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Essay Available:
Pages:
2 pages/≈550 words
Sources:
6 Sources
Level:
APA
Subject:
Health, Medicine, Nursing
Type:
Essay
Language:
English (U.S.)
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Topic:

07-U4-T1-T2 Financial Models Of Reimbursement And Effects On Patients And Healthcare Providers (Essay Sample)

Instructions:

07-u4-t1-t2 

Financial Models Of Reimbursement And Effects On Patients And Healthcare Providers

The United States healthcare system is like a patchwork quilt. There are public and private third-party payers, cash payments, co-pays, deductibles, out-of-network treatments, in-network treatments, dental coverage, no dental coverage, uncovered drugs, generic drugs, Medicaid, Medicare, Workers' Compensation, the No-Fault system, managed care, PPO's and now, the Affordable Care Act. How the advance practice nurse fits into all of this, as well as the physician and other health care providers, can be complex.

There is an opportunity for the advance practice nurse to move into a position of providing some of the services that had formerly been provided by primary care physicians. There are gaps in care. These gaps can be filled by the nurse practitioner or the advance practice nurse.

There are a number of provisions in the Affordable Care Act where interdisciplinary care is encouraged. An important function of interdisciplinary care is having interdisciplinary education.

•Analyze implications of managed care. •Assess the Affordable Care Act and cost shifting implications. •Identify health care policies that use cost shifting.

Direction:

Topic 1: Cost Shifting

Identify health care policies that use cost shifting. Argue the benefits of cost shifting. How might the Affordable Care Act decrease cost shifting within hospitals?

1 page, APA format, 6th edition, 3 references within 5 years.

Topic 2: Managed Care

In what way does managed care actually manage cost? Does it do so without diminishing the quality of care? If so, how does it accomplish this?

1 page, APA format, 6th edition, 3 references within 5 years.

source..
Content:


Cost Shifting and Managed Care
Student's Name
Institutional Affiliation
Cost Shifting and Managed Care
Topic 1: Cost Shifting
Cost shifting is a process where healthcare institutions charge patients who are insured a higher price compared to what uninsured patients are charged for the same services or procedures. There are a number of healthcare policies that use cost shifting, with policymakers arguing that this strategy is large and inevitable. First, health care providers use cost shifting in such a way that patients with health insurance end up paying for losses incurred when hospitals treat patients who do not have insurance (Coughlin, et al, 2014). This implies that a patient who relies on Medicare will be charged less compared to the one who has a private insurance.
There are several benefits of cost shifting. First, healthcare institutions are able to recover losses from services provided to uninsured patients. Second, patients are able to access quality care offered to insured patients despite the lack of enough resources to pay for health insurance. Furthermore, price discrimination, which is closely related to cost shifting, can be applied based on market power, implying that patients are charged for services provided depending on the ability to pay (Frakt, 2015). Lastly, cost shifting enables hospitals to increase premiums for wealthy neighborhoods and subsidize services for low-income areas, thus promoting the implementation of free universal health care system.
The Affordable Care Act (ACA) can decrease cost shifting within hospitals since, under ACA, the substantial amount of money that is paid to private health insurers will drastically reduce and thus prevent the prevalence of cost shifting. Moreover, ACA increases the number of insured patients under Medicare and Medicaid and this prevents hospitals from charging differently for services provided (Dranove, Garthwaite & Ody, 2017). Lastly, before implementation of ACA, the health care institution had to cater for the cost of services offered to uninsured p

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