Challenges Facing Health Care Providers and Health Insurance

Challenges Facing Health Care Providers and Health Insurance Topic: challenges facing Health care providers while dealing with Health insurances: a case study of a private hospital in Nairobi Kenya Introduction Define health financing (who,2000)world health report ‘ A health system is the sum total of all the organizations, ititutions and resources whoseprimary intent is to promote, restore or maintain health (WHO, 2000).Effectiveness, efficiency andequity of health financing system is determined by interaction of the three health financing functions namely collection of revenues, the pooling of pre-paid revenues and purchasing.Purchasig means the process by which interventions are selected and services are paid for or providers are paid. Healthcare providers are part of health system and re key component of health system strengthening and they play a significant role in determining whether the goals of a health system can be achieved.It is important that the buyers of services align provider payment methods with organizationalarrangements for service providers and other incentives for efficient service provision In Kenya most of the private health insurances operate on a purchaser provider split model with the insurances being directly responsible for entering into purchase agreements with providers and reimbursing them. Most of the provider payment is fee for service with a few health management organizations trying out the capitation mode of payment on outpatient services.Before the claims are approved for payments they have to undergo through the schemes claims process for eligibility purposes. According to S. Sodzi-Tetteyet al (2012) the purchasing function of health financing has been beset with problems of delay in provider payments. A study by Ministry of Health, Ghana, (2009) showed that in 2008 health facilities nationwide were owed a total of USD 32.6M most of it in unpaid claims while health providers themselves reported a 2-6 month delaying having their bills settled. Health insurance schemes are being used as an alternatives funding for health sector (Baltussen et al 2000).Insurance authorities are established to secure improvements in the health of the population by assessing health needs of the population ,determining the most cost effective mean of meeting these needs and contracting with providers to supply the required services. They are different types of health insurance models and one of them is the purchaser /provider splint models .they are many advantages to this arrangement according to ZurnAdams (2004) among them compiling of services providers to offer quality care however this model can also lead to major problems which according to Sakyi et al (2012)could be enormous among them being late reimbursement thus increasing the financial volatility of health providers which may in turn affect service delivery due to lack of finances to buy drugs ,to improve health facilities, to pay health workers to buy commodities among other things .witterGarshong ,(2009) says that providers who depend heavily on subsidies from the insurances could offer poor quality care when they are under billed or a large portion of their claims are rejected. The study will explore the challenges experienced by health care providers dealing with private health insurances especially the claim processing. Problem statements Health providers are offering health services to health insurances clients yet the insurances are not honoring their pledges to pay. There so many rejected bills after clients are discharged; many providers have unsettled bills by the patients because after services were offered the insurances give decline letters or covered bills up to a certain limit. A lot of time and money ,human resource is used in reconciliation of the accounts and in most cases the claims are not paid and as sakyi et al (2012) says this increases financial volatility of the health care providers which may in turn affect service delivery due to lack of finances to buy commodities and pay workers.witter Garshong (2009)continue to say that providers wo depend heavily on subsidies form the insurances could offer poor quality care when they are under billed or a large portion of their claims are rejected. . Research Objectives The study seeks to explore the challenges facing healthcare providers while dealing health insurance companies. The specific objectives of the study will be: To establish the administrative challenges facing health providers in executing operational guidance of health insurances. To establish the challenges healthproviders face from the health insurance during service delivery to their clients. To establish the challenges health providers face from the health insurance after the delivery of service to their client To come up with recommendation’s that would be used by the health providers and health insurance to ensure a workable purchaser –provider splint system Research Questions The study will answer the following research questions: What are the administrative challenges facing health providers in executing operational guidance of health insurances(admission process, scheduled cases ,emergency cases ) What are challenges health providers face during service delivery to health insurance clients(declines,exclusion ,limited covers ,clients not knowing their limits ) What are the challenges health providers face from the health insurance after the delivery of service to their clients.(rejections of claims ,late reimbursements What are the political challenges facing healthcare financing towards universal coverage by NHIF? What are the recommendation’s to health providers and health insurance to ensure a workable purchaser –provider splint system Theoretical framework Health insurance theory Utility theory Behavioral model of utilization Event model of studying health services utilization med care 1998. Conceptual framework Dependent variable- Challenges faced by health providers Independent variable- Operational guidelines (preauthorization process-preadmission process). service provision(admission post service provision (claim and reimbursement process) Significance of the Study Health providers are key in health system strengthening and key stakeholders in attainment of universal health coverage (delloitte ,2012)hence the importance to find out ways of ensuring both the private and public insurance work harmoniously with providers. Help policy makers in making decision like proper ttraining their enrolessabout their benefits ,providers to hve mechanism to carry out operational guidelines, Policy makers need access to knowledge on purchaser –provider splint system dynamics and the appropriate responses. Therefore, the study provides guidance and recommendations instrumental in designing appropriate policies that regulate the healthcare sector and what need to be done to ensure workable /effective and efficient system. The study will also be a reference material to the healthcare insurance firms, healthcare providers/institutions and other stakeholders. Relevant data that could allow for recommendations that could be implemented to strengthen the role of private health insurance players or providers or to strengthen provider and purchaser reltionship Methodology of the Study It will be an exploratory study .Qualitative andquantitative approaches will be used for primary datacollection using interview guides and checklists. References WHO,the world Health report 2000:Health systemsimproving performance ,Geneva ,World Health Organisation,2000

Job-hopping †Is It Good or Bad?

It is barely get to hear of a person who started their career with an organization many years back, dedicated his entire career with the organization and finally retired from the same organization. As it is said, nothing last forever; same is in the case with job these days. Jobs today do not last unlike previous generations. In the past few years, job-hopping has become so widespread across the industries that even a four years stint in the same organization is considered to be a stable job. Three jobs in less than a year, no longer raised eyebrows and gaps mouths. Job-hopping, in fact, has become a new mantra for success. People no longer believe in sticking to one job and waiting for that golden leap to come. So, what’s the job-hopping is? In simple terms it is the practice of changing jobs frequently, especially as a means of quick financial gain or career advancement. Basically, there are two kinds of job-hopping – random job-hopping which is moving every time you get a better job offer (the typical quick financial gain job-hopping) and strategic job-hopping which is taking a new job because it enhances and helps build your career. Key reasons for job-hopping Welcome to the world of job-hoppers. It’s an employee-driven economy. With more opportunities and avenues round the corner organization are really at the mercy of the employees. Some of the common reasons for hoping jobs as quoted by job-hoppers include dissatisfaction with the job, lack of challenging work, stagnation or less pay, Poor Human resource policy of the corporate, miss handling of the employees, corporate vision and mission not colliding with the employee's persona, too much control applied on the employees, privileges are being delivered on the basis longevity of the employees with the corporate, the eye-popping fat salaries and many more. These appear to be the main reasons for their resignations. Job-hopping also acts as a shortcut to success. Employees make their way to higher levels in the management hierarchy as each job change brings with it a hike in pay and position. Moreover, sticking to the same organization from which you started off your career is passe now. It is believed that those who hang on to the same job are taken for granted and declared not competent enough to move ahead in their career. Job-hopping: How It Effect Your Career Success Is job-hopping and career success related to each other? What is the effect of one on the other? Job-hopping affects career success in a negative way. By hopping jobs frequently, you are sending negative signals to your potential employer. Too often, job-hopping employees learn nothing substantial. Companies like to invest on those job seekers who align their career goals with the corporate goals. The reason is simple. They are able to contribute better in the company and if they are constantly moving from one job to another, they send a signal of non commitment. It gives a pessimistic image in the mind of the employer. Grass is not always green on the other side No doubt job-hopping has become the latest trend today, or a shortcut to success; one cannot jump from one job to another as and when it strikes one’s imagination. Moreover, though two or more jobs on a resume no longer are an employment risk, too many jobs in less than two years time portray one as a chronic job-hopper. A series of rapid, random and pointless moves will show up as annoyances on the resume. Employers view such contenders as dysfunctional – lacking in loyalty, trust and self-motivation. Quick moves from one job to other raise big questions for prospective employers as to one's staying power and ability to withstand challenges, as well as accept accountability. Employer may feel that you are not committed to a particular organization. The future employers, who are probably looking for a long term employee, might not be impressed with the job-hopping tendencies. They might perceive that one has become a job-hopper may be because of inability to get along with colleagues or employers. It does not even leave substantial time to acquire sufficient experience and hands-on skills. What’s more is that after innumerable hops, one may find himself at the same place where he first started. The downside of job-hopping Many job-hoppers think that jumping from one job to another in rapid succession is a sure way to reach the top. However, they have to encounter the hidden consequences. In unstable industries like hi- tech, advertising and television, job-hopping is the norm. In these industries, workers find out later that a resume with short period is a turn-off to employers. They may suspect a job-hopper of being unable to get along with the co-workers. Moreover, the job-hopper is also taking on a new boss who may turn out to be a tough leader. Studies indicate that employees often wrongly believe that they will get promotions if they switch organizations. However, the job-hoppers have to overcome obstacles like a clearly hostile boss, demotion or a significant decrease in pay etc. HR experts suggest that not to run out the first chance you get. A little patience can go a long way. Though job-hopping is a negative signal to prospective employers, but depending on the reasons it can also be a positive. Mick Hager, a leading HR expert explains the reasons why job-hopping is a bad thing as quoted in the website – www. greenbaypressgazette. com. These include:- * You’ll never have the chance to lay down roots, establish a strong reputation and be viewed as an asset to the company. Job-hoppers miss the opportunities given to the solid, loyal, staying- put performers. * Job-hoppers are huge expenses for employers. It takes an employee at least six months to go from being a liability to contributing to the bottom line. That is why employers hate dealing with job-hoppers, they cost too much. Job-hopping sends the message that you are not dependable, suggesting that you lack loyalty and commitment. Please don’t tell me the woeful tale of how companies aren’t loyal to employees these days – companies are loyal to the dependable, productive ones. * Job-hopping suggests incompetence, if you’re so good- why you leave? * Job-hopping takes a mental toll. At some point you need stability in your life to maintain balance. * Your next boss could be worse! * It suggests you are irresponsible or cannot maintain relationships * It indicates that you lack resolve and the ability to stick-to-it. Employees promote those they trust; trust is earned over time. * It is just plain stupid! In today’s new environment, how short is too small to stay at a job? The answer varies among industries and professions. Earlier two to three years used to raise a red flag. Today, depending on the industry, it is 1 to1. 15 years. But what employers are really looking at, did the person complete the project or commitment that he made? B Lynn Ware, an employee retention expert with the Integral Ta lent Systems suggest the job-hoppers â€Å"You’re really looking at a very limited window of productivity. Let’s say someone stays with an organization for 2. 5 years. It takes them the first year and a half to really get up to speed. Then they spend their last three t six months looking for the next thing. That leaves about a half year of real productivity†. Look beyond the fat pay offer to avoid another hop in a short time and perhaps less pleasant circumstances. Learning Relevant Skills and Knowledge Matters People who are in the new workforce and have been job-hopping quite a bit, it is advisable to find out what you want. If you able to recognize it, then find a organization that is willing to train or how they are willing to commit to their employees career in the long term. Instead of job-hopping frequently for career growth, make learning the relevant skills and knowledge in that industry one’s key objective for a successful career. The skills and knowledge that one learns in the process will contribute to career success in the long term. If job-hoppers realize the benefit of committing to a company who is willing to train them for more than two years, hopefully they won’t be job-hopping often anymore. Are job-hoppers are listening!

The Native Occupation of Alcatraz Island and Its Effects...

The Native Occupation of Alcatraz Island and its Effects on the Greater American Indian Movement. On November 20th, 1969 a group of Indian students, and urban Indians from the Bay Area led by Richard Oakes landed on Alcatraz Island claiming it as Indian Land (Johnson). This was a multi-tribal group and so they adopted the name Indians of All Tribes (Johnson). The 1969 landing and subsequent 19 month occupation was not the first attempt at an occupation; it was however the last and the longest in a string of 3 attempts (Winton). This Occupation would have a significant effect on the Native American rights movement and also a profound effect on the Country as a whole. The First attempt was made on March 9, 1964. It was led by Sioux†¦show more content†¦Then on January 5, 1970 Oakess daughter Yvonne fell three stories in one of the abandoned building and died (Eagle). With this tragic event Oakes lost a daughter and the occupiers lost a charismatic leader. Richard Oakes left the Alcatraz movement saying Well, you guys do what you can with it. I dont have the heart for it anymore. (Eagle). After Oakes departure there was almost no hope of attaining their goals anymore. Even if negotiations could be set up, there was no longer a centralized Indian leadership with whom to negotiate. The government decided to hurry along the stalemate by shutting off all electrical power to the island and removing the barge which supplied water to the occupiers (Eagle). Three days after the removal of the barge a fire broke out on the east side of the island gutting and destroying many historic buildings (Eagle). The government blamed the increasingly out of control occupiers. Many occupiers however claim that a passing boat had fired a flare onto the island. The cause of the fire remains a mystery but it did however succeed in swaying public opinion away from the occupiers and towards a speedy resolution to the problem (Eagle). People were becoming increasingly upset with the stalemate and the burning of the island and damage to the islands lighthouse (a SF icon) was just fuel to the fire. Soon reports of power struggles, assaults and beatings on the island began to circulateShow MoreRelated Native American Rights, Federal Government Plenary Power and Land Takings5465 Words   |  22 PagesNative American Rights, Federal Government Plenary Power and Land Takings Abstract Native Americans are entitled to the same Constitutional protections that guard other citizens from federal government infringement. Plenary power and the accompanying seizure and use of indigenous land bases have violated the rights of Native Americans and demonstrated the inability of the federal government to manage Indian affairs. The United States should give ownership and control of original, non-privately