Compare and contrast the pitfalls of health planning.

The pitfalls of health planning are the difficulties experienced by different methods of health planning. In a bit to highlight the pitfalls of various health Planning methods, a detailed definition of health planning itself will be helpful. Health Planning can be referred to as planning concerned with improving health, whether undertaken comprehensively for a whole community or for a particular population, type of health service, institution, or health program. The components of health

planning include: data assembly and analysis, goal determination, action recommendation, and implementation strategy.

Types of Health Planning

Health planning can be categorized into four different types. They are; the fee for service, health maintenance organization (HMO), point of service plan (POS) and preferred provider organization (PPO).

The Fee-for-Service Plan

The fee-for-service plan or the indemnity plan is the most expensive option. In this planning method, the individual chooses the hospital or who the doctor who carries out health care services. The individual is at liberty to terminate of change who carries out this services. In the real sense, the individual can hire or fire who attend to his health care services. In this plan, the individual sign up for a year plan by paying a premium for the services expected. After meeting that deductible the plan pays a percentage of your doctor or hospital bill. The typical percentage arrangement is 80/20. The plan pays 80 percent of the bill while you pay the remaining 20 percent. Because this tends to be the most expensive arrangement for families, it is the least popular selection for most people.

Health Maintenance Organization (HMO)

The  HMO is another type of health planning in which the health care services is rationed among a given organisation for the purpose of saving cost of medical cost of services rendered to the employees of the organisation or members of the family. It is in the interest of the HMO to ensure the health and safety of you and your family, so it covers all necessary treatments. The HMO provides you coverage with no deductibles for a fixed fee. You are a member of the HMO and typically are asked to choose a doctor in the plan, who will be your primary care provider. Your primary care provider will refer you to specialists or other doctors within the HMO network as needed.

 

Preferred Provider Organization (PPO)

The PPO has a network of doctors it has contracted with to provide care at specific fees, and if you seek care within this network, your costs will be less than if you choose a doctor outside the plan. A PPO is a managed care plan, where health care is rationed but to a lesser degree. Unlike the HMO, you have the choice to select the doctors and specialists you'd like to see, but you are encouraged to select doctors within the PPO.

 

Point of Service Plan (POS)

The POS is a combination of an HMO and PPO. Your primary care provider will refer you to specialists, just like in an HMO. Just like the PPO, if you decide to go to a doctor outside the plan, your bill will be higher than if you choose a specialist within the network. These plans are typically not as expensive as a PPO plan but are more expensive than an HMO.

 

Advantages of HMOs

According to the American Heart Association (AHA), HMOs usually offer the broadest range of services for the lowest out-of-pocket cost. Also, according to a Consumer Reports National Research Center survey of over 37,000 people, HMO members were more satisfied with their providers' customer support and reimbursement policies than were PPO members.

 

Disadvantages of HMOs Compared to PPO

HMO plans are more restrictive than PPO plans in that members must choose from a limited pool of health care providers, according to the AHA. Also, in order to see a specialist under an HMO plan, patients must first get a referral from their primary care physician.

Disadvantages of PPOs Compared to HMOs

PPO plans are less restrictive than HMOs with regard to choice of health care provider, and PPO members are not typically required to obtain a referral from their family doctor in order to see a specialist, according to the AHA. Also, unlike HMO plans, which normally only reimburse for medical services rendered by providers belonging to the HMO network, PPO plans reimburse for some health services procured from out-of-network providers, albeit for a higher cost to the patient than is paid for in-network services.

Disadvantages of PPOs Compared to HMOs

According to Consumer Reports, PPO members not only pay more for their health care; they also experience greater difficulty receiving reimbursements owed to them. Among seriously ill individuals surveyed by Consumer Reports, 32 percent of PPO members reported having billing hassles compared to only 13 percent of HMO members.