course materials

1. Discussion: The Impact of Healthcare Insurance and Reimbursement
Discussion: The Impact of Healthcare Insurance and ReimbursementDiscussion: The Impact
of Healthcare Insurance and ReimbursementCLICK HERE TO ORDER YOUR
ASSIGNMENTHealthcare 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 your Discussion with a reference to
course materials or a reference within the last three years.BY DAY 6Respond to at least

2. 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, 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

3. 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