0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Week 3 Health Insurance design in the workplace
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Employee health insurance is about pooling resources to cover the group risk that could be any illness from road traffic accident to basic chronic diabetes as described in the scenario (Getzen, T. 2015). The company in the scenario provided, has 50 employees with 40% categorized in the higher risk group because they have chronic diabetes, a potentially deadly disease if not managed well. This is less than half of individuals in the group. The rest are young people unlikely to need more than a yearly physical.
In order to design a suitable cost effective, beneficial health plan for the employees it is important to give them choices they can afford depending on their age and health status. It is also important to consider the out of pocket costs for health care. A young person that is living a predominantly preventive lifestyle, who gets a sudden head trauma is not going to seek proper treatment that comprises of costly co-pays and deductibles. Decades of evidence have shown that higher out-of-pocket prices reduce the use of health care across a range of settings, including hospitals, office visits, and prescription drugs (Baicker, K., & Levy. H., 2015).
The employer should design a system that favors the majority in the group giving them options to save money since they are a lower risk group and yet offering them the best insurance to be able to get the best level of health care when they need it. Adverse selection should be part of the design. This occurs when an employer subsidizes the cost of insurance because healthy workers opt out and in some cases go for Medicaid if they qualify resulting in higher premiums for the at risk older workers with chronic conditions (Getzen, T., 2015).
A good group insurance for 50 employees may include an option of an HMO plan and a more comprehensive PPO plan targeted at workers with chronic diabetes. Included in the design offered to all employees would be a health coach offered to help those with chronic diabetes manage weight issues and blood glucose monitoring, as a preventive measure, and for younger healthier individuals an attractive wellness initiative, that will engage them and offer incentives to keep healthy.
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