Economics Issues Simulation Paper Essay

The purpose of a managed give care organization is to coordinate the cost and delivery of wellness care. A managed care organization oversees gold spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a wellness Maintenance Organization (HMO). A HMO pictures medical care for all its enrollees in slip by for a fixed annual fee per enrollee (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care go thereby reducing costs and controlling utilization. For example, HMOs reduce costs and control utilization among services are by requiring second opinions, performing pre admission testing and reviews for proceed stays or additional procedures, and allowing generic substitutions for drugs. Managed care organizations can save capital by providing overturn prices through contracting large volumes of services and reducing the summate of hospitalizations (Getzen & Allen, 2011).This essay presents a scenario in which I am a representative of silk hat collins Health Plans responsible for maximizing profits and minimizing risks. inwardly my job description, I am advised to develop a comprehensive health redress platform for two entities ConstructIt and E Editors. This essay explains the play alongs employee demographics, health risk factors, premium amount the company is volition to pay, and what company I chose to strait a health insurance plan. Based upon my analysis of effectiveness utilization, I will provide two reasons for why to each one plan could be selected as soundly as explain my reasoning for choosing the plan. Last, I will explain why I did not declare the company a different plan.ConstructIt Employee ProfileConstructIt is a construction company composed of 1,000 employees. ConstructIt is Avoid it is, etc. comprised of 550 men and 450 women amid the ages of 26 42 with 60% having spouses. ConstructIt employeeswork p rofile consist of 32% great physical activity, 25% mode identify physical activity, and 43% sedentary activities. The age and gender profile of ConstructIt is as follows Almost half(prenominal) of the population is between the ages of 26 30 years One 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 little than 10% ages 41 45 years. (University of Phoenix, 2010, Health Profile Section)The health profile of major risk factors among ConstructIt employees is portrayed within the following tableObesity39%High Cholesterol19.6%High Blood pressing19.3%Allergies17.7%Migraines16.8%Respiratory Diseases13.5%Digestive Disorders8.4%Thirty eight percent of the population is diagnosed as having no major health risks.Economic Issues trickIn addition, a combined 18% of the population smokes (University of Phoenix, 2010, Major Health Risks Section). ConstrucIt has a naughty number of people diagnosed as not ha ving any major health risks. This is good because it mean fewer people will seek health care services resulting in saving money for top hat collins Health Plans. However, ConstructIt does hand over a high incidence of obesity rates 39% of the group. Obesity predisposes a person to developing other serious chronic ailments such as high blood pressure, high cholesterol, and diabetes. The high rate of obese individuals may ontogeny the risks involved whenever offering health insurance to ConstructIt.Chosen Company and PlanConstructIt is willing 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 have clear-cut to offer ConstructIt the opera hat normal 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 caster Collins Health Plans because E Editor has high utilization rates. In addition, E Editors employee age groups roll out 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 person 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 alike increases the expected utilization rates.Two Reasons For Why Each Plan Can Be SelectedCastor Collins Health Plans contain certain factors affecting the pricing of services. These factors include limitations and exclusions for what Castor Collins is willing to pay. Castor Standard health plan does not cover pre existing conditions where as Castor compound does provide coverage for enrollees with pre existing conditions. One reason for why I can offer Castor Standard health plans to ConstrucIt is that the majority of ConstructIt employees are younger in age and almost half the population is excess from major health risks. A second reason for why I can offer Castor Standard Insurance 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 middle aged individuals requiring specialized services. Many pre existing conditions require specialized services that may be added or customized to the Castor Enhanced health plan. codaIn 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 hea lth 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.Economic Issues SimulationThis prompted me not to offer any health plans to E Editors at a time whenever Castor Collins Health Plans is trying to maximize 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 adequate and correct amount of coverage is available.ReferencesGetzen, T. E., & Allen, B . H. (2007). Health Care political economy. Hoboken, NJ John 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.