course materials

1. HLTH 4530 Walden University Impact of Healthcare Insurance &
Reimbursement HW
HLTH 4530 Walden University Impact of Healthcare Insurance & Reimbursement HWHLTH
4530 Walden University Impact of Healthcare Insurance & Reimbursement HWCLICK HERE
TO ORDER YOUR ASSIGNMENTLearning 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

2. 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
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 BELOWKRYSTAL WESTRE: Discussion – Week
2COLLAPSEDiscussion: The Impact of Healthcare Insurance and ReimbursementFor 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,

3. 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_Health
care_ConsumersPenner, S. J.(2017). Economics and financial management for nurses and
nurse leaders (3rd ed.). New York, NY: Springer Publishing.Shasta BlandRE: 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.ReferenceASPE (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_health
insurancepayersplans.htm