Assignment: Financing Healthcare Consider how compensation for healthcare services shape delivery of care and reflects policy and policy changes, then 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 1500 words. This week you will reflect upon accountability in healthcare finance to address the following: Discuss the history of private health insurance and manage care and how it involved into a 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. Assignment Expectations Length: 1500 words in length Structure: 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 (3) current scholarly sources are required for this assignment.
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Introduction:
The delivery of healthcare services is heavily influenced by the payment and compensation system in place. The way healthcare services are paid for can shape the way care is delivered and can reflect policy and policy changes. In this paper, we will explore the history of private health insurance and managed care, federal laws that protect individuals enrolled in private insurance, consumer-driven healthcare, and opportunities for nurses within the private insurance market.
History of Private Health Insurance and Managed Care:
Private health insurance has been around in some form or another since the early 20th century. Initially, it was offered by employers as a way to incentivize employees and attract new hires. As the cost of healthcare began to rise, insurers began to implement managed care as a way to control costs. Managed care is a system in which insurers negotiate directly with providers to set prices and determine what services are covered. This system incentivizes providers to keep costs low and provide only necessary care. However, it has also been criticized for limiting patient choice and reducing the quality of care.
Key Federal Laws that Protect Individuals Enrolled in Private Insurance:
The Affordable Care Act (ACA) is one of the key federal laws that protect individuals who are enrolled in private insurance. It requires insurers to cover essential health benefits, such as hospitalization and prescription drugs. It also prohibits insurers from denying coverage based on pre-existing conditions or charging higher premiums for certain groups of people. The Employee Retirement Income Security Act (ERISA) is another federal law that regulates private health insurance. It sets standards for employer-sponsored plans and establishes rules around claims and appeals processes.
Consumer-Driven Healthcare and Empowerment of the Healthcare Consumer:
Consumer-driven healthcare is a system in which individuals are empowered to make their own healthcare decisions and have more control over their healthcare spending. One example is a health savings account (HSA), which is a tax-advantaged savings account that individuals can use to pay for healthcare costs. Another example is a high-deductible health plan (HDHP), which has lower monthly premiums but higher out-of-pocket costs. These plans incentivize individuals to make more cost-conscious decisions about their healthcare.
Opportunities for Nurses within the Private Insurance Market:
Nurses have a number of opportunities within the private insurance market, including as case managers, utilization review nurses, and health coaches. Case managers are responsible for coordinating care for individuals with complex medical conditions. Utilization review nurses evaluate the medical necessity of treatments and services. Health coaches work with individuals to develop healthy habits and manage chronic conditions.
Conclusion:
In conclusion, the payment and compensation system in healthcare has an enormous impact on the delivery of care. Private health insurance and managed care have a significant history and have evolved over time to address rising healthcare costs. The federal laws that protect individuals enrolled in private insurance ensure that patients have access to necessary care without worrying about pre-existing conditions or high premiums. Consumer-driven healthcare empowers individuals to make decisions about their healthcare spending and is a growing trend in the industry. Lastly, nurses have a number of opportunities within the private insurance market to contribute to the delivery of high-quality care.
