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I JUST NEED HELP ON THE PREMIUM RATE. NOT THE EXTRA CREDIT. Determine the premium rate for a group (1000 members) given the expected utilization
I JUST NEED HELP ON THE PREMIUM RATE. NOT THE EXTRA CREDIT.
Determine the premium rate for a group (1000 members) given the expected utilization shown below and a 15% load factor (12% to cover administrative expenses and 3% profit). If the number of med/surg days increases to 2800, what profit will the insurer earn? Annual Co-pay Co-payment Co-pay Net Service Frequency Cost PMPM Frequency Amount PMPM PMPM Med/Surg Days 2500 $1000 2500 $30 ICU Days 400 $2000 400 $30 Physician Visits 3000 $100 3000 $10 O/P Surgery 600 $600 600 $50 ER 500 $500 500 $25 Lab/X-ray 1500 $125 1500 $10 Extra Credit; 1 point per question 1) What disease did the first patient discussed in How We Do Harm have and what was the outcome? 2) Brawley states "Wealth can increase your chances of getting lousy care", what common healthcare problem is he referring to? 3) In chapter 4 Brawley discusses intellectual dishonesty, malfeasance, and conflict of interest, what is his primary conflict of interest concern? 4) Why was Procrit prescribed for cancer patients and why was it eventually recommended for restrictive-access? 5) Describe the difference between evidence based on a) random clinical trials, b) peer testimonials, and c) anecdotes, which according to Brawley supply the best and least evidence? Determine the premium rate for a group (1000 members) given the expected utilization shown below and a 15% load factor (12% to cover administrative expenses and 3% profit). If the number of med/surg days increases to 2800, what profit will the insurer earn? Annual Co-pay Co-payment Co-pay Net Service Frequency Cost PMPM Frequency Amount PMPM PMPM Med/Surg Days 2500 $1000 2500 $30 ICU Days 400 $2000 400 $30 Physician Visits 3000 $100 3000 $10 O/P Surgery 600 $600 600 $50 ER 500 $500 500 $25 Lab/X-ray 1500 $125 1500 $10 Extra Credit; 1 point per question 1) What disease did the first patient discussed in How We Do Harm have and what was the outcome? 2) Brawley states "Wealth can increase your chances of getting lousy care", what common healthcare problem is he referring to? 3) In chapter 4 Brawley discusses intellectual dishonesty, malfeasance, and conflict of interest, what is his primary conflict of interest concern? 4) Why was Procrit prescribed for cancer patients and why was it eventually recommended for restrictive-access? 5) Describe the difference between evidence based on a) random clinical trials, b) peer testimonials, and c) anecdotes, which according to Brawley supply the best and least evidenceStep by Step Solution
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