider has an incentive to contain costs. Adverse selection: Arises from consumers having more complete information than insurers on their own health status, which may result in selecting plans that give them the greatest benefit. On the other hand, insurers can profit by excluding high-risk individuals. Diseconomies of small-scale operations

8. Reference: https://www.who.int/health_financing/private_health_in_dp_04_3.pdf https://slideplayer.com/slide/9758287/