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From a market power perspective, what contracting advantages and disadvantages accrue to the provider of care, and 3rd party payers relating to quality assurance, payment, and cost control?
From a market power perspective, what contracting advantages and disadvantages accrue to the provider of care, and 3rd party payers relating to quality assurance, payment, and cost control?
Expert Solution
The resulting benefit from care providers is that they are a form of health insurance. The care providers offer care to their members at minimal costs. The providers also give a structured network of how the responsibility will be quickly provided. The resulting disadvantage is that the amount of care paid by the care providers is dependent on network rules, which may cost more.
The 3rd party payers are as described below in terms of standard assurance, payment, and control of cost:-
1. Preferred Provider Organizations. They make more payments if care is acquired within the network and partially pay for expenses if care is obtained outside the system.
2. Health Maintenance Organizations. They only handle costs within the network, and the beneficiaries are required to select the primary care doctor that controls care.
3. Point of Service; It advocates for either the Preferred Provider Organizations or Health Maintenance Organizations when in need of attention.
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