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A report of the management team of doctors on the proposed $100 million expenditure for establishing a health care insurance facility

A healthcare insurance facility acts as a cornerstone towards safeguarding of our present and future health status. Good health is considered as the most basic and fundamental aspect as far as a healthy and working nation is concerned. Every individual is entitled to better and affordable medical facilities and services. The importance and the urgency health provision prompted the conduction and further the advice to the group of 20 medical doctors wanting to establish a health insurance facility, 30 miles from the heart of the city. The report focuses on the core objectives, aims and goals of the proposed health insurance facility, the suitability and appropriateness of the proposed health insurance facility, the staff and the general management, the establishment of the physical health facility and the estimated total expenditure for the project and further gives the conclusion and the recommendations. In addition, different health care insurance models, health care financing models and legal models that were used in the construction of the final proposed health care insurance facility.

Findings

Aims and objectives of the proposed health insurance facility and the health care models that were used to construct them.

The following are the core objectives and aims of the proposed facility healthcare insurance facility. The aims are so far realistic, measurable, objective and achievable hence are relevance and most appropriate.

  • The proposed health insurance facility will provide different types of medical insurance covers that ranges from, individual health insurance plan, group health insurance plan, and indemnity insurance plan to managed care insurance plan.

The provided health insurance plan will facilitate:

  1. Provision of routine care that includes regular check-ups and tests, different physical examinations, treating and taking care of minor injuries and accidents.
  2. Rapid response to emergencies that will consist of: treatment of sudden injuries, combating acute diseases, issues involving the overdose and underdose of drugs and many other unexpected medical complications and disorders.
  3. Treating the chronic diseases such as diseases that are repeatedly repeated extensive interventions and pieces of advice. Patients will get these services from any reorganized health facility free of charge or at a subsidized rate if they are the members who have successfully subscribed to any of the above health insurance scheme and whose contributions is up to date. Members are required to contribute little amount of money monthly to be legible members who should be taken consideration
  4. Purchasing of pharmaceuticals. The members will buy medical products free based on the prescriptions from the doctors.
  • The health insurance will cover the cost that a patient may incur upon production of a member identification card. The health insurance may at some time negotiate on behalf of the members to purchase medical products at a subsidized rate.

The above objectives and aims has been constructed the patient- driven healthcare model. This model is used to supplement the former traditional health care delivery model in an effort to empower health care to individuals. This model was the most appropriate that suited the current health situations of the new era. It is characterized by availability of high information levels, transparency, collaboration, patient choice. It is therefore quantitative, responsibility –taking, preventive and predictive in nature.

The goal of the proposed health insurance facility

The main goal of this proposed insurance health facility is to provide cheap, quality and affordable services  and medical products that will improve the health status of the residents and even other people from far beyond the region regardless of their gender, age, status, religion, education and their position in the society . This act will improve the general living standards of the people hence creating a healthy working climate.

The suitability of the proposed health insurance facility, the model used to influence its location and the legal compliance of health insurance facilities.

The proposed health insurance has been suitably located, and has complied with all the legal procedures to be implemented and start operating. The micro econometric model for the health insurance demand influenced the location of the health insurance facility that is determined by moral hazard and health selection. This model sees the facility be located far away from town, an area of approximately 500,000 people. This area proves to be a potential area where there will be a high demand for the services offered by the facility. The facility can be termed as legal because it has complied with the legal procedures as stipulated in the patient protection and the affordable care act of 2010.

The location of the proposed health insurance facility is appropriate. Generally, many health facilities and insurance health facilities are located in towns. Very few medical facilities are located away from town. The fact that the proposed health facility is located thirty miles away from the central business district gives it an advantage over those many facilities that are located in towns. This is because, the facility will be one of its kind located far away from the town and will be in a position to serve those people who are unable to afford to make it to the city to deal with their medical issues. So, this service has been brought near these people.

The medical insurance facility is suitable for in that it will be offering its services to a very large population who are in demand for medical service. It is estimated that the region where this health insurance facility is to be located is inhabited by approximately fifty thousand people.

This health insurance facility is suitable in that it will act as a savior for the needy people who for a very long time have not been able to benefit from the expensive medical services and products. So they can be relieved by this kind of a health insurance company. It is believed that the majority of the people in this region are poor.

The facility will be manageable because it will be managed and facilitated by twenty medical doctors. This number of personnel will act as top managers of the facility besides employing other people to help them. Moreover, the twenty medical doctors have vast experience now that they have been doctors for a long time, as far as the management of the medical facility is concerned.

The proposed health insurance facility has complied with all the legal requirements the establishment and operation of the health insurance facility. The following had been done:

  1. The strip of land on which the buildings and the offices of the health insurance facility had been identified, thirty miles away, paid for and its certificate obtained. The transaction followed the required legal procedures.
  2. The physical location of the health facility has passed an environmental impact assessment examination and thus the location is secure and officially granted permission for any development. The possible environmental pollution and the effect to the surrounding were taken into consideration.
  3. The architectural design of the facility was certified and was drawn by a certified architecture.
  4. The facility was registered under the ministry of health and medical services.
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The management and the staff

The health insurance facility will solely be managed by the twenty medical doctors. However the administration will also consist of professionals from different fields such as accounting, finance, sociology, psychology, sales and marketing, computer scientists and programmers. These people will be responsible for various sections of the facility

At the top of the administration will be the chief executive officer (C.E.O), the human resource manager, the operation manager, the head of research services, head of finance, the procurement officer, among other employees in the health insurance facility. The management will be guided by a strict legal framework.

The financing of the proposed health care insurance facility and the health care insurance financing models implied.

This health care insurance facility has utilized two main financing models in order to come up with the future final framework for its sustainability and effectiveness. The two financing models used were the Bismarck’s model and the Beveridge’s models respectively. The Bismarck’s heath insurance financing model implies that contributions to the health insurance company is solely contributed by employees and employers while on the other hand, the Beveridge’s models holds it that, the health care insurance facility should be financed by the government.

This proposed health care insurance facility needs a lot of capital to implement because of its complex nature. The twenty medical doctors who initiated the project have tried to pull the resource together in an effort to raise an approximate total of$ 100 million. After the implementation and the building of this health care insurance facility it will get its finance from the following source:

  1. Premiums
  2. Exclusions
  3. Out-of –pocket maxima
  4. Capitation
  5. Deductable funds
  6. Investments
  7. Government and non-governmental donors.

The estimated budget for the $100 million health care insurance facility that will be used for the construction and equipping the proposed health insurance facility.

The total estimated budget of about$ 100 million dollars will be put aside to complete the budget and see to it that it has been operational.

The table that shows the major requirement that needs to be purchased and their correspondent estimated price in $ million dollars

Requirement

Estimated Amount in million $

Infrastructure

45

Drugs

10

Equipment

25

Stationery

12

Miscellaneous

8

The table showing the infrastructure budget for each requirement in $ million dollars

requirement

Estimated  cost in million$

Building materials

30

Transport cost

3

expertise

9

labor

2.

miscellaneous

0.8

total

45

The following tableshows the percentage of the total expenditure for each needed requirement.

requirement

Percentage of the total expenditure (%)

Building and construction materials

30

Transport cost

3

expertise

9

labor

2

drugs

1

equipments

25

stationeries

12

miscellaneous

8


Conclusion

From the above report, it is worth to note that if the above health care insurance facility is to be constructed and operational zed. The facility will improve the social life of the people. Health issues are an everyday phenomenon and are part of everyday society. Many of such kind of health care insurance facilities has been established across the United States of America and across the globe, this is according to the available statistics from the department of medical services. It will be by far a hard task to come up with such facility but a lot of efforts is required. This project requires high  amount of capital and need a lot of cooperation from the involved stakeholders.

Recommendations

The following recommendations can be put forward regarding the above report:

  1. The government and the non-governmental organizations should join hands to support a project of this kind. The work should not entirely be left with all the responsibilities of financing and implement such a project that require an immense amount of capital.This is a project that is geared towards improving the health status and living standards of the citizens.
  2. The local citizens should be sensitized through medical campaigns that should be fully supported by the government, private sector and individuals on the importance of utilizing such facility and also to understand their health implications.
  3. The government should soften the tight rules that must be satisfied in order for them start such an important project. People tend to fear the tight rules and demanding regulations. The softening of the rules will encourage more establishments of such facilities.
  4. The established health care insurance facilities should be closely monitored to ensure that they are not exploiting the clients that are being insured. Recent reports have shown that many insurance facilities have resorted to the exploitation of their clients and by doing so; they have done more harm than good to their clients.
  5. The health care insurance should be inspected to ensure that they meet the standards before they are given an okay to serve the citizens.

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