Start by reading and following these instructions: Quickly skim the questions or assignment below and the assignment rubric to help you focus.Read the required chapter(s) of the textbook and any add it.
Start by reading and following these instructions:
- Quickly skim the questions or assignment below and the assignment rubric to help you focus.
- Read the textbook’s required chapter(s) and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
- Consider the course discussions so far and any insights gained from them.
- Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.
Consider how compensation for healthcare services shapes the delivery of care, reflects policy and policy changes, and write a paper that addresses the bullets below. Be sure to completely address each bullet point. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics. This assignment will be at least 1250 words.
This week you will reflect upon accountability in healthcare finance to address the following:
- Discuss the history of private health insurance and managed care and how it is involved in the healthcare industry?
- Identify the key federal laws that protect individuals who are enrolled in private insurance.
- Briefly discuss consumer-driven healthcare and the empowerment of the healthcare consumer.
- Explore the opportunities which have emerged for nurses within the private insurance market.
Length: 1250-1500 words in length
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word amount for this assignment. Your essay must include an introduction and a conclusion.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.
Format: Save your assignment as a Microsoft Word document (.doc or .docx).
Filename: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)
Submission: Submit to the D2L dropbox for grading
Expert Solution Preview
Healthcare financing plays a crucial role in shaping the delivery of care and reflecting policies and policy changes within the healthcare industry. This paper aims to discuss various aspects related to the financing of healthcare, including the history of private health insurance and managed care, federal laws protecting individuals enrolled in private insurance, consumer-driven healthcare, and opportunities for nurses within the private insurance market.
The history of private health insurance and managed care is deeply intertwined with the development of the healthcare industry. In the early 20th century, private health insurance began to emerge as a means for individuals to protect themselves against the financial burden of medical expenses. Initially, it was mainly offered by nonprofit organizations or community-based plans. However, the landscape of private health insurance changed significantly with the introduction of for-profit insurance companies.
Managed care, on the other hand, is a system that seeks to control healthcare costs while maintaining the quality of care. It involves various strategies, such as utilization management, network contracting, and financial incentives, to manage the delivery of care. The rise of managed care in the 1980s and 1990s was driven by the increasing healthcare costs and the need for cost containment.
To protect individuals enrolled in private insurance, several key federal laws have been implemented. One of the most important laws is the Employee Retirement Income Security Act (ERISA) of 1974, which sets standards for private employee benefit plans. It provides protection for plan participants, including access to plan information and remedies for breach of fiduciary duty.
Another significant federal law is the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which aims to improve the portability and continuity of health coverage. HIPAA protects individuals from losing health coverage when changing jobs or experiencing certain life events. It also includes provisions for the privacy and security of individual health information.
Consumer-driven healthcare has gained attention in recent years, with an emphasis on empowering healthcare consumers. This approach encourages individuals to take an active role in their healthcare decisions by providing them with greater control over their healthcare dollars. Consumer-driven healthcare typically involves high-deductible health plans coupled with health savings accounts (HSAs) or health reimbursement arrangements (HRAs). These arrangements allow individuals to save and spend healthcare dollars on their own, providing them with more choices and responsibility in managing their healthcare expenses.
The opportunities for nurses within the private insurance market have expanded significantly in recent years. Nurses can play important roles in insurance companies, such as case managers, care coordinators, or utilization review nurses. Their clinical expertise and understanding of patient needs make them valuable assets in ensuring the appropriate utilization of healthcare services. In addition, nurses may also contribute to the development and implementation of policies and procedures that promote quality and cost-effective care within insurance companies.
In conclusion, financing healthcare has a profound impact on the delivery of care and reflects the policies and policy changes within the healthcare industry. Private health insurance and managed care have evolved over time, shaping the way healthcare services are provided. Federal laws have been enacted to protect individuals enrolled in private insurance, ensuring access to information and remedies for breaches. Consumer-driven healthcare emphasizes the empowerment of healthcare consumers, enabling them to make informed decisions about their health. Nurses have emerged as important stakeholders within the private insurance market, contributing to care coordination and utilization management. These various aspects of healthcare financing highlight the complex interplay between financial considerations, policy, and the delivery of care.