The Healthcare Market (Essay Sample)

The Healthcare Market
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Introduction
Georgia is known to be a sovereign state, and is situated at the Caucasus region. It is near the black sea and Armenia from the south. The region adopted the Semashko system of health care in the year 1921, and after the Soviet Union collapsed a market system evolved. Around the year 1994 expenditures on health care had plummeted to $ 1.00 (Eskildsen, 2009, p. 2). In the years following 1990, the social health care system was used but later abandoned after replacing it with the private health insurance. The region is currently adopting new health policies and systems in both the private and public sectors. Coverage for private insurance for people living under poverty is paid using funds from the public. Other citizens are supposed to have the health care cover through their own initiative. Using the out of pocket system of funding health care by citizens has made most people lack special services like those from pharmaceuticals. Regulations on health care services are weak compared to the available challenges it faces.
Health Plan Overview
The current health plan for Georgia region is delegated to the claims administration. The Blue Cross Blue Shield of Georgia handles all the medical benefits, while the Express Scripts oversees the pharmacy benefits. The well being programs and benefits is under the leadership of Healthways. All these administrators are mandated to perform all duties that pertain to the provision of quality health care services to the people of Georgia as a whole.
The three non-Medicare SHBP is only given to their members together with other new hires. Their eligibility is often determined by BCBSGa, and all former employees are given an opportunity to continue with their coverage through Blue Cross Blue Medicare. TRICARE in the region is provided as a supplement to SHBP, and only considers military personnel. Military depends who are under the age of 65 years are also considered under the plan. SHBP never considers kids for Preach Care and TRICARE under their provisions (Balabanova, 2009).
Claims Administration
Blue Cross Blue Shield is mandated to provide all medical claims in the region, and also works towards ensuring that medical management services are of high quality. The HRA on the other hand, is driven by the consumers of various plans offered in the state of Georgia. They ensure that all the members get discounts from all the service providers. The providers are also checked by the HRA to ensure that members are not billed more money than is expected of them. Citizens from Georgia are permitted to receive treatment from outside providers on condition that they do not exceed 110% of the total Medicare provision. The HRA has an annual contribution which is provided by SHBP to ensure dollar coverage for all pharmacy and medical expenses for their members. Retirees and their dependants receive Medicare using the MAPPO plan which consists of all benefits in the Medicare plan offering. Healthways also provides couples with well being resources and other incentive programs (Rukhadze, 2013).
Qualifying Events
A qualifying event is a change that is personal, and allows citizens to make changes in their benefit elections. Examples of QE may include change in marital status of members, employment status and the total number of dependents from one family. People who follow after QE rules often depend on the premise of being an employee, former employee, surviving spouse or surviving child.
Student Health Insurance Plan
Georgia State ensures that all the students from the region have access to medical care and other necessary provisions. Coverage is provided by SHIP, which is underwritten by United Health Insurance Company and rolled out by UHSR. The program follows after all the requirements of health provision from the region and individual health requirement provisions. The widely used healthcare plan by the universities in the region is the UHCP, because it is recommended by the university system in the region. The plan also allows students to have their spouses enrolled in the program and receive treatment any time they are sick.
The university system in the region has a rule of ensuring that a certain group of students is enrolled for health care as a condition for enrollment. Without such provision such students are not allowed to enroll in the certain universities. The method is referred to as Mandatory Enrollment, and allows all the students to be able to use the services of USG-SHIP Plan when they have no other health cover. After fulfilling this condition the student is often registered automatically and charged from the finance office.
Georgia Health Insurance Exchange
The number of members in the year 2015 who have sort health insurance services from various providers has exceeded that of 2014. The members desire to have more coverage because of the new laws in the country and the state as a whole. February 15th was set as the last day to register for the policies and a fine was attached to all the members who will be late after the period. Currently, there are three companies which are mandated to sell policies as opposed to one in the year 2014. The increase in the number of companies was necessitated because of the increased number of citizens who desire to have health care provisions. The increasing number of such companies was also necessitated because of the influx of overall competition leading to reduced disparity in costs of premiums.
The citizens of Georgia make use of Healthcare.gov to enroll for healthcare services. The system is currently revamped, and new features added to ensure easy access by all members. The new site is faster and can be able to handle more users within a short period. It is also secure and able to handle hackers appropriately, and this is crucial as it will ensure minimal information sharing. Members are allowed to do window shopping without necessarily having to log into the system. This is vital because members will have the information they require from their service providers before making any application. Members are given the opportunity to make their own choices and have a plan that they feel they are comfortable to use. The time spent by new entrants into the system is also minimal compared to the old system which had 76 screens.
The first time people were allowed to enroll for their health covers 45% of the total were old members who had previous coverage and were automatically renewed. The new members were advantageous as they were able to make choices that were suitable for them and their families. Earlier policies gave restrictions to members, and all of them were supposed to enroll under policies they were not comfortable joining. During the 2014 fiscal period, Georgia accounted for 5.8% of the total enrollment of the health care provision. The enrollment of 2015 ends on the 15th February and members who will not have registered by then will be fined heavily.
Auto renewal of policies is also made possible for members who had previous coverage from the year 2014. Such members will not need to apply afresh in the year 2015 because the state allows their membership to be renewed automatically. Subsidies are provided for different members in the new plan of 2015, and this has made many members to make changes to their previous policies of 2014. In the year 2015 new insurers are also operating in the field to ensure full provision of all the required insurance provisions for the people.
TheNew Year will also see Georgians pay one percent more for their health plans on the marketplace when compared...