Discussion The Impact Of Healthcare Insurance And Reimbursement 1 Question Description Le …

Discussion The Impact Of Healthcare Insurance And Reimbursement 1Question Description Learning ResourcesRequired ReadingsPenner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.Chapter 2, “Health Insurance and Reimbursement” (pp. 27-60)Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015: Current population reports. Retrieved from https://www.census.gov/content/dam/Census/library/…Glatter, R. (2017). In 3 states, if Anthem thinks you shouldn’t have gone to ER, it won’t pay. Retrieved from https://www.forbes.com/sites/robertglatter/2017/10… Keith, K. (2018). Litigation update: Challenges to Kentucky’s Medicaid waiver, cost-sharing reduction, and risk corridors. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog2018…U.S. Department of Health and Human Services, Office of Minority Health. (2016). Minority population profiles. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl…Discussion: The Impact of Healthcare Insurance and ReimbursementHealthcare economics are affected by the push and pull of three participants: the payer, the provider, and the consumer. Consider this example:You work full time for your employer who provides vision insurance as a benefit. Your contribution is $5 a month or $60 a year. Your employer contribution is $10 a month for each employee enrolled.You find yourself in need of new glasses and have fallen in love with the designer $600 frames. Your copay on glasses is 20% for one pair of glasses so your out-of-pocket cost is $120. For your new glasses, the insurance company has to pay the $300 difference between what they collected from you, your employer, and your copay.Clearly, the insurance company cannot do this for every employee every year so they increase rates, which means your employer must increase your contribution as well. In addition, the insurance company adds purchase limits on the maximum it will pay for new glasses or how often it will do so, say once every 2 years.Consider this scenario as it applies to other healthcare costs, copays, and contributions. If we can demand to have the most expensive healthcare solutions, and only pay our co-pay, that impacts insurance companies, employers, businesses, and other patients.In this Discussion, you will consider the point of view of each party-the payer, the provider, and the consumer-and reflect on the impact of health insurance and reimbursement on behaviors.To Prepare:Review the Learning Resources for this week and consider the role of health insurance on reimbursement strategies, healthcare costs, healthcare access and utilization.You will be assigned to one of the following three perspectives by your Instructor for this Discussion:Healthcare payer * This the one I was assign to by my instructor for this discussion* *ELEGANCE***Healthcare providerHealthcare consumerReflect from the perspective of your assigned role, on how healthcare reimbursement programs, the demand to improve quality outcomes, and access to healthcare impacts utilization and under-utilization in the healthcare market. By Day 4Post a comprehensive response that includes the following:Describe the perspective you were assigned.Give at least one example of how health insurance may affect healthcare costs, reimbursement, healthcare access, and utilization. Be specific about how health insurance impacts each concept.Explain how aspects of healthcare costs, reimbursement, healthcare access, and utilization might affect experiences with healthcare for the perspective you were assigned. Explain. Be sure to support your Discussion with a reference to course materials or a reference within the last three years.By Day 6Respond to at least two of your colleagues (one from each of the perspectives to which you are not assigned). If you were assigned the payer, then respond to a patient and provider perspective, and expand upon or suggest an alternative to the perspective described by your colleague. HERE IS THE TWO CLASSMATES I HAVE TO RESPOND TO LISTED BELOW
KRYSTAL WEST RE: Discussion – Week 2COLLAPSE Discussion: The Impact of Healthcare Insurance and Reimbursement For this discussion, I have been assigned the role of the consumer. “Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare.” (Jennings, Loan, Swanson, Heiner, & Hemman, 2005). A consumer wants more bang for their buck, so to speak. Most consumers do not go to the doctor for minor things unless they have excellent health insurance, such as Medicaid or Chip.I am a 40-year-old woman in good health; therefore, I carry the cheapest insurance that my employer offers. I rarely go to the doctor unless I am in dire need to do so, that’s why I chose the more affordable health insurance. That being said, I do have an extremely high deductible. When I do have to go to the doctor due to illness, it costs me more out of pocket than someone who has a more expensive policy. I would rather pay less a month out of my paycheck and more for a doctor’s visit since I do not have to go that often. I feel a lot of the working population does the same if they are, for the most part, healthy individuals. Since the cost of medical care increases every year, the cost of health insurance must rise. “Insurance coverage and adequate insurance coverage are both serious concerns for many Americans.” (Penner, S.J., 2017).Health insurance does affect health care utilization. Some insurance is not accepted at every healthcare facility, and not all healthcare providers accept all health insurance. In my hometown, for instance, we have two urgent care clinics. One clinic will accept Medicaid, and the other does not except that healthcare coverage. This limits the patients that have Medicaid or Chip insurance to receive care in one urgent care clinic unless they want to pay the cash price for treatment. Health insurance affects healthcare costs, reimbursement, healthcare access, and utilization for the consumer in a variety of ways.References:Jennings, B., Loan, L., Swanson, K., Heiner, S., & Hemman, E. (2005). What Really Matters to Healthcare Consumers. The Journal of Nursing Administration. Retrieved from https://www.researchgate.net/publication/7903452_What_Really_Matters_to_Healthcare_ConsumersPenner, S. J.(2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.
Shasta Bland RE: Discussion – Week 2COLLAPSEI was given healthcare payer As my role for the assignment. A healthcare payer takes care of the financial aspect. According to Patient Navigator Training Collaborative, there are two types of healthcare payers. There are private payers which are insurance companies and public payers which are federal or state governments. Insurance affects healthcare in general.The insurance companies are starting to only pay for certain procedures only if the patient has certain test done or has a certain diagnosis. Another example on reimbursements is Medicaid has a low reimbursement for healthcare facilities that are privately owned and in a low income community. Certain doctors are not credited with certain healthcare insurance companies due to reimbursement reasons. This makes it harder for patients to go to the doctor specially if they do not accept their insurance. Reference ASPE (2/22/2005). Effects of Health Care Spending on the US Economy. https://aspe.hhs.gov/basic-report/effects-health-care-spending-us-economyPatient Navigator Training Collaborative (N.D) Module 2: Insurance. http://www.patientnavigatortraining.org/healthcare_system/module2/3_healthinsurancepayersplans.htm