Each organization has to have the flow of funds for its operations. The flow of funds helps every health care organization to generate income from other different organizations. Health care centers do not depend on making profits but the quality of service delivery. Their finances come from the third party, donations, and medical bills expenses. The third party experiences difficulties in paying to health care due to frauds. Therefore, health care centers have the flow of funds, which is different from other organizations due to their sources.
The Flow of Funds within an Organization: Including Private Pay and Third-Party Reimbursement
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The funds that flow within an organization can be generated by creating businesses which are allocated through different agencies and departments (King, 2013). Also, the flow of capital or funds accounts must show how the money was obtained from its source, method of transaction, and the expenses. The flow of funds also shows how the money transacted by any other department in the organization is being used for accountability purposes. Every organization has to manage their expenses and the revenue for them to make profits at the end.
Health care depends significantly on the third-party reimbursement, which included the employer, the insurance agencies, and the private bill pay system for their financial sources. Health care flow of funds is a complex process with different services offered and modes of payments (King, 2013). A good example is when a patient is admitted for surgery in a hospital, the hospital will provide them with the hospital expenses along with those from each doctor who took part in the treatment such as the pathologists, anesthesiologists, and radiologists. Being treated in an in-network facility, some of the health care providers, for instance, the physicians might not be in an individual`s health plan provider network. Instead of rewarding each provider for every service offered, the payment system in health care should be based on efficient outcomes and quality.
How to Prevent Abuse and Inefficiencies in Third Party Payments
Inefficiencies, inappropriateness, or misuse by the third party payment in the healthcare might happen due to the presence of different fraud in the organization as well as the abuse or errors available in the system: the magnitude of the subject is so significant, and as a result, it is a prioritized matter in the health organizations (Ginter, Duncan, & Swayne, 2018). There are old-fashioned methods that were used to identify the fraud in health care financial system. Presence of the computerized and electronic record system in the health care system has made it even easier to identify the fraud activities.
Availability of both automated methods and statistical knowledge has improved greatly the science known as "Knowledge Discovery from Databases" (KDD) (Davey, 2016). The KDD helps the third party to get the most valuable information from different sources and target the small groups for scrutiny on the fraud activities. The third party has to conduct the assessment before they handle the fraud issues. Finally, new technological development in health sectors will help the third parties to conduct any transaction with the fraudulent institutions. The available healthcare institutions should also ensure they come up with the best and safest way to receive financial services from the third party (Joudaki et al., 2015). The money should also be paid for the correct service for the interest of the patient to be always protected.
Definition of Flow of Funds in Care Organizations
In the context of the care system, the flow of funds entails transactions where the money is given in exchange for services and medicines. Such flow of funds in care organizations is often more complex when put against other markets because they entail two subcategories, healthcare insurance and healthcare service (Davey, 2016) . In a healthcare financial situation, the consumer is eligible to purchase health insurance at a related company. Upon the purchase, money is occasionally paid to the insurance company by the consumers of healthcare services (Jeon, & Kwon, 2013) . When such consumers utilize the goods and services covered by the insurance company, they are eligible for compensation by the providers of these goods and services through treatment, in this case (Jeon, & Kwon, 2013) . Likewise, the purchaser may pick to obtain eccentric degrees of protection inclusion. However, in the case a consumer is not under full insurance by the company, the cost is shared between the insurer and the consumer at relevant agreed upon percentages. Alternatively, a consumer is subject to reimbursement if they are fully covered by the insurer and do not pay any amount to the goods or services they receive. Concerning the safety net provider installments, medical clinics can be repaid either by spending plan or unit base-per administration, per case, or understanding day.
Challenges Faced by Purchasers Enrolled in Private Insurance
Parties that oppose private health insurance suggest that the health insurance system is counterfeit and should be abolished and, remain with one health insurance company. Such suggestions come from top health organizations and consumer bodies who argue that private health insurance is exploitative due to high premium subscription rates (Jeon, & Kwon, 2013) . Also, they suggest that private insurance companies tend to force consumers into living low lives to cope and avoid surges from the authorities. Consumers argue that private health insurance is inadequate and not comprehensive enough in coverage despite their high premiums (Davey, 2016) . For example, the Affordable Care Act controls private insurance funds. Research has addressed private insurers have failed to meet the key goal of insurance, which is to remove congestions from health providing outlets (Mills et al., 2018) . Besides, many consumers under private health insurance almost certainly end up in paying for the goods and services from their financial accounts (Jeon, & Kwon, 2013) . This is the opposite of the case that the insurance partially covers from the consumer. As a result, purchasers of private consumers pay their medical bills in doubles rather than the intended prior amount. Also, most consumers of private health insurance are subjects to the effects of changing complexities in private sectors that sometimes they are not notified of.
Method Used to Empower Consumers
Involvement and empowerment of consumers and patients are essential objectives of any health care providers that aim to provide better treatment (Jeon, & Kwon, 2013) . On the contrary, most health care providers have not yet established the best ways to incorporate patient empowerment and involvement in their systems. My suggestion as a health care practitioner is first to ensure consumers are well conversant with the health care policies and some other related changing policies. I would even ensure consumers know the right procedures for seeking medical attention, like knowing their health conditions and how to properly state them for diagnosis. I would also use reminders like phone applications that notify patients of what they have learned from doctors, wards, clinics, or any other prescriptions.
Conclusion
In conclusion, health care institutions should monitor the flow of funds carefully. For the effective flow of fund, both integrity and accountability are required. Therefore, necessary since every patient is entitled to proper treatment from both industries. Improper services do occur as a result of fraud, greed, or errors which can always be avoided. Computerization of these industries, for instance, can help reduce errors and fraud. Automation and statistical methods can be used where necessary to remove fraud and greed where applicable. Healthcare is a vital component of any society and should, therefore, be treated with the utmost respect.
References
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of healthcare organizations . John Wiley & Sons. Retrieved on July 7, 2019, from https://books.google.co.ke/books?hl=en&lr=&id=3qVFDwAAQBAJ&oi=fnd&pg=PR7&dq=The+Flow+of+Funds+in+the+Care+Organization&ots=4TDvqmySJG&sig=lxOch7zqS0vpfLNkfoJyzJLBYNg&redir_esc=y#v=onepage&q=The%20Flow%20of%20Funds%20in%20the%20Care%20Organization&f=false
Jeon, B., & Kwon, S. (2013). Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea. Health policy , 113 (1-2), 69-76.
Joudaki, H., Rashidian, A., Minaei-Bidgoli, B., Mahmoodi, M., Geraili, B., Nasiri, M., & Arab, M. (2015). Using data mining to detect health care fraud and abuse: a review of the literature. Global Journal of Health Science. Retrieved on July 7, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4796421/
King, A. (2013). Understanding the Flow of the Dollar and Payor Reimbursement in Tangcharoensathien, V., Witthayapipopsakul, W., Panichkriangkrai, W., Patcharanarumol, W., & Mills, A. (2018). Health systems development in Thailand: a solid platform for the successful implementation of universal health coverage. The Lancet , 391 (10126), 1205-1223.
