Health sciences and medicine
Please review the following case study in bellow and respond to the question at the end.
Your analysis should reflect material that I upload for you . (This is not an opinion
question.)
In your analysis, please define and use the following terms: behavioral risk factors,
strategies of change model, medical model, population health model, chronic care model,
organized health care delivery, access, economic and noneconomic barriers to health care,
quality/quality care, moral hazard, cost shifting.
[Extra credit: Select and incorporate additional terms from the text. Bold and italicize
these extra credit words. Be sure these terms make sense in the overall analysis of the case.]
(check spelling and grammar) and paste it into the space.)
Case Study :
Mr. Smith has just hired you as the director of strategic planning for Goliath Health Care
Plan. Goliath Health Care Plan insures 30% of the residents in Great City, Alabama which
has a population of 500,000 people.
The people insured under this plan are employed by large companies in the city. These
companies pay for their employees health insurance.
Mr. Smith explains to you that both he and the employers in Great City recognize that
their respective business models depend on the their success in addressing behavior risk
factors that play a critical role in the prevention and management of chronic diseases, (b)
containment of health care costs and enhancement of employee productivity. He jokes with
you saying, A healthy worker is a productive worker!
Mr. Smith asks you to create a comprehensive plan for addressing behavioral risk factors
and increasing community based efforts. Specifically, he asks you to provide him with a
strategy that lays out a plan (including assumptions, models, and evidenced-based
strategies) to reduce the levels of tobacco use, improve unhealthy diets, and increase
physical activity.
In addition, Mr. Smith informs you that 20% of the residents in Great City lack health
insurance coverage. He is dismayed that Great City has just passed a local ordinance which
requires all health care plans in the city to create and implement a plan to increase basic
health insurance coverage to residents who currently lack coverage. He suggests to you that
you ought to consider this as part of your plan since it will, ultimately, ‘cost us an arm and
a leg.’
In summary, Mr. Smith expects you to include in your plan strategies to change behavior
(related to tobacco use, diets, and physical activity), improve community based efforts, and
increase access while maximizing the cost-effectiveness of the plan. What type of plan
would you provide to Mr. Smith?”
In formulating a new insurance plan for Goliath Health Care, the factors to consider
include a wider basic health insurance coverage of the 20% uninsured people in the Great City,
promoting social behavioral change, improve community efforts in accessing quality affordable,
healthcare while at the same time maximizing profits for the organization. The strategies of
Health sciences and medicine 2
change model which is an insurance plan aimed at segmenting the population and giving each
and every segment specialized treatment makes this plan discriminative hence inapplicable. In
addition, the plan does not guarantee maximum cost efficiency because of complexity in
calculating individual behavioral risk factors.
The second insurance plan which is the medical model was formulated basing on the
analysis of traditional approaches to insurance as well as psychiatric practices. The model is
discriminative and was formerly used in the Western World by nurses who majorly focused on
the physical dysfunctions of a personal and judged his or her behavior pegging on the physical
defects. The medical model loses out since it is subjective since it tends to subject a person’s
physical appearance to their behavior. On the other hand, the chronic care model is biased
insurance plan that deals with specific elements of the health of a population mainly chronic
illness (Fennel, 2006, p 34). This makes the plan limited in scope hence it will be expensive for
the residents of the Great City. Additionally, it is aimed at providing chronic illness care but fails
to acknowledge the need for preventive care.
The fourth plan is the population health model which is also known as the group
insurance plan. It is a comprehensive insurance plan pegged on the health outcome of a group of
people who can help monitor each other’s health thus curbing behavioral risks. The model is
believed to employ evidence based strategies and because of this, it is assumed that it will fully
satisfy the Affordable Insurance Act made by administrators of the Great City. Another
assumption underlying the population health model is that it will accommodate approximately
50% of the city residents while ensuring that moral hazard is practiced as the only way to
achieving quality, access and beating economic and non-economic barriers that may hinder
Health sciences and medicine 3
organized healthcare delivery. The other assumption is that the model will promote good morals
among a large group of people unlike strategies of change model, medical model, and chronic
care model which do not advocate for collective responsibility.
Coupled by the emerging trends and the prevalence of health hazards at work places and
our immediate environments, the population health model provides a comprehensive insurance
plan for the residents of the Great City, Alabama (Kindig & Stoddart, 2003, p 17). The need for
the insurance plan has been driven by an increase in the behavioral risk factors which elements
associated with the lifestyle and social behavior of an individual making them prone to chronic
diseases. Thanks to the qualified team of personnel at Goliath Health Care Plan who have come
to the rescue of the over 500,000 inhabitants of this city. This implies that it is the duty of
Goliath Health Care to bring quality care services; where quality means delivering affordable
and superior services through designing of an all-inclusive health care plan while balancing key
parameters to make it accessible to all residents despite their walks of life.
With the realization that a recent health bill passed by the Great City Authorities demands
that all residents in the city should have an insurance cover, improving our product visibility
means that more people will have access to our insurance services. In addition to the network
that we have created between medical agencies, healthcare providers and health facilities we
have partnered with fitness centers, aerobics and other providers of facilities for physical
exercises in a bid to achieve our agenda for organized health care delivery.
Nonetheless, our endeavor to provide these services will be costly but with the
population health model, services offered to residents will be given membership cards which
give them access to subsidized insurance cover that suits both the employed and unemployed.
Health sciences and medicine 4
Goliath Health Care will be placed in a better position to provide quality care even with the
prevalence of medical emergencies (Scholle, 2013, p 51). This is simply because gaining
membership of 50% which will be 20% above our current health care coverage. This
consequently has the implication that Goliath Health Care will be able to accommodate both
economic and noneconomic barriers to health care in due time. In defining the term economic
and non-economic barriers to health care, attention is given on the scope and demand of
medical services which adds up while calculating insurance policies.
For instance, higher customer coverage translates into a higher pool of finances collected
as premiums from individuals and organizations. In case of an accident, emergency of illness of
an insured member of an insurance plan, then the pulled funds can be used to cover for the
medical bills of the person afflicted (Parker & Simpson & Sim and Re, 2009, p 20). Different
from cost shifting, purchasing an insurance cover with Goliath Health Care will help in
encouraging our clients to practice restraint in engaging in behavioral risk activities. The fact that
with the inclusion of a cost shifting principles into the aforementioned group insurance plan
could help a great deal because the policy holders will avoid taking on risky social behaviors
such as excessive alcohol consumption, excessive use of drugs, tobacco use, improved health
diets and increase attendance to physical exercises because failure to check on personal behavior,
much of the insurance costs will be shifted to an individual rather than the group insurance
(Lubkin & Larson, 2002, p 21).
The ideals behind cost shifting are motivated by the need for individual responsibility
rather than group responsibility which have proved burdensome in the implementation of the
Affordable Insurance Act as demanded by the administrators of the Great City, Alabama. Thus
Health sciences and medicine 5
the proposed healthcare insurance plans ensures that moral hazard is practiced whereby people
who put their lives at more risk due to poor choice of diet, lifestyles and physical activities pay
more premiums for their insurance policies as compared to those individuals who do not engage
in behavioral risk factors.
Health sciences and medicine 6
References
Fennel, P (2006). The chronic illness workbook: Strategies and solutions for taking back
your life (2 nd Ed.) Delmar NY: Spring Harbor Press.
Kindig, D. & Stoddart, G. (2003). What is population Health? American Journal of
Public Health
Lubkin, I. & Larson, P. (2002). Chronic illness impact and interventions (5 th ed.)
Sudbury, MA: Jones and Bartlett.
Parker, T. Simpson, C, Sim, S. & Re, M. (2009). Living safe – a self-management
program for people with vision impairment. Perth: Curtin University of Technology
Scholle, S. (2013). Support and strategies for change among small patient centered
medical home practices Journal. Ann Fam Med.