Tools and Resources for Analyzing Health Insurance, Hospitalization Services, and Costs

Resourcing plans are critical components of an organization's overarching visions, aims, and objectives. The numerous resources available in a healthcare facility must be balanced and economically employed with the primary purpose of increasing healthcare quality, safety, and accessibility (Rundio, 2012). As a result, these resource plans must be managed by experts with unrivaled experience in the fields of human resources and financial management. A good resourcing plan includes money and staffing components. The budget part of a resourcing strategy is the subject of this article because financial resources are crucial in the heart failure clinic. Different organization manage their activities in various ways (Cranmer & Nhemachena, 2013). However, the heart failure clinic would conduct its activities basing on the guidelines prescribed by American Heart Association and other professional bodies. Different scientific literature and professional expertise would be used as evidence for all the activities. The clinic would also appraise, apply, and assess the empirical studies to identify the best practices in budgeting.

Business Plan Categories and Subcategories

Start-up expenses

Fixed Costs

Variable Costs

Capital Budget Items





Legal and Professional fees

Salaries of the Staff



Hygiene supplies

Staff benefits

Fixed Payments

Staff healthcare

Transportation costs to and from the clinic.

Legal services

Staff overtime

Other personnel line items

Capital budgeting assists in saving for the future.

Some critical capital budget items for this clinic would include:

equipment and software upgrades


computers for the clinical sessions.

Buildings where the clinics would take place

Contingency Fund and Parameters

Most organizations set aside some financial resources for unseen expenses of the future. The important fund parameters include scope, sustainability, size, financial sources, and operations (Zelman et al., 2014). The size of the participants of the heart failure clinic would determine the contingency fund for this activity. This fund is also aimed at sustaining the population. The management must be aware of the scope of the clinic before allocating any finances.

Legal and Professional Standards for Outpatient Services Resourcing

The legal aspects of nursing and healthcare facilities are broad. However, for this specific case, the institution must analyze the different aspects of outpatient service resourcing. Some of the federal and state regulations include the privacy act, patient determination act, social networking, healthcare quality improvement act, and the Health Insurance Portability and Accountability Act. These legal aspects could be incorporated into the professional standards enshrined in the nurses’ codes of ethics and prescribed by JCI, FDA, ANA, and AHRQ to determine how resourcing the outpatient services ought to be done (Goodman et al., 2013).

Alignment to the Best Practices and Professional Standards

All the services offered by the Heart Failure Clinic would be aligned to the standards of professional bodies such as the FDA, AHRQ, and other guidelines of the nurses’ code of ethics. These professional bodies have diverse standards that dictate the staffing of a hospital and the minimum resources that a healthcare facility could use in their clinics (Goodman et al., 2013). Only evidence-based practices would be conducted.

Managing Insured and Uninsured Patients

Insured patients would be cautioned from enormous hospital costs (Zelman et al., 2014). Therefore, managing this group would be easy as the insurers could be contacted in case of any pressing issues. However, uninsured patients would be advised to pick up insurance cover, or the management would ensure that they are given an estimation of the costs of the healthcare services before any procedures or counselling are conducted.

Management and Accountability Tools

The most effective management and accountability procedures and tools would comprise of the six-sigma model and the root cause analysis that would assist in the management of the various patient outcomes and health delivery services (Simons, Leroy, Savage, 2013).

Tools and Resources for Analyzing Health Insurance, Hospitalization Services, and Costs

The most appropriate data sources for the evaluation of the health insurance, hospitalization services and other costs include Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP). MEPS comprises of different surveys that are conducted with the objective of sourcing for healthcare insurance and cost-related data (Goodman et al., 2013). The HCIP, on the other hand, is primarily applied in sourcing for information relating to the quality and charges of services, access to healthcare, hospital use, and other health care procedures.


The finance department would have an electronic system of conducting all the billing services. Patients would be able to pay for these outpatient services not only by the use of cash but also electronically through debit and credit cards and other online avenues such as PayPal.

Determination of the Cost-Effectiveness of Outpatient Management

Self-monitoring is a perfect methodology of determining whether or not the outpatient management is cost effective (Zelman et al., 2014). The management could determine the readmission rate and relate it to costs. Therefore, the management could determine whether or not outpatient management is cost effective by monitoring the rates of readmissions.

Impacts of Transparency on the Consumer

Transparency has diverse impacts on the consumers, i.e., the patients taking part in this clinic. The primary effect of transparency on consumers is that it embraces a culture of trust. Transparency would also assist the consumers in managing their financial resources as they would know the exact amount of finances that would be required of them.


Cranmer, P., & Nhemachena, J. (2013). Ethics for nurses: Theory and practice. Maidenhead,Berkshire, UK: Open University Press.

Goodman, R. A., Posner, S. F., Huang, E. S., Parekh, A. K., & Koh, H. K. (2013). Peer Reviewed: Defining and Measuring Chronic Conditions: Imperatives for Research, Policy, Program, and Practice. Preventing chronic disease, 10.

Rundio, A. (2012). The nurse manager's guide to budgeting & finance. Indianapolis, IN: SigmaTheta Tau International.

Simons, T., Leroy, H., Savage, G. T. (2013). Leading in health care organizations: Improvingsafety, satisfaction, and financial performance. Bingley, UK: Emerald Group.

Zelman, W. N., McCue, M. J., Glick, N. D., Thomas, M. S. (2014). Financial management ofhealth care organizations: An introduction to fundamental tools, concepts, and applications (4th ed.). San Francisco: Jossey-Bass.

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