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.
Assignment:
Financing Healthcare
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.
Assignment Expectations
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
Introduction:
Healthcare financing is a critical aspect of the healthcare industry, influencing the delivery of care and shaping healthcare policy. Compensation for healthcare services affects the quality of care that patients receive and plays a significant role in healthcare organizations‘ financial stability. This paper will discuss the history of private health insurance and managed care and its involvement in the healthcare industry. It will 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, and explore the opportunities for nurses within the private insurance market.
History of Private Health Insurance and Managed Care
Private health insurance and managed care have a long history that dates back to the early 1900s. The first private health insurance plans were indemnity plans that reimbursed patients for their medical expenses. In the 1930s and 1940s, the first prepaid health plans emerged, providing prepaid medical services to members for a set fee. By the 1960s, managed care emerged as a way to control healthcare costs by managing the delivery of care, focusing on preventive care and promoting healthy behaviors.
Today, managed care is a widely accepted method of healthcare financing, and most private health insurance plans are managed care plans. Managed care plans offer a network of providers who agree to provide care at a discounted rate to plan members. These plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.
Key Federal Laws Protecting Individuals in Private Insurance
The Affordable Care Act (ACA) is the primary federal law protecting individuals who are enrolled in private insurance. The ACA established minimum standards for health insurance coverage, including essential health benefits such as preventive care, prescription drugs, and mental health services. The law also includes consumer protections, such as prohibiting insurers from denying coverage to individuals with pre-existing conditions and prohibiting annual and lifetime limits on coverage.
The Health Insurance Portability and Accountability Act (HIPAA) is another federal law that protects individuals with private insurance. HIPAA established national standards for protecting the privacy and security of individuals’ health information, ensuring that individuals have access to their medical records and prohibiting discrimination based on health status.
Consumer-Driven Healthcare and Empowerment of the Healthcare Consumer
Consumer-driven healthcare is a movement that promotes greater involvement of patients in their healthcare decision-making and responsibility for their healthcare costs. This model emphasizes transparency of healthcare prices, choice of healthcare providers, and financial incentives for patients who make cost-effective healthcare choices.
The empowerment of the healthcare consumer is also central to this model. This means that patients are given information about their healthcare options and encouraged to make informed decisions based on their healthcare needs, preferences, and financial situation. Empowerment of the healthcare consumer can lead to better health outcomes, improved patient experience, and greater cost savings in the healthcare system.
Opportunities for Nurses within the Private Insurance Market
Nurses play a vital role in the private insurance market, contributing to healthcare delivery and healthcare policy. Opportunities for nurses within this market include working as case managers, utilization review nurses, and nurse navigators. These roles require nurses to use clinical knowledge and critical thinking skills to manage patients’ care and ensure that they receive the most appropriate and cost-effective care.
Conclusion
The history of private health insurance and managed care has influenced the healthcare industry, shaping healthcare policy and healthcare delivery. Key federal laws protect individuals who are enrolled in private insurance, and consumer-driven healthcare empowers patients to make informed healthcare decisions. Nurses can contribute to the private insurance market by working in various roles, such as case managers, utilization review nurses, and nurse navigators. By understanding these aspects of healthcare financing, nurses can play a vital role in improving the quality of care that patients receive and ensuring the financial stability of healthcare organizations.
