DHA650 MODULE 1 FINANCING OF HEALTH CARE IN THE UNITED STATES

Module 1 – Home

THE FINANCING OF HEALTH CARE IN THE UNITED STATES

Modular Learning Outcomes

Upon successful completion of this module, the student will be able to satisfy the following outcomes:

  • Case
    • Articulate the purposes of health insurance.
    • Summarize the current health insurance status of the U.S. population.
    • Explain how the presence or absence of health insurance coverage affects health care utilization, disease treatment/outcomes, self-reported health, and mortality.
  • SLP
    • Analyze state-level health insurance status data to study types of payers, percent of uninsured, and graphical timeline trends regarding insurance coverage.
  • Discussion
    • Assess both the potential benefits and the drawbacks of the Patient Protection and Affordable Care Act: should health insurance be mandatory?

Module Overview

In today’s health care environment, financial realities play a critical role in many, if not most, decisions. All levels of health care managers should understand the basics of health care finance, common public and private health insurance payers, reimbursement levels, and the various methods of reimbursement calculation.

In this first module, we begin examining the financing of health care services in the United States population. What are the purposes of having health care insurance? Who are our insured, our underinsured, and our uninsured? Is the level of health insurance coverage in this country getting better, worse, or staying the same over time? What disparities persist, and what effects do these have on the population’s health status and outcomes? Why is having health insurance so important anyway – does it really help us? We’ll look at current data and current research to examine each of these areas, as a foundation to understanding the financing of health care.

Module 1 – Background

THE FINANCING OF HEALTH CARE IN THE UNITED STATES

Required Reading/Viewing

Please review the following materials in this order and access via ProQuest where no link is provided:

Frean, M., Gruber, J., & Sommers, B. D. (2017). Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act. Journal of Health Economics, Vol. 53, 72-86. Available in the Trident Online Library.

View:
Pullman Regional Hospital. (2017, May 23). Healthcare Finance 101 with Steve Febus [Video file]. Retrieved from https://youtu.be/N-SumPdb2PI

Kaiser Family Foundation. (2019). Health insurance coverage of the total population. Available at  https://www.kff.org/other/state-indicator/total-population/?activeTab=map&currentTimeframe=0&selectedDistributions=employer&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health: What the recent evidence tells us. The New England Journal of Medicine, 377(6), 586-593. Available in the Trident Online Library.

U.S. Census. (2018). Health insurance coverage in the United States: 2017. Available at  https://www.census.gov/library/publications/2018/demo/p60-264.html

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Module 1 – Case

THE FINANCING OF HEALTH CARE IN THE UNITED STATES

Assignment Overview

What’s the importance of health insurance? No one plans to get sick or hurt, but most people need to access health care services at some point in their lives. Health insurance status in the United States is varied and inconsistent – and it is changing over time. Critics argue both in favor of or against universal coverage, citing both benefits and drawbacks of coverages and their associated costs.

Assessing the impact of health insurance coverage on a person’s health is complex; health effects may take a long time to be realized, can vary based on insurance benefits/lack thereof, and are often clouded by confounding variables. Let’s begin our Case by examining the purposes of health insurance, the current health insurance status of the U.S.population, and what current research tells us regarding the use vs. outcomes of health insurance coverage.

Case Assignment

Using the information in the required readings, as well as some additional research in peer-reviewed sources, complete your Case assignment by addressing the following:

  1. Articulate the specific purposes of health insurance.
  2. Provide a summary of the current health insurance status of the U.S. population. Who is covered, and by what type of insurance? What portion of the population is uninsured and underinsured? What are the trends in coverages over time?
  3. Explain how health insurance coverage affects health care utilization, disease treatment and outcomes, self-reported health, and mortality.

Assignment Expectations

  1. Conduct additional research to gather sufficient information to support your analysis.
  2. Provide a response of 3-5 pages, not including title page and references.
  3. There are multiple required items to be addressed herein; please use subheadings to show where you are responding to each required item and to ensure that none are omitted.
  4. Support your paper with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals:
    Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php
  5. You may use the following source to assist in formatting your assignment:
    Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/.
  6. For additional information on reliability of sources, review the following source:
    Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Module 1 – SLP

THE FINANCING OF HEALTH CARE IN THE UNITED STATES

Much variation is present in the United States population’s health care insurance coverage status. This Module’s SLP is intended to allow you to study health insurance status and access to health services in either your home state or your state of current residence. Using the “Health Insurance Coverage of the Total Population” link in the background readings, examine the Table, Map, and Trend Graph for your home state or state of current residence. Refine ‘coverage year’ choice to the most recent coverage year posted in the left side navigation bar on the site. Address the following:

  1. Summarize the key insurance findings regarding your state of choice.
  2. Who are the primary payers, and to what percentage of the coverages?
  3. What percentage of your state’s population is uninsured? Underinsured?
  4. What does the trend graph show in terms of the public/private payers and the uninsured? Explain what is changing, for better or for worse, in the last few years.

SLP Assignment Expectations

  1. Conduct additional research to gather sufficient information to support your analysis.
  2. Provide a response of 3-5 pages, not including title page and references.
  3. There are multiple required items to be addressed herein; please use subheadings to show where you are responding to each required item and to ensure that none are omitted.
  4. Support your paper with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals:
    Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php
  5. You may use the following source to assist in formatting your assignment:
    Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/.
  6. For additional information on reliability of sources, review the following source:
    Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Module 1 – Outcomes

THE FINANCING OF HEALTH CARE IN THE UNITED STATES

  • Module
    • Articulate the purposes of health insurance.
    • Summarize the current health insurance status of the U.S. population.
    • Explain how the presence or absence of health insurance coverage affects health care utilization, disease treatment/outcomes, self-reported health, and mortality.
    • Analyze state-level health insurance status data to study types of payers, percent of uninsured, and graphical timeline trends regarding insurance coverage.
    • Assess both the potential benefits and the drawbacks of the Patient Protection and Affordable Care Act: should health insurance be mandatory?
  • Case
    • Articulate the purposes of health insurance.
    • Summarize the current health insurance status of the U.S. population.
    • Explain how the presence or absence of health insurance coverage affects healthcare utilization, disease treatment/outcomes, self-reported health, and mortality.
  • SLP
    • Analyze state-level health insurance status data to study types of payers, percent of uninsured, and graphical timeline trends regarding insurance coverage.
  • Discussion
    • Assess both the potential benefits and the drawbacks of the Patient Protection and Affordable Care Act: should health insurance be mandatory?

Module 1 Discussion: Benefits and Drawbacks of the Patient Protection and Affordable Care Act

 

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After reading the required background resources for this Module, use additional peer-reviewed/scholarly sources to discuss the impacts of the Patient Protection and Affordable Care Act. Include both the realized benefits and also the difficulties experienced by those who are being mandated to participate. Should health insurance be mandatory – why or why not? Explain, and justify your position in a 200-word summary, using facts from peer-reviewed sources to support your explanations and position.

Your posts will be graded on how well they meet the Discussion Requirements posted in the “Before You Begin” section.” Review this section, as well as the discussion scoring rubric.