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The term "Professional Caregiver Insurance Risk" [39] [40] explains the inefficiencies in health care finance that result when insurance risks are inefficiently transferred to health care providers who are expected to cover such costs in return for their capitation payments. As Cox (2006) demonstrates, providers cannot be adequately compensated ...
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. [1] In the United States, where health care costs are the highest as a percentage of GDP, overuse was the predominant factor in its expense, accounting for about a third of its health care spending ($750 billion out of $2.6 trillion) in 2012.
This model compares real-time data sets of insurance coverage in 2014 to a baseline scenario without ACA coverage. By doing so, the model can project future enrollment numbers in California health programs. According to this model, at some point in time, an estimated 1.1 to 1.3 million Californians will be enrolled in Covered California.
Additionally, states regulate the health insurance market and they often have laws which require that health insurance companies cover certain procedures, [149] although state mandates generally do not apply to the self-funded healthcare plans offered by large employers, which exempt from state laws under preemption clause of the Employee ...
The insurance company is an individual health care provider under the Affordable Care Act (ACA) and has continued to expand its availability in the marketplace for those who aren’t getting ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
California insurers will be required to sell coverage in wildfire-prone regions that have seen an insurer exodus in recent years, state Insurance Commissioner Ricardo Lara announced Monday. Under ...
The California Major Risk Medical Insurance Program (MRMIP) is a program of the Managed Risk Medical Insurance Board that provides health insurance for Californian citizens who are unable to obtain coverage in the individual health insurance market because of their pre-existing conditions. Californians qualifying for the program, participate in ...