Blue Cross and Blue Shield Healthcare Program - Essay Example

Blue Cross and Blue Shield Healthcare Program Abstract This paper is about Blue Cross and Blue Shield Healthcare Program historical background through decades, and advantages and disadvantages of the service. Introduction The pathway to covering America: Ensuring quality, value and access (2008) states that BlueCross BlueShield medical care is an insurance plan, run by about 37 autonomous companies for the provision of healthcare insurance services. The medical plan is tailored for the transformation of healthcare solutions on different platforms. Chronological Setting, Benefits and Shortcomings In the year, 1910 groups launched blue healthcare plans for insurance by means of prepaid practices. Monthly membership was paid by members of the plan for a receipt of a range of medical services, which were exclusively provided by a group of suppliers. According to McElroy (2002), prepaid plans for hospital care got introduced in 1929 based on a prototype when there was a tremendous growth on the number of subscribers to the service. The subsequent year saw BlueShield start plans for reimbursing services provided by physicians. In the year 1935, the National Labor Relations Act , which stipulated the need for insurance based health services, saw BlueShield drastically offer services to people in employment. The act was meant for the empowerment of many people inactive employment to access medical care. NDPERS PPO and basic: An overview of benefits and services provided by this plan (2005) states that in the year 1946, it got into partnership with the Greenville Hospital Benefit Association. The initial base of finance sprung up from this partnership, which saw the insuring of approximately thirty thousand people. In the year 1949, a charter got administered to the company for provision of doctor’s services on the platform of a nonprofit grouping. By the onset of the year, 1955 insurance services had covered a wide span and ensured the uptake of both medical and home insurance services throughout America. After Greenville, BlueCross repositioned to Columbia in the year 1957. On the onset of Medicare, which is a federal insurance service that cares for individuals, suffering various disabilities and senior societal members BlueCross got endorsement nomination by hospitals. The nomination was for the handling of hospital plan in the first phase of the Medicare stipulations. Enactment of Medicare Medicaid in the 1960’s saw the selection of BlueCross and BlueShield by the administration to provide Medicare program. The 1973 Healthcare Maintenance Organization Act intensified market competition allowing BlueShield to emphasize more on quality provision and accountability. This led to the improvement of efficiencies on healthcare money expenditure. In the 1970’s the organization premiered new benefits for holding down expenses. Expenses got held down by providing plans that ensured the wellbeing of the customers was improved. In the following year, the two companies merged to become one organization. Gapenski (2003) writes that for the second phase of the Medicare program, BlueShield was chosen by the federal administration. This second phase was for handling of the services of doctors. Immense success emanated from the partnership with Medicare, which resulted in the creation of subsidiaries that were distinct from it, for the handling of other federal contracts and Medicare. Repealing of the legislature, which formed the basis of BlueShield and BlueCross, ensured the two companies become mutual companies of insurance. The outcome of this repeal gave the companies the platform for provision of major medical reimbursements, and entitlement of equal treatment as every other joint Insurer. According to Gapenski (2003), the onset of the 1980’s saw the introduction of novel services and products alongside winning of new contracts from the federal government. During this period, the company experienced financial stability, excellence in reputation, and strength in the industry of health benefits. Gapenski (2003) further states that streamlining of member’s administration benefits inhabiting in areas with different plans from their plans was introduced so they could enjoy the service plans of their subscriptions. This plan also catered for travelling members, and it got introduced in 1995. The subsequent year a service that guarantees the clients privacy got introduced by BlueCross in line with the Health Insurance Portability and Accountability. McElroy (2002) asserts that in the subsequent years spanning into the millennium and some new services were introduced, that included provision of support to health provision organizations. The services were especially catered for the organizations without insurance, and those that were under insured. Some of the services provided during this period, included services that offered the consumers incentives for practicing wellness activities for members suffering particular health distress. Benefits of the Service The care provided is customer centered taking into consideration the preferences of the clients, their family situations and values and the clients are integrally involved in the decision-making plans. The clients benefit by receiving effective and safe healthcare under this program. Timeliness and efficiency in the delivery of care to the patients since the system structural capabilities enable the caregivers and the client’s timely information for prompt actions and decision-making. Enhanced coordination between facilities and caregivers improves efficiency in for medical attention provision. This results in elevated excellence in care to the customers. Disadvantages It has inefficiencies such as its lack of coverage for prescription drugs and lack of care for chronic care for complications arising from unjustifiable medical procedures. The program is very costly since for one to benefit from the program in the final two years of life, they have to consume more of the service, which is a very costly undertaking. Only one third of the expenditure goes to the clients and this is quite burdensome on the clients looking on to benefit from the service. Conclusion The healthcare service has been there for over eight decades and the services and coverage have improved over time. However, as it gets better it continues having its share of disadvantage. References Gapenski, L. (2003). Cases in healthcare finance: Includes diskette with student case models (2nd ed.). Chicago: Health Administration Press. McElroy, B. (2002). True blue: The history of Blue Cross Blue Shield of Georgia 1937-2001. Atlanta, Ga.: Blue Cross and Blue Shield of Georgia. NDPERS PPO and basic: An overview of benefits and services provided by this plan. (2005). Fargo, N.D.: Bluecross Blueshield of North Dakota. The pathway to covering America: Ensuring quality, value and access. (2008). Chicago, Ill.: BlueCross BlueShield Association. RTop of Form Read More