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Dual Insurance System: Public and Private

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What are the challenges and benefits to health care professionals providing care in a dual insurance system: public and private?

What do health care professionals need to remember when caring for patients in managed care organizations?

How does being old (65 years old or older) or being poor affect oneâ??s ability to access health care?

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This solution public and private insurance systems.

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There are many benefits to health care providers, in a dual insurance system. The most
common benefit is the ability to serve a greater number of patients, which helps increase
revenue. It can also help providers increase the level of continuity in care, when patients move
from private to public sources. An example might be a retiree who is no longer eligible for
employer benefits and who now relies on Medicare or some other public source. As long as
the provider accepts the public source, the patient can continue using the provider he or she is
familiar with. Patients with current dual coverage may be more likely to seek medical care
when they need it, rather than putting it off. This makes follow up much easier and providers
can more easily treat illnesses in the early stages, rather than it later stages.

Challenges for health care providers are in developing automated systems for patient
records and billing, that will satisfy the requirements of both public and private health care
insurers. Some insurers may require a format that is different from others. In addition, some
insurers may require authorization for procedures that others do not. This can be confusing
to patients, when they move from one insurer to another. Health care providers are left with
the responsibility of explaining this to patients in ...

Solution provided by:
Beatrice Martino, MEd
Education
  • MEd, Jones International University
  • BSc, DeVry University
  • MPH, Walden University
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