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Consider how compensation for healthcare services shape delivery of care, and 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 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.
Length: 1250-1500 words in length
Structure: Include a title page and reference page in APA format. These do not count towards the minimal 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).
File name: 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
M7 Assignment UMBO – 3
Expert Solution Preview
Financing Healthcare is a crucial aspect of the healthcare industry since it involves how services are compensated, which can shape the delivery of care, and it reflects policy and policy changes. Healthcare financing ranges from private health insurance to federal laws that protect individuals enrolled in private insurance. Nurses also have opportunities within the private insurance market. This paper addresses the history of private health insurance and managed care, the key federal laws that protect individuals who are enrolled in private insurance, consumer-driven healthcare, the empowerment of the healthcare consumer, and the opportunities that have emerged for nurses within the private insurance market.
Section One: History of Private Health Insurance and Managed Care:
The history of private health insurance and managed care began in the early 20th century when the American Medical Association (AMA) opposed compulsory health insurance. They argued that it violated the doctor-patient relationship since the physician-patient relationship was based on trust, privacy, and confidentiality. However, during the Great Depression and World War II, employers began offering health insurance as a benefit to attract workers. This led to the proliferation of health insurance plans, and by 1954, over 80% of Americans had some form of coverage.
Managed care emerged in the 1970s as a response to the rising costs of healthcare. Managed care organizations (MCOs) sought to control healthcare costs by limiting patient choice, reducing reimbursement to providers, and enhancing the quality of care through utilization review, quality assurance, and disease management. MCOs were successful in controlling healthcare costs, but they had negative consequences, such as increased bureaucracy, reduced physician autonomy, and lower quality of care.
Section Two: Federal Laws that Protect Individuals Enrolled in Private Insurance:
The Affordable Care Act (ACA) of 2010 is a federal law that protects individuals who are enrolled in private insurance. The ACA has four key provisions that protect consumers. The first provision is the prohibition of denial of coverage based on pre-existing conditions. The second provision is the annual and lifetime limit on coverage. The third provision is the establishment of health insurance marketplaces where individuals can purchase health insurance plans. The fourth provision is the creation of subsidies to offset the cost of health insurance premiums for low-income individuals.
Another federal law that protects individuals enrolled in private insurance is the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA provides eligible employees and their families the right to continue health insurance coverage for a limited time after their employment has ended. COBRA also covers individuals who have experienced a reduced work schedule or job loss.
Section Three: Consumer-Driven Healthcare and the Empowerment of the Healthcare Consumer:
Consumer-driven healthcare is a healthcare delivery model in which individuals have greater control over their healthcare decisions, such as choosing their healthcare providers, treatments, and insurance plans. Consumer-driven healthcare is based on the principles of transparency, competition, and accountability. The goal of consumer-driven healthcare is to empower consumers to make informed decisions about their healthcare and to increase the quality of care while reducing costs.
The empowerment of the healthcare consumer is essential in consumer-driven healthcare. Empowered consumers are those who have the knowledge and skills to make informed decisions about their healthcare. Empowered consumers are knowledgeable about their healthcare needs and preferences, healthcare quality, healthcare costs, and the available healthcare options.
Section Four: Opportunities for Nurses in the Private Insurance Market:
Opportunities for nurses in the private insurance market have emerged due to the increasing demand for healthcare services and the shortage of healthcare professionals. Nurses can work in various roles within the private insurance market, such as case managers, utilization reviewers, and quality assurance coordinators. Nurses in these roles work to ensure that patients receive high-quality and cost-effective care. Nurses can also work as liaisons between healthcare providers and health insurance companies.
In conclusion, healthcare financing plays a crucial role in the healthcare industry, and it can shape the delivery of care. Private health insurance and managed care emerged in the early 20th century and the 1970s, respectively, and have since evolved. Federal laws, such as the ACA and COBRA, protect individuals enrolled in private insurance. Consumer-driven healthcare and the empowerment of the healthcare consumer are increasingly becoming essential components of the healthcare industry. Finally, nurses have several opportunities within the private insurance market and can contribute significantly to the quality of care provided.
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