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Fundamentals of Risk and Insurance, 11th Edition by Therese M. Vaughan, Emmett J. Vaughan

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CHAPTER OBJECTIVES

When you have finished this chapter, you should be able to

  • Identify and describe the major problems associated with the current health care system
  • Identify the past efforts that have been made to address the problems associated with the financing of health care in the United States
  • Distinguish between the traditional fee-for-service approach to health insurance and the capitation system of managed care providers
  • Identify common cost-containment activities that have been adopted by health insurers
  • Identify and describe the traditional forms of medical expense insurance, distinguishing between basic policies and major medical insurance
  • Explain how managed care and consumer-directed health plans differ in their approach to controlling health care costs
  • Describe the key features of the Patient Protection and Affordable Care Act

A well-planned program for financing medical expenses is an important part of any personal risk management plan. Unexpected illnesses and injuries can result in catastrophic medical expenses for the individual and his or her family. In this chapter, we turn to the subject of insurance against the cost of medical expenses.

Medical expense insurance provides for the payment of the medical care costs that result from sickness and injury. It helps meet the expenses of physicians, hospital, nursing, and related services, as well as medications ...

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