求助一道曼哈顿逻辑题

Jez

In a certain country, insurance companies pay only a fixed percentage – set by law and uniform across all insurance companies – of the fees actually billed by healthcare providers; the remaining balance is waived. Patients without insurance coverage, however, are legally responsible for the full amount of those fees. If the fixed percentage set for insurance companies is changed, healthcare providers will adjust their fees so that the insurance companies pay the same dollar amount that they would have paid before the change.

The information given most strongly supports which of the following general claims about the country described?

A. If the percentage prescribed by law for insurance companies is decreased, private patients without insurance coverage will pay more for healthcare services.
B. The dollar amount paid by insurance companies to healthcare providers will not change unless the legally specified percentage is changed.
C. If the number of patients without insurance coverage grows beyond the number of patients covered by insurance, healthcare providers will adjust their billing practices according to the needs of those patients.
D. If an economic recession causes the healthcare industry to suffer, the legally prescribed percentage paid by insurance companies will be increased.
E. Acquiring insurance coverage, if possible, would be a sound economic decision for any patient.

A


不太理解原文的意思，是这样吗？——
保险公司支付受保人一定比例的医药费，该比例由法律规定。【the remaining balance is waived——这句话怎么理解，是受保人不需要缴剩下的医药费还是保险公司不需要缴剩下的医药费？】没投保险的人就要自己支付全部的医药费了。当这个比例改变时，【healthcare provider是谁？是医院吗？】healthcare provider会随之改变医药费，使保险公司支付的金钱保持不变。
【完全不理解啊，healthcare provider为什么这么做？】





曼哈顿自己的解释
Under the law, insurance companies only have to pay a fixed percentage of healthcare bills, but private patients must pay the full amount. In addition, if the percentage is changed, healthcare providers will adjust the amount of the bill, so that the dollar amount does not change. If the legal percentage is decreased, healthcare providers must increase the billing level in order to offset the change. Alternatively, if the legal percentage is increased, healthcare providers would have to decrease the billing level in order to offset the change. 【？？？】

Jez

有点明白了——每次都在打完字才有点感悟——说明阐述问题的重要性

受保人不需要交一分钱，医药费中一定比例保险公司付，剩下的谁都不需要支付。所以healthcare provider（应该是医院）提高医药费时，受保人无影响，保险公司交一样多的钱，受苦受难的就是没投保的人了（因为医药费提高了）。
真欺负人

安成

诶，所以是选a？这题真的有点绕诶。

the remaining balance is waived －我的理解是，insurance 和healthcare provider 是合作滴，所以当healthcare provider 提供了服务之后，claim直接寄到保险公司，保险公司付部分claim里面的金额，剩下全免掉了。他们之间有个long term 的合作关系。所以healthcare provider 这么做等于给个折扣给保险公司。保持长期合作，或者拉新的客户。

所以individual 没有保险的就是用来调整里面的差价的，我觉得楼主的理解完全正确。

顺带一提，虽然我觉得和这题没什么关系。但是healthcare provider 可以是医院，药店，私人护理师，甚至是医疗注册的按摩师 etc。

这个运营的关系是，保险公司charge fixed premium，然后公司收到claim也是个几率问题。统一charge的premium可以用作投资。一部分付claim, 剩下的运营开销和profit。
healthcare provider 之所以这样做是因为这个最适合他们运营，毕竟不只是医院。还有小型的机构，很多地方如果和保险公司有合作，会有更多的客户。

当然我觉得以上完全和题目没啥关系，正好了解这块，分享一下。

Jez

安成 发表于 2017-8-3 21:48
诶，所以是选a？这题真的有点绕诶。

the remaining balance is waived －我的理解是，insurance 和healthc ...

嗯 没错 谢谢你的分享！ healthcare provider如果和保险公司合作会有更多客户——这里的客户是指的受保人吗？ 他们不考虑没有投保的人吗？

安成

Jez 发表于 2017-8-4 10:17
嗯 没错 谢谢你的分享！ healthcare provider如果和保险公司合作会有更多客户——这里的客户是指的受保人 ...

客气客气。healthcare provider （在这里waive一些费用）的主要目的是吸引那些有保险的人来使用保险。相对而言，没有投保的客人是可以另外的办法吸引，比如打折啊什么的。

Jez

安成 发表于 2017-8-4 21:50
客气客气。healthcare provider （在这里waive一些费用）的主要目的是吸引那些有保险的人来使用保险。相 ...

明白了 果然还是常识不足

安成

Jez 发表于 2017-8-4 21:57
明白了 果然还是常识不足

不会不会啦，互通有无互通有无哈哈。