Unit I Essay
Instructions
For this assignment, you will write an informed essay. In your essay, complete the tasks outlined below.
- Outline the creation and expansion of modern health insurance in the United States.
- Discuss how major developments in private health insurance, group health insurance, and government-sponsored health insurance have impacted the medical reimbursement process.
- Explain how you foresee payers reacting in regard to how care is paid for as the health care industry undergoes changes to costs and coverage models.
Your response should be at least two pages in length, not counting the title and reference pages. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.
Take advantage of the resources within the CSU Online Library to find credible sources of information. At least one source must come from the CSU Online Library.
Expert Solution Preview
Introduction:
The creation and expansion of modern health insurance in the United States have impacted the medical reimbursement process significantly. There have been major developments in private health insurance, group health insurance, and government-sponsored health insurance programs that have influenced how medical care is paid for in the country. In this essay, we will discuss the history of health insurance in the United States and how different insurance models have impacted medical payments. We will also analyze how payers are likely to react to changes in the health care industry with regards to costs and coverage models.
Outline the creation and expansion of modern health insurance in the United States.
The modern health insurance policy in the US began in the early part of the 20th century. However, it was not until after World War II that the concept of health insurance as a benefit provided by employers gained momentum. The government also started to provide funding for health care through programs like Medicare and Medicaid. The Affordable Care Act (ACA) in 2010, also known as Obamacare, expanded the reach of government-sponsored health insurance programs, increasing accessibility to healthcare for American citizens.
Discuss how major developments in private health insurance, group health insurance, and government-sponsored health insurance have impacted the medical reimbursement process.
Private health insurance, group health insurance, and government-sponsored health insurance programs have impacted the medical reimbursement process significantly. Private health insurance policies are usually paid for by individuals, and the payment is made directly to the health care provider. In contrast, group health insurance policies are usually provided by employers and offer a type of coverage or medical plan for a group of employees. Government-sponsored programs such as Medicare and Medicaid pay providers for their services, and the payment is usually made at a discounted rate. The medical reimbursement process has become more complicated due to these different schemes, but it has also increased accessibility to healthcare for all Americans, regardless of their ability to pay.
Explain how you foresee payers reacting in regard to how care is paid for as the health care industry undergoes changes to costs and coverage models.
As healthcare costs continue to rise, payers are likely to react by exerting more control over how care is paid for. One reaction may be to limit the number of procedures that are covered, increasing the need for individuals to pay out-of-pocket for procedures that were previously covered. Another reaction might be to introduce more cost-sharing arrangements, such as deductibles, co-insurance or co-payments, making it less appealing for people to seek medical care. Payers may also take a more proactive approach to managing the health of its members, introducing wellness programs with the intention of getting healthier and decreasing the number of procedures that need to be performed. Ultimately, payers must find a way to balance the costs associated with medical procedures and treatments with the need to provide Americans with access to effective medical care.
Conclusion:
Health insurance has come a long way in the United States, evolving from small, employer-subsidized policies to vast, government-subsidized programs like Medicare and Medicaid. While the medical reimbursement process has become more complex with the introduction of different insurance models, the goal is to ensure that Americans have access to healthcare, increasing life expectancy and improving overall health. As the healthcare industry undergoes changes to cost and coverage, payers are likely to adapt and react accordingly, using new and innovative measures to balance costs while maintaining the quality of care offered to its members.
