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
In this paper, we will explore the topic of financing healthcare and how it impacts the delivery of care in the healthcare industry. We will discuss the history of private health insurance and managed care, as well as their involvement in the healthcare industry. Additionally, we will identify the key federal laws that protect individuals enrolled in private insurance and briefly discuss consumer-driven healthcare and the empowerment of healthcare consumers. Lastly, we will explore the opportunities that have emerged for nurses within the private insurance market.
Section 1: History of Private Health Insurance and Managed Care
Private health insurance and managed care have played a significant role in the healthcare industry. Private health insurance emerged in the late 19th century as individuals sought protection against the high costs of medical care. Initially, it was provided by fraternal organizations and mutual benefit associations. However, with the rise of employer-sponsored health insurance during World War II, the landscape of private health insurance changed dramatically.
Managed care, on the other hand, emerged in the 1970s as a response to rising healthcare costs and the need for better coordination and management of care. Managed care organizations aimed to control costs by negotiating contracts with providers, implementing utilization management techniques, and promoting preventive care.
Section 2: Key Federal Laws Protecting Individuals in Private Insurance
Several key federal laws have been implemented to protect individuals enrolled in private insurance. The first is the Health Insurance Portability and Accountability Act (HIPAA), which was enacted in 1996. HIPAA ensures the portability and continuity of health insurance coverage for individuals transitioning between jobs and prohibits discrimination based on pre-existing conditions.
Another important federal law is the Affordable Care Act (ACA), which was signed into law in 2010. The ACA provides a range of consumer protections, including the prohibition of insurance companies from denying coverage based on pre-existing conditions, the creation of health insurance marketplaces, and the requirement for individuals to have health insurance coverage.
Section 3: Consumer-Driven Healthcare and Healthcare Consumer Empowerment
Consumer-driven healthcare is a model that emphasizes consumer choice and responsibility in healthcare decision-making. It involves high-deductible health plans paired with health savings accounts or health reimbursement arrangements. This model aims to empower healthcare consumers by giving them greater control over their healthcare spending and decision-making.
The empowerment of the healthcare consumer goes beyond just consumer-driven healthcare. It includes providing individuals with access to information about healthcare quality and costs, promoting shared decision-making between patients and healthcare providers, and ensuring that individuals have the ability to choose their healthcare providers and services.
Section 4: Opportunities for Nurses in the Private Insurance Market
Nurses play a crucial role in the private insurance market. They are involved in various aspects, including utilization management, case management, and patient education. With their expertise in patient care and healthcare systems, nurses are well-positioned to contribute to the efficient and effective delivery of care within the private insurance market. Additionally, nurses can serve as advocates for patients within the insurance system, ensuring that their needs and preferences are considered.
In conclusion, financing healthcare has a significant impact on the delivery of care in the healthcare industry. Private health insurance and managed care have evolved over time and continue to shape the healthcare landscape. Key federal laws protect individuals enrolled in private insurance, ensuring access to coverage and prohibiting discriminatory practices. Consumer-driven healthcare and the empowerment of healthcare consumers aim to give individuals greater control over their healthcare decisions. Finally, opportunities have emerged for nurses within the private insurance market, where they can contribute to the delivery of quality care and advocate for patients.