The Co-operative Insurance Company of Kenya Limited

The Co-operative Insurance Company of Kenya Limited

The cooperative insurance company of Kenya has an acronym as CIC.  It was established in nineteen seventy eight. Formerly this company was known as cooperative insurance services (CIS). The company is most preferred in the cooperative e movement as the core founders of the insurance industry, Rösner, Hans J (2012 pp. 71) It has recorded an average growth rate of thirty seven percent in the year two thousand and five. Its premiums have also grown from 180million to 1.7billion in a life span of eight years. Its general growth has been attested globally as a well known company with an annual income of 1.7billion.

The Co-operative Insurance Company of Kenya Limited

In Kenya CIC insurance company has 3878 shareholders and it remains the greatest strategic shareholder with 74.3 percent stakeholders and individual investors contribute 25.7%. In the Nairobi stock exchange, CIC is a leader in providing insurance services in the cooperative movement and the middle low income markets of Kenya

The number of outlets of CIC insurance

In Kenya CIC insurance has quite number of branches. Just to name a few we have; CIC insurance group ltd- upper hill branch, CIC plaza Mara road off upper hill road, reinsurance plaza, mess Flr,aga khan walk Nairobi. In the world there are many branches situated in different countries such as in southern Sudan, Rwanda and Tanzania among other areas. It works on the principle of integrity, productivity, team work, fairness and dynamism. The customer value propositions include fastest in service delivery, fairest price makers, offering friendly relationships not forgetting quality customer service.

In the year 2008, CIC launched a micro finance package of vending I Kenya. It aim is targeting a market of 5m people. Its key components of the package are to offer ksh100, 000 to people in case of death, 300000 ksh for funeral expenses and also weekly income for a period of two years when a person is in total disability. The other component is the medical scheme benefit called the national hospital insurance fund. This is supposed to provide customers with a package of impatient services both I private, government and in mission hospitals.

 According to Margaret E. Lynch (1976 pp. 465), CIC insurance operates on many principles which include,

Principle of insurability

for an individual to be insured against any risk, he or she must meet the following conditions; the risk should have definite time of occurrence, it should have large number of similar risks, define the loss clearly, the risk should be fortuitous in regard to the beneficially of the insurance, have or specify available premiums in which the insured is able to pay, and the risk should be catastrophic meaning that it should not be the one which occurs all the time

Principle of legality

CIC works on this principle of legality by considering the following requirements which include: indemnity, in which the CIC insurance company ensures that the insured is taken back to his original financial position he or she enjoyed before the risk occurred. Insurable interest, it requires that the insured to directly suffer from a loss for compensation to take place. Utmost good faith requires that material things should be displaced at the time of taking an insurance cover. Customers should give the right information concerning their property in good faith. Contribution, it defines a method in which the insured contributes towards indemnification. Subrogation, here the insured surrenders all the legal rights to the insurance company so as to persue recoveries at the time of loss. Proximate cause, in this case the cause of the risk and the one in which the insured had insured against should be related, for compensation to take place. And finally mitigation, it requires the owner to keep the loss suffered to the minimum in case of any loss if the asset was not insured.

Insurance companies operates on the principle of protecting the financial well being of its customers, company or the property in case of any unexpected  loss,Gollier C. (2003)

Mode of operation of CIC insurance company in Kenya

The CIC insurance group comprises CIC insurance and CIC asset management ltd. It is a leader of the micro finances other financial markets in Kenya. It has been in operation for the last 33 years providing insurance services to cooperatives and low income earners in various market segments. It offers services like general insurance, life insurance, pension, medical and asset management. According to the Mr. Karanja, a technical Engineer, CIC faces the following connectivity challenges: 

Business continuity concerns

CIC uses 2ISP links to the Internet. At any given point, only one of them is being used up while the other one is left idle. In case of failure, the operation has to be performed manually thus causing delay

Deluge of Spam

Here we have a maximum number of inbox mails which are received per Spam; they are normally 10-20 spams each day.

The purchase of cyber am solution, came about after looking at a number of Internet security solutions as Karanja puts it. They had to deploy the use of two(2)CR 300i so as to purchase the cyber am from Ace Micro Services,Venzin Markus (2002 PP. 348).

Economic importance of CIC insurance in Kenya

In the past 2 years, you CIC insurance in Kenya have received seven awards which include the annual think business insurance award in 2011. These awards were audited by business advisors, accountants and the pkfn east Africa. This has motivated the company to resolving into empowering its employees and thereby uptake its products and advancing in terms of technology, Barrett, Christopher B (2007 PP. 675).  It has come up with internal training program to enable employees and other outsiders to develop and foster their capabilities and thus creating employment importunity in the country. The awards promoted the general standard sod the industry and its performance in life insurance, general insurance, composite underwriter of the year, and the ICT award among other areas of specialization.

The main competitors of the organization

Life in Kenya today has become insurance oriented. People are insuring their goods and property to reduce the risk of being grossly affected by various calamities. In this regard, there has been a major increase in insurance companies so as to accommodate the rising number of customers demanding the service. Te main competitors of the CIC insurance are discussed below.

Madison Insurance Company

This is one of the leading companies that offer insurance services in Kenya. It has a total of fourteen branches all over the country; western region, Nairobi region, coast and central regions. Blue Shield Insurance Company

This company is among the top insurance companies in Kenya. Some of the products it offers are; insurance on agricultural products, general insurance and life insurance.

Jubilee Insurance Company

It is widely spread since it is found in the entire east African region. It has a very strong financial background since it has been in the market for over 70 years. Jubilee insurance company is an amalgamated insurer, for example Kenya leads in offering medical insurance services.

British American Insurance Company

This company was established in the year 1965 in Kenya. It provides a number of services among them; group life, individual life, pension schemes and even health care insurance services.

 Kenindia Assurance company

The company was established in the year 1978. It was formed the same time when four Indian insurance companies came up and it mostly deals with non-life issues.

Heritage Insurance Company

This company provides insurance services only for short term basis. It mainly deals with payment claims. It was recently named as one of the most outstanding insurance companies that offer claim payment services in Kenya. The reward came from the association of Kenya insurance brokers.

Insurance Company of East Africa (ICEA)

The company is an associate of the first chartered security agencies in Kenya. It mostly deals with product of business corporations.

APA Insurance Services

This is the American photographic artist insurance company that issues photographic products to professional photographers. It also compensates workers and provides employment liability services

Pan Africa Insurance Holdings

It was established in Mombasa in the year 1947. It started using the name Pan Africa Insurance limited in 1963 and was then recorded on the Nairobi stock exchange.

UAP Provincial Insurance Company

 It deals with life insurance, commercial insurance and also personal insurance.

The marketing strategies of the CIC

Consumer needs change each and every time, for this reason insurance companies have developed various marketing strategies to manage the quality of service delivery among customers.  CIC as a company has developed various strategic techniques to accommodate the competitive economic environment. Some of the strategies it uses are:

Pricing Strategies

The choice of the price you settle no has consequences to not only you but also your competitors. In the case your price is higher than that of the competitors, and then there is a higher possibility of your competitors experiencing an increase in profit due to the increase in the number of customers.  CIC has most of its services subsidized to match with the consumer demands of the Kenyan economy.

Distribution strategy

This strategy deals with the place you sell your products. It is very critical because it’s a key component towards increasing sells. The company has offices all over the country hence there is even distribution of services to the clients.

 Branding Strategies

CIC uses specific demographics so as to be uniquely identified. This aspect makes it enjoy monopoly since it has a distinct cording of its goods and services. The company also enhances this strategy by using layouts of modules.

Test marketing strategy

Testing a new strategy helps in evaluating whether the new method is viable and economical. It is therefore necessary to always conduct a test hypothesis before implementing the market strategy. CIC embraces this strategy by ensuring that all the new business projects are evaluated before being implemented

Communication creation

The company exercises this market strategy by ensuring that there is an integrated channel of communication through each and every subsystem of the entire organization. Meetings are always held in case of any information that needs to be channeled through. Communication is indeed a perfect tool towards attaining economic stability.

Strengths and challenges of the organization

The CIC has a number of strengths namely;

  1. It is widely spread all over the country with over 20,00000 million clients
  2. It experiences maximized profit due to the higher number of customers
  3. The association of Kenyan insurance brokers recognizes it as a top insurance agency in Kenya.

The company also has a number of challenges namely;

  1. It faces a great challenge from the high emergence of insurance firms which leads to a high competition rate on the stoke market. The high competition eventually leads to a decrease in profits in the long run.
  2. Kenya is a developing country facing economic challenges due to constant weakening of the Kenyan shilling. This in the long run leads to banks developing higher interest rates thereby grossly affecting the insurance company.
  3. In the year 2007, Kenya experienced the worst post election violence. This lead to emergence of internally displaced people thus stabilizing the Kenyan economy thereby grossly affecting the insurance policies in Kenya since new legal policies had to be generated to accommodate the changing economy.
  4. External investors pose a major challenge to the organization though they also improve the company to some extent. These investors invest in the country but take with them higher interest rate which at the end affects the company financially.

The management of the organization

The corporate insurance company is a private organization managed by a board of directors. The board of directors participates in the management of the organization and they are decision makers of the entire agency. This board of directors works hand in hand with the chief executive officer of the company.

Opportunities for future growth

The company has various opportunities for future growth among them;

  1. An increase in man power developed by the rising number of students taking actuarial science in colleges and university. As most students are taking mathematics and business oriented courses it leads to increase in professionals in the field thus an opportunity for future growth.
  2. Kenya is a country with a rising economy. This has a positive impact because it gives rise for growth among companies one of them being the CIC.
  3. The large number of external investors gives room for new growth and development of the entire company.

CONCLUSION

CIC has contributed economically through the development of M-Bima policy to enable money transfer. Being one of the leading micro finance company in Kenya, it is capitalizing on banks, Saccos and monetary institutions so as to promote micro insurance in Kenya. Financially, the company’s investment grew by about 169 percent as a result of high interest rates  invested in the market property, Jarvis, Christopher R (2002 pp. 338). The factors that have enabled CIC Insurance group  to succeed include; proper planning, clear communication within the company, implementation of open door policy, staff empowerment, partnership within cooperatives sector, good and visionary leadership, updated lCT systems.

References

Ouma, Sylvester J. Development in Kenya Through Co-Operatives. Nairobi, Kenya: KNFC Printing Press, 1989. Print.

Jarvis, Christopher R. Wealth Protection: Build and Preserve Your Financial Fortress. New York: John Wiley & Sons, 2002. Internet resource. 

Rösner, Hans J, Gerald Leppert, Philipp Degens, and Lisa-Marie Ouedraogo. Handbook of Micro Health Insurance in Africa. Wien: Lit, 2012. Print.

Margaret E. Lynch, Editor, “Health Insurance Terminology,” Health Insurance

venzin Markus (2002 PP. 348). Building an International Financial Services Firm: How to Design and Execute Cross-Border Strategies. Oxford: Oxford University Press, 2009. Print.

Barrett, Christopher B, Andrew G. Mude, and John Omiti. Decentralization and the Social Economics of Development: Lessons from Kenya. Wallingford: CABI, 2007. Print

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Health Insurance and Economy Essay

Health Insurance and Economy Essay

When dealing with public health policy and laws, we need to consider  various aspects of the economy. Concepts of efficiency can be utilized  when deciding which goods and services should be produced and who should  receive them.

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The three types of efficiencies are allocative, production, and  technical. The two types of health economics are positive and normative.  Positive Economics deals with “what is” or the current status that is  linked to a clear standard of measurement. Normative economics deals  with “what ought to be” and is subject to interpretation with the moral  or ethical aspects of a policy. Your lecture has more details.

Using South University Online Library or the Internet, search the  article, “The Interplay of Public Health Law and Industry  Self-Regulation: The Case of Sugar-Sweetened Beverage Sales in Schools.”

On the basis of the article and your understanding on the topic,  write a 3- to 4-page essay in a Microsoft Word document on the three  types of economic efficiencies and both positive and normative economics  as it relates to regulating sugar-sweetened beverage sales in schools. Health Insurance and Economy Essay.

Support your statements with at least two other scholarly sources,  correctly formatted in APA style. This assignment requires a title page,  an introduction, a body, a conclusion, and a separate reference page.

Submission Details:

  • Support your responses with reasoning and examples.
  • Cite any sources in APA format. Health Insurance and Economy Essay

 

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Analyze the benefits of health insurance on access to care, including two examples of the benefits of having insurance

Explore policies and regulations related to health insurance and examine different factors that impact patient access. In this assignment, you will explore health insurance, how it works, and the challenges in accessing healthcare to communicate the benefits of coverage to patients and families.

Instructions

Write a 2–3 page paper in which you:

  1. Analyze the benefits of health insurance on access to care, including two examples of the benefits of having insurance.
  2. Evaluate barriers to accessing healthcare, including two examples of barriers and recommendations for their removal.
  3. Summarize the Affordable Care Act including two provisions that affect patient care.
  4. In addition to the textbook, provide two sources to support your writing. Choose sources that are credible, relevant, and valid. Cite each source listed on your source page at least one time within your assignment. For help with research, writing, and citation, access the library or review library guides.

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Insurance Institute for Highway Safety Highway Loss Data Institute. (2015). Motorcycle helmet use. Retrieved from http//www.iihs.org/iihs/topics/laws/helmetuse

Health Care Policy|Nursing

University at Albany, School of Public Health [CPHCE PHL]. (2013, July 1). Ethics in public health: A closer look at current issues [Video file]. Retrieved from https://www.youtube.com/watch?v=ySJElZEoFMI

The Washington Post [Washington Post]. (2014, February 23). For California marijuana reform advocates, the tide is turning [Video file]. Retrieved from https://www.youtube.com/watch?v=wfBKv43c_g8

Choo, E. K., Benz, M., Zaller, N., Warren, O., Rising, K. L., & McConnell, K. J. (2014). The impact of state medical marijuana legislation on adolescent marijuana use. Journal of Adolescent Health, 55(2), 160–166. Retrieved from the Walden Library databases.

Morris, R. G., TenEyck, M., Barnes, J. C., & Kovandzic, T. V. (2014). The effect of medical marijuana laws on crime: Evidence from state panel data, 1990–2006. PloS one, 9(3), e92816. Retrieved from the Walden Library databases.

Satterlund, T. D., Lee, J. P., & Moore, R. S. (2015). Stigma among California’s medical marijuana patients. Journal of Psychoactive Drugs, 47(1). Retrieved from the Walden Library databases.

Vargo Cavalet, J. (2016). The Highs and Lows of Medical Marijuana. Clinician Reviews, 26(10), 40-53. Retrieved from the Walden Library databases.

American Politics. Retrieved from http://www.laits.utexas.edu/gov310/PEP/policy/

Ethics and Compliance Initiative. (n.d.). The PLUS ethical decision making model. Retrieved from https://www.ethics.org/resources/free-toolkit/decision-making-model

National Research Council. (2011). Why we need health-informed policies and decision-making. In N. Grossblatt (Ed.), Improving health in the United States: The role of health impact assessment (pp. 23–42). Washington, DC: National Academies Press. Retrieved from the Walden Library.

Gauld, R. (2009). The new health policy. In C. Ham (Series Ed.), State of health series (pp. 22–41). New York, NY: McGraw-Hill Education. Retrieved from the Walden Library.

University of Massachusetts Medical School [UMass Medical School]. (2014, January 17). Would a fast food tax improve public health? [Video file]. Retrieved from https://www.youtube.com/watch?v=I8SNDm0d-4Y

University of Michigan School of Public Health [UM School of Public Health]. (2013, February 22). Why is public health so contentious? [Video file]. Retrieved from https://www.youtube.com/watch?v=HW8VDok3xxg

Debinski, B., Smith, K., & Gielen A. (2014). Public opinion on motor vehicle–related injury prevention policies: A systematic review of a decade of research. Traffic Injury Prevention, 15(3), 243–251. Retrieved from the Walden Library databases.

Insurance Institute for Highway Safety Highway Loss Data Institute. (2015). Motorcycle helmet use. Retrieved from http://www.iihs.org/iihs/topics/laws/helmetuse

Centers for Disease Control and Prevention (CDC). (2012). Motorcycle safety guide: Helmet laws save lives and money [Data set]. Retrieved from http://www.cdc.gov/motorvehiclesafety/mc/guide/save.html

Brill, A. (2013). The long-term returns of obesity prevention policies. Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf405694

This Exploration will help you better understand public perception about public health practices. You will consider the impact of health policy decisions, which is part of your Competency Assessment. Interview a friend, family member, or colleague regarding the advantage perceived by state laws on one of the following topics:

· Prevention of childhood obesity through a healthy diet in school meals

· Education campaign on healthy food consumption

· Required helmet laws for motorcyclists

· Childhood immunization

· Adult immunization for flu

· Curtailing cigarette smoking in public or tax on cigarettes

Holford, T. R., Meza, R., Warner, K. E., Meernik, C., Jeon, J., Moolgavkar, S. H., & Levy, D. T. (2014). Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964–2012. JAMA, 311(2), 164–171. Retrieved from the Walden Library databases.

Centers for Disease Control and Prevention (CDC). (2011). Ten Great Public Health Achievements—United States, 2001–2010. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.htm

Centers for Disease Control and Prevention (CDC). (2013). Current cigarette smoking among adults aged 18–64, by urbanization level and selected characteristics: United States average annual, 2002–2004 through 2010–2012 [Data set]. Retrieved from http://www.cdc.gov/nchs/data/hus/2013/059.pdf

Health Resources & Services Administration. (2016, October). About the Ryan White HIV/AIDS program. Retrieved from https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program

Warner Jordan Education [WarnerJordanEducation]. (2013, October 31). Special interest groups [Video file]. Retrieved from https://www.youtube.com/watch?v=n703tOumqbY

Douglas, M. R., Manion, C. A., Hall-Harper, V. D., Terronez, K. M., Love, C. A., & Chan, A. (2015). Case studies from community coalitions: Advancing local tobacco control policy in a preemptive state. Retrieved from the Walden Library databases.

Berman, M. L. (2011). From health care reform to public health reform. Journal of Law, Medicine & Ethics, 39(3), 328–339. Retrieved from the Walden Library databases.

Karnik, S., & Kanekar, A. (2014). A narrative review of public health policies for childhood obesity prevention in the United States. Retrieved from http://www.qscience.com/doi/pdf/10.5339/jlghs.2014.4

Shelley, D., Ogedegbe, G., & Elbel, B. (2014). Same strategy different industry: Corporate influence on public policy. Retrieved from the Walden Library databases.

Boundless. (n.d.). The function of interest groups. Retrieved from https://www.boundless.com/political-science/textbooks/boundless-political-science-textbook/interest-groups-7/interest-groups-47/the-function-of-interest-groups-281-7055

Universtiy of Texas at Austin. (2015). Participation, interest groups, and lobbying. (2015). Retrieved from http://www.laits.utexas.edu/gov310/PIG/glossary.html

American Public Health Association (APHA). (2015). Policy statements and advocacy. Retrieved from https://www.apha.org/policies-and-advocacy

Project HEALTH. (2012). About Project HEALTH. Retrieved from http://project-health.org/about-project-health/

American Nurses Association (ANA). (2015). Policy & advocacy. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy

U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). A living history: The Ryan White HIV/AIDS Program. Retrieved from http://hab.hrsa.gov/livinghistory/index.htm

The American Citizen Interest Groups in American Politics. (2013). Retrieved from http://www.twyman-whitney.com/americancitizen/links/lobbies.htm

Grossmann, M. (2012). Interest group influence on US policy change: An assessment based on policy history. Interest Groups & Advocacy, 1(2). Retrieved from http://link.springer.com/article/10.1057%2Figa.2012.9

The American Citizen Interest Groups in American Politics. (2013). Retrieved from http://www.twyman-whitney.com/americancitizen/links/lobbies.htm

Health Resources & Services Administration. (2016, October). About the Ryan White HIV/AIDS program. Retrieved from https://hab.hrsa.gov/about-ryan-white-hivaids-program/about-ryan-white-hivaids-program

Warner Jordan Education [WarnerJordanEducation]. (2013, October 31). Special interest groups [Video file]. Retrieved from https://www.youtube.com/watch?v=n703tOumqbY

Douglas, M. R., Manion, C. A., Hall-Harper, V. D., Terronez, K. M., Love, C. A., & Chan, A. (2015). Case studies from community coalitions: Advancing local tobacco control policy in a preemptive state. Retrieved from the Walden Library databases.

Berman, M. L. (2011). From health care reform to public health reform. Journal of Law, Medicine & Ethics, 39(3), 328–339. Retrieved from the Walden Library databases.

Karnik, S., & Kanekar, A. (2014). A narrative review of public health policies for childhood obesity prevention in the United States. Retrieved from http://www.qscience.com/doi/pdf/10.5339/jlghs.2014.4

Shelley, D., Ogedegbe, G., & Elbel, B. (2014). Same strategy different industry: Corporate influence on public policy. Retrieved from the Walden Library databases.

Boundless. (n.d.). The function of interest groups. Retrieved from https://www.boundless.com/political-science/textbooks/boundless-political-science-textbook/interest-groups-7/interest-groups-47/the-function-of-interest-groups-281-7055

Universtiy of Texas at Austin. (2015). Participation, interest groups, and lobbying. (2015). Retrieved from http://www.laits.utexas.edu/gov310/PIG/glossary.html

American Public Health Association (APHA). (2015). Policy statements and advocacy. Retrieved from https://www.apha.org/policies-and-advocacy

Project HEALTH. (2012). About Project HEALTH. Retrieved from http://project-health.org/about-project-health/

American Nurses Association (ANA). (2015). Policy & advocacy. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy

U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). A living history: The Ryan White HIV/AIDS Program. Retrieved from http://hab.hrsa.gov/livinghistory/index.htm

The American Citizen Interest Groups in American Politics. (2013). Retrieved from http://www.twyman-whitney.com/americancitizen/links/lobbies.htm

Grossmann, M. (2012). Interest group influence on US policy change: An assessment based on policy history. Interest Groups & Advocacy, 1(2). Retrieved from http://link.springer.com/article/10.1057%2Figa.2012.9

The American Citizen Interest Groups in American Politics. (2013). Retrieved from http://www.twyman-whitney.com/americancitizen/links/lobbies.htm

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State children health insurance programs

The final project for this course is a Research Paper. The first two assignments will help you find the tools needed to prepare and gradually build your final research paper. The research paper for this course will be argumentative. The argumentative research paper requires you to take a position on an issue and support the position with persuasive facts and statements.
First, select a Research Paper TOPIC that can be assessed using health care economics principles.

Please choose from the following topics the issue you are going to discuss.

A history of Medicare cost containment policies
Not-for-profit versus for profit
Medicare prospective payment program
Medicare and Medicate dual eligibility
Health maintenance organizations
Long-term health care insurance
The managed care backlash
Impact of obesity on healthcare costs
Impact of diabetes on healthcare costs
Impact of smoking on healthcare costs
Nursing shortages
Cost of Pharmaceuticals

Second, provide your research paper with the following OUTLINE (Your final paper assignment should include a detail explanation of this outline):
a. Introduction -Your introduction should give a brief overview of the topic you are going to discuss. The last sentence of your introduction section should be your thesis statement. Your thesis statement should start with – The purpose of this paper is to…..

b. Body of paper – The body of your paper should organize how you plan to address each required section of the paper. Each supporting item is then broken down into smaller supporting items.

An overview of the issue
Why is this issue a concern from a health care economics perspective?
Who are the major parties involved in this issue?
Which market forces have an impact on this issue?
How is demand illustrated in this issue?
How is supply illustrated in this issue?
How has the affordable care act impacted this issue?
How are health disparities demonstrated in this issue?
How has this issue been improved in other global markets?
What is your recommendation for making improvements based on economic principles.

c. Conclusion – The conclusion of your paper should summarize your thesis statement and the supporting items discussed in your paper. In this outline, please indicate what you expect the finding to be.

d. References – Provide list of five (5) bibliographic references (using APA format).  Your final research paper will require seven (7) bibliographic references. (You may use your textbook as a reference and you should have a minimum of 6 academic outside references including 3 peer-reviewed journal articles

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WHAT ARE THE EXPECTED RATES OF REIMBURSEMENT FOR THIS TIME FRAME FOR EACH PAYER?Evaluating Financial Statements Part 1 Your facility has the following payer mix 40% commercial insurances 25% Medicare insurance

Evaluating Financial Statements Part 1 Your facility has the following payer mix: 40% commercial insurances 25% Medicare insurance 15% Medicaid insurance 15% liability insurance 5% all others including self-pay Assume that for the
View complete question » Part 1 Your facility has the following payer mix: 40% commercial insurances 25% Medicare insurance 15% Medicaid insurance 15% liability insurance 5% all others including self-pay Assume that for the time in question you have 2000 cases in the proportions above. Commercial insurances average 110% of Medicare, Medicaid averages 65% of Medicare, Liability insurers average 200% of Medicare and the others average 100% of Medicare rates. The average Medicare rate for each case is $6200. 1) What are the expected rates of reimbursement for this time frame for each payer? What is your expected A/R? 2) What rate should you charge for these services (assuming one charge rate for all payers)?(this gives you your total A/R.) Calculate the total charges for all cases based on this rate. 3) What is the difference between the two A/R rates above? Can you collect it from the patient? What happens to the difference? 4) Which of these costs are fixed? Which are variable? Direct or indirect? a. materials/supplies (gowns, drapes, bedsheets) b. Wages (nurses, technicians) c. Utility, building, usage exp (lights, heat, technology) d. Medications e. Licensing of facility f. Per diem staff 5) Insurances (malpractice, business etc.) 6) Calculate the contribution margin for one case (in $) with the following costs for this period, per case: a. materials/supplies: 2270 b. Wages: 2000 c. Utility, building, usage exp: 1125 d. Insurances (malpractice, business etc.): 175 7) Using the above information, determine which is fixed and which cost is variable. Then calculate the breakeven volume of cases in units for this period. 8) Suppose you want to make $150,000 profit between this period and next period to fund an expansion to the NICU, how many cases would you have to see, and at what payer mix would this be optimal? Show all calculations. Part 2 There is said to be two types of accounting operations in health care finance that lie at the heart of the financial department of any organization in the industry. What are these two types of accounting? Briefly describe each and provide 2 examples for each. Do you feel one is more important to business than the other? Is one more effective or efficient for certain types of business operations?

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What are the hazards and opportunities associated with shifting healthcare expenditure away from government to private insurance companies and individuals?

 

What are the hazards and opportunities associated with shifting healthcare expenditure away from government to private insurance companies and individuals?

 

 

The US Government and Healthcare

Paper instructions:
The government is a significant payor source in healthcare. Through Medicare and Medicaid the government is picking up the tab for a significant amount of care delivered in the United States. Consider the Patient Protection and Affordable Care Act, signed into law in 2010 and evaluate the prospects for the future of government™s role as a payor source? What are the hazards and opportunities associated with shifting healthcare expenditure to government? What are the hazards and opportunities associated with shifting healthcare expenditure away from government to private insurance companies and individuals?

****Just needs to be 2 paragraphs with one cited source.

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What economic and societal factors affect the demand and pricing of healthcare services in todays health insurance market?

Trends in Healthcare Services

You are a member of a presidential commission appointed to consider a mandatory national health insurance plan and the question of how to fund the plan is being discussed.

Specifically, three separate options are being considered to generate an average of $4,000 per worker—a flat mandatory premium, a doubling of the current 7.65% payroll tax that comes out of people’s pay to cover social security and Medicare, and a 7% increase in income tax.

Think about funding plans from the perspective of three workers:

  • One who makes $25,000 per year
  • One who makes the same in salary but also has $1,000 in investment income
  • One who makes $85,000 per year, including $10,000 in investment income

Based on the above scenario, answer the following questions:

  • Which of the three funding measures, considering the relative financial contributions it imposes on individuals such as these, would you support and why?
  • How has the emergence of different types of health insurance plans—FFS, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation—affected the trends in healthcare services today?
  • What economic and societal factors affect the demand and pricing of healthcare services in today’s health insurance market?

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What do you think about allowing some people to purchase additional insurance, thereby creating a two-tier health system based on affordability?

Healthcare Synthesis

Using the Scholarly library, the Internet, and the data from the Organization for Economic Cooperation and Development (OECD), research comparative international work and compare the United States and Canada with respect to which country is more effective in the areas of (1) economic growth; (2) expenditure (public and private expenditure on health); (3) information and communications technology; and (4) health.

Click here to access data from the OECD.

On the basis of your observations, create a 1- to 2-page report.

Your report should address the following questions:

  • After going through the statistics:
    • What information or statistic you find either surprising or reasonable?
    • Do you anticipate the statistics will be similar in ten years? Why or why not?
  • The current structure of healthcare coverage in the United States has a combination of employer-based coverage and public program (e.g., Medicare, Medicaid) coverage, with a large uninsured population. If a single-payer system is implemented where Medicare is expanded to cover all citizens for those who prefer private insurance, there will be comparable coverage under the same range of private insurance plans already available. Keeping in mind these considerations, answer the following questions:
    • What do you think about allowing some people to purchase additional insurance, thereby creating a two-tier health system based on affordability?
    • What are the advantages and disadvantages of this initiative?
  • Considering the fact that healthcare is not a guaranteed right for in 2 pages
  • everyone in the United States, there are different kinds of barriers and obstacles in obtaining healthcare. In contrast to this fact, the notions of equity and fairness are considered very important. You will notice that these notions aren’t considered when we discuss people’s access to other goods, such as cars and computers.
    • What are these barriers? Give examples of the different barriers to health care under the following headings:
      • Financial barriers
      • Scarcity of healthcare providers
      • Barriers to access healthcare
      • Cultural barriers
      • Barriers of healthcare resources
    • How would you define the term, “equity and fairness”, in the context of the healthcare situations prevailing in the United States and Canada?
    • Why are they considered important when discussing people’s access to care?
  • It is believed that government funded healthcare for all citizens is consistent with a capitalist economy and the cultural values of self-determination and free enterprise.
    • Do you agree with this statement? If not, what other approaches do you think will resolve the current inequities in the system?

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Examine conditions and terms of insurance firm

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