Health Insurance Coursework Example | Topics and Well Written Essays - 1250 words

Health Insurance - Coursework Example HMOs first emerged in the 1940s with Kaiser Permanente in California and the Health Insurance Plan in New York. However, they were not adopted widely until the 1970s, when health care costs increased and the federal government passed the HMO Act of 1973, which required that companies that offered health insurance and employed more than 25 employees include an HMO option. The law also supplied start-up subsidies for these health plans (Barsukiewicz, Raffel, & Raffel, 2010). HMOs often operate on a prospective or prepaid payment system where providers are paid a capitated fee—one flat amount per beneficiary—per month, quarter, or year, regardless of the frequency or quantity of services used (Barsukiewicz, Raffel, & Raffel, 2010). In staff model HMOs, such as Kaiser Permanente, providers are salaried, but this arrangement is the exception, not the norm. In-group policies, where health insurance is provided through the employer, the employer pays the insurance company a set amount agreed upon in advance. According to Austin and Wetle (2012), employers covered 83% of premium costs for single coverage and 73% for family coverage in 2009. The employee, or beneficiary, paid the difference. Then, the health insurance company pays the provider directly. HMOs have the strictest access structure, called a gatekeeper model, where patients must have a primary care physician (PCP) through who all care is routed. PCPs decide which diagnostic tests are needed and control access to specialists through referrals, deciding when it is necessary for a patient to seek more expensive specialty care (Barsukiewicz, Raffel, & Raffel, 2010). HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in

Case Study Bribery Coursework Example | Topics and Well Written Essays - 500 words

Case Study Bribery - Coursework Example h companies are liable if its authorized officials commit a bribery act unlike FCPA that does not outline a strict liability offence for corporations. Under the FCPA, there must be a proof of corrupt intention, but the bribery Act is stringent since there is no requirement for improper intent as such situations constitute general bribery offence. The FCPA creates certain loopholes that make companies engage in corruption since companies are allowed to incur promotional expenses that may either be in the form of gifts, entertainment or incentives in order to secure contracts. However, the UK bribery act does not make an exemption for promotional expenses. There are various reasons why companies have continued to violate the FCPA in the recent past such as the poor prosecution abilities, the loopholes inherent in the Act and unethical corporate governance practices in the US. Some of the companies that have been charged by the Securities Exchange Commission (SEC) in the recent past for engaging in bribery include BHP Billiton, Goodyear Tire and Rubber Company, Avon Products Inc, Bruker Corporation and Hewlett-Packard. The companies have exploited the weak foreign legislation on bribery and the exemption on promotional expenses that is created by the FCPA to engage in acts of bribery. The FCPA has limited territorial reach and may fail to apply in some cases when the bribery act takes place outside the US borders. Another reason for this bribery trend is the less severe criminal penalties for bribery since prosecutors have imposed small company fines for violation and up to five years imprisonment. There are difficulties experienced in determining when a minor gift, entertainment or incentive constitutes a bribe since the anti-bribery law allows for companies to incur promotional expenses which are reasonable and bona fide expenditures related to a contract. The provision for making small gifts or incentives constitutes an important aspect of cultivating