The U.S. Health Care Insurance Industry

Paper Summary:

This paper explains that the U.S. health insurance industry is a faltering system as witnessed by poor performance, difficulty accessing physicians and rising premiums that cut into after-tax income. The author compares two health plans in Texas: Aetna Life Insurance Company's PPO 500 plan, which is judged better for a younger workforce that is predominantly unmarried and without children, and Blue Cross and Blue Shield of Texas' PPO Select Saver Plan IV Blue Cross plan, which is deemed a better arrangement for an older, "graying" workforce. The paper evaluates the Health Insurance Portability and Accountability Act (HIPAA), which is generally seen as a watershed event for health insurance reform.

Table of Contents:
Introduction
The U.S. Health Care Industry over the Last 10 Years
The U.S. v. Canadian Approach to Health Care
Development of Managed Medicare Insurance Products in Texas
A Comparison of Two Health Plans in Texas
A Plan for Managed Care Organization Seeking Accreditation from JCAHO or NCQA
The Health Insurance Portability and Accountability Act (HIPAA)
A Plan for Comprehensive Improvement of a Managed Care Organization's Processes
Conclusions

From the Paper:

"In fairness, the U.S. model has its advantages. For one thing, wealthier individuals/employees who wish to "cut through" the bureaucratic red-tape of socialized medicine in Canada can go to the United States and have their needs promptly addressed in a way not possible in Canada. Moreover, from a strictly business perspective, the fact that American HMOs are prepared to exclude various clientele in order to serve the "bottom line" and are likewise prepared to similarly slash services can be just the excuse private American corporations need in order to exclude various members of their workforce."

Sample of Sources Used:

• Aetna Life Insurance Company. (n.d.). Texas Aetna advantage plan options. Aetna: We want you to know. Retrieved October 6, 2006, from <http://www.ehealthinsurance.com/ehealthinsurance/benefits/ifp/Aetna/Aetna-TX-PPO500_06-06.pdf>
• Atlantic Information Services. (2006). HIPAA compliance strategies. AIS Compliance. Retrieved October 6, 2006, from <http://www.aishealth.com/Compliance/Hipaa/RMC_HIPAA_Caseworkers.html>
• Blue Cross and Blue Shield of Texas. (n.d.). Patient Protection Act: Disclosure statement. Retrieved October 6, 2006, from <http://www.ehealthinsurance.com/ehealthinsurance/benefits/ifp/TX/TX-BCBS-SelectSaver.pdf>
• Cowen, Tyler. (2006, October 5). Poor U.S. scores in health care don't measure nobels and innovation. New York Times. Retrieved October 6, 2006, from <http://www.nytimes.com/2006/10/05/business/05scene.html?_r=1&oref=slogin>
• Health Canada. (2006). 2003 First Ministers' health accord. Overview of the Canadian Health Care System. Retrieved October 7, 2006, from <http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/fs-if_hcs-sds_e.html>

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