HBF Business Case

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HBF Business Case

Executive Summary

Any health insurance company faces the challenge of being under the pressure to keep their premiums low because members do not like to see high increase in premiums. The managers are not the price-setters; hence, it is difficult for the companies to control the prices at the public hospitals. However, the health insurance company pays the benefits to members to help them meet the costs of public hospital bills. There have been difficult setting the prices of the public hospitals; hence, could go up depending on the premiums. However, for the case of the private hospitals such as the Hollywood and Ramsey, the company can negotiate with them to control their prices to suit their clients’ needs.

The HBF and the private hospitals negotiate on a periodic basis through discussions so they make slight increases to help the patients meet the prices without difficulties. They do this by making their increase as low as possible or not at all. However, they failed to respond to the issues of high increases, where they thought it was viable. The Ramsey had a chance of running the pressure, where they increased the dividends by putting the members and stakeholders first just like any business could do. It was quite different with their stakeholders because they hold the business as it is. The public hospitals and private hospital perspectives are quite different.

Ramsey is a setup ground that could have been used to change the costs of premiums of other groups. It could be difficult to draw a line where other hospital groups were not involved. Negotiations take place yearly; therefore they were able to handle the issues although they still faced issues of credibility and basic financial management. The criteria for deciding on the premiums are therefore difficult and put the HBF Health Limited at a difficult situation.

There are several issues that the HBF Health Limited insurance company faces. One of the critical problems is the control of premiums, where they are faced with the challenge of increase in premiums that is objected by their customers. Having being mistaken to set prices, they face the difficulty of convincing the public hospitals to reduce their premium rates to suit the capability of their client. As a company, they have taken the initiative to pay the members the benefits that could help them meet their private hospital bills, the doctor’s, the dentists’ and optician’s fees.

The hospital bills are not set by the insurance companies as the case of the private hospitals where they could hold negotiations to lower their premiums to match the needs of their patients. Issues have been faced therefore, in cases where the companies are not in the position to compensate for the needs of the patients and could handle their situations by assessing the conditions of the premium companies. Difficulties are also faced during the periodic negotiations held between the insurance companies and the public hospitals to reduce their premium rates.

For the case of private hospitals, HBF has some concerns where they could negotiate over the fees charged in their patients by having their prices reduced or their premiums increased slightly or not at all. As the premiums rates could be controlled over certain periods, the private companies gave priority to their members and stakeholders as other businesses could do. They prioritized on the members more than the patients; hence, the patients had to put up with their rates as much as possible since it could have been difficult to complain over the same. Therefore, private only some private hospitals like the Ramsey and the Hollywood could allow for periodic negotiations to control their premiums and to be able to control the management of finances.

The increase in premiums was caused by the lack of access and the delays to negotiate initially with the public and private hospitals to reduce their premium rates. Had the company agreed to hold prior discussions with the health facilities, it could have been easy to have them reduce their rates and to meet their daily requirements to serve the patients well. The failure to hold prior discussions was therefore the major cause of the ever rising rates of premiums by the private and public sectors.

The causes were important to the private and public hospitals as it enhanced their motivation to look back into their premium rates and access their pricing. Although it was difficult to make alternative changes, the two entities were responsible for handling their patients’ cases as critical as possible to increase their rates of visits. Had the HBF Health Limited Company taken an earlier initiative to discuss the issues with the concerned parties, the issues could not have led to the development of difficult situations where premiums get increased without the consultation of all the relevant parties.

Pricing control was however difficult because the hospitals were responsible of deciding on the prices for their commodities. Various periodic discussions and negotiations were held responsible for the available premiums rates on the basis of the regulations of the pricing. Indicators revealed the policies of the hospitals pricing were difficult to change without the consultation of the higher authorities. Additionally, the various insurance companies had failed to take the earliest initiatives to ensure the premium rates were in control. Their failures were therefore attributed to the difficult conditions in place, which could not allow any further form of negotiations.


The issues and the causes that the company and the hospitals face could be addressed by other means or alternatives. The inability to decide on the premium rates increase could be discussed in an amicable way with the responsible parties. The management of the finances could be carried out in a comprehensive manner where all the relevant stakeholders could be involved in bringing about change. To address the issue of premium rates increase and decrease, better policies could be set by the government to control the public hospitals from increasing their premiums beyond certain rates.

The providence of benefits to the patients to meet their hospital bills could also be provided in a comprehensive way. Membership committees ought to be formed by both sectors to ensure the premium rates do not deviate so much from the recommended standards set by both the private and the public agencies. Additionally, the minimum rates for the development of constant and lasting rates could be addressed to ensure all the managers are responsible for holding important premium rates for their customers.

Another alternative could be the setting of standards that could control the increase and decrease of the premium rates in the companies. Since everybody is entitled to good health and the right to obtain of the same, both the private and the public sector entities ought to form one body that is responsible for the management of the issues at hand. The body should develop critical standards for the control and management of the premium rates to reduce the cases where other entities increase the rates and pricing beyond the normal rates. Other cases ought to be considered too. The private sectors should prioritize on their patients more that the members or the stakeholders.

Decision Criteria

Decision criteria ought to be very friendly and meet the needs of both the patients, stakeholders, and the responsible entities. The insurance company should come up with effective criteria for assessing the various developments that could help them handle the alternative sources effectively. The criteria ought to consider the alternatives for the causes and the issues at hand. It should be based on the needs of the customers and ought to cover the essential needs of the customers to improve on a daily basis.

The conditions under which the patients are considered could be held very critical to the assessment of the many forms of challenges. Increasing competition on the premium rates should be controlled and the clients given the priority to choose from one alternative to the other. For effective control of the many developments in place, the responsible parties ought to be held accountable for the various ways in which they clients could be attended to in both the private and the public hospitals.

The criteria should also consider the conditions of the patients by assessing its situations through involvement in decision making. They ought to be consulted in cases where the increase of the premium rates is made. Alternatively, they should be considered in all the steps by giving those notices and communicating to them the changes that are in progress of being developed in the health insurance companies and the hospitals. It should also be based on the accessibility of the healthcare in both sectors and ought not to be discriminative of class or race. The decision criteria are therefore essential especially where the forma of developing change is necessary. Therefore, both the health insurance companies and the hospitals should join hands in ensuring better health is offered to the public irrespective of their abilities.

Recommended Solution

The issues derived from the alternatives needed effective solutions. It was recommended that the premium rates be controlled at the national level to avoid contradictions and to reduce on the biasness from the private hospitals. Solutions were chosen for every alternative provided. For the case of the involvement of the public in decisions making, it was recommended that effective communication be made to all the relevant stakeholders to transmit the messages to the public on the changes that needed to be change on a periodic basis. That could only be an effective solution based on the responses that could be obtained from the same.

It was also recommended that the insurance companies should increase their benefits to their customers by reducing the rates at which they are charged so as to avoid inconveniences. The premium rates ought to be increased only to a slight difference and to avoid getting the commands of challenging the conditions in the health sectors. Additionally, the various conditions for the challenges in place could be handled in the most effective manner to avoid getting involved in difficult situations that could challenge the health of the public. Finally, the management of finances is key to increase the levels of credibility and to ensure the companies are at pace with the current development.

Implementations and Implications

The implementations of the solutions in both the public and the private sector hospitals are critical for the success of the health of the public. To achieve the financial implications of the organizations, the national government ought to be involved. Training of the staff on the proper criteria to alter the premium rates would be very necessary. It is recommended that the government ought to challenge the private sector to improve on the conditions given to the public and to give a priority to the patients.

The private sector ought to get involved in assessing the necessary requirements for the achievement success in the insurance company. It should control the prices by setting targets that are achievable and manageable by the organizations concerned. Additionally, premiums rates ought to be issued by the government to both sectors to help them regulate the essential increments on the premium rates and pricing. All the sectors should also take the initiatives to ensure that the public is attended to in a very friendly manner and to avoid any cases of having to change from one point to the other due to pricing. The preferred solution is therefore the involvement of the public in decision making, which would be expensive but manageable by the organizations.


Issue Backgroundhttps://www.youtube.com/watch?v=wWaQvzb3ctE&feature=youtu.be


Cause Background