Module 1required Readingbaicker K Chandra A 2008 Myths And Misc ✓ Solved

Module 1 Required Reading Baicker K, & Chandra A. (2008). Myths and Misconceptions about U.S. Health Insurance. Health Affairs , 27(6), w533-43. Retrieved from ProQuest on 11/21/2012.

Blumenthal D. (2006). Employer-Sponsored Health Insurance in the United States – Origins and Implications. New England Medical Journal , 355(1), 82-88. Retrieved from ProQuest on 11/21/2012. Bodenheimer, T. (2005).

High and Rising Health Care Costs. Part 1: Seeking an Explanation. Annals of Internal Medicine , ), . Available at: Choudhry, N., Rosenthal, M. & Milstein, A. (2010). Assessing the Evidence for Value-Based Insurance Design.

Health Affairs , 29 (11), . Retrieved from ProQuest on 11/21/2012. Claxton, G. (2008). How Private Health Care Coverage Works: A Primer. A Henry J.

Kaiser Family Foundation Report. Available at (Retrieved 11/21/2012) Eibner, C., Hussey, P., & Girosi, F. (2010) The Effects of the Affordable Care Act on Workers’ Health Insurance Coverage. New England Journal of Medicine , ), . Available at Trident University Online Library. RAND Corporation. (2010).

US Health Care Today: Coverage. Available at (Retrieved 11/21/2012) Required Website Kaiser Family Foundation (2009). Health Insurance and Access to Health Care: the Evidence. Available at: Module 2 Required Reading Kaiser Family Foundation. (2010). Medicare: A Primer.

Available at Kaiser Family Foundation. (2010). Medicare at a Glance. Available at Medicare Payment Advisory Commission. (2016). Context of Medicare Payment Policy. In Report to Congress: Medicare Payment Policy .

Washington: The Commission. Retrieved from Newhouse, J. (2010). Assessing Health Reform's Impact on Four Key Groups of Americans. Health Affairs , 29 (9), . Available at Zarabozo, C., & Harrison, S. (2009).

Payment Policy and the Growth of Medicare Advantage. Health Affairs , 28 (1), W55-W67. Retrieved from ProQuest on 11/21/2012. Required Website Kaiser Family Foundation (2010). Health Reform and Medicare: Overview of Key Provisions.

Available at: Kaiser Family Foundation (2009). Medicare 101: the Basics. Available at Module 3 Required Reading Kaiser Commission on Medicaid and the Uninsured. (2011). Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform. (Retrieved 11/21/2012) Kaiser Commission on Medicaid and the Uninsured. (2011). Top 5 Things To Know About Medicaid. (Retrieved 11/21/2012) Kaiser Commission on Medicaid and the Uninsured. (2010).

Medicaid: A Primer. Available at (Retrieved 11/21/2012) Kaiser Commission on Medicaid and the Uninsured. (2010). The Medicaid Program at a Glance. Available at (Retrieved 11/21/2012) Mortensen, K. (2010). Copayments Did Not Reduce Medicaid Enrollees' Nonemergency Use of Emergency Departments.

Health Affairs , 29 (9), . Retrieved from ProQuest on 11/21/2012. Sommers, B. (2010). Enrolling Eligible Children in Medicaid and CHIP: A Research Update. Health Affairs , 29 (7), .

Retrieved from ProQuest on 11/21/2012. Decker, S.. (2009). Changes in Medicaid Physician Fees and Patterns of Ambulatory Care. Inquiry , 46(3), . Retrieved from ProQuest on 11/21/2012.

Required Website Kaiser Family Foundation (2010). Health Reform: How will Medicaid Change? Available at: Kaiser Family Foundation (2009). Medicaid 101. Available at: Module 4 Required Reading Medicare Payment Advisory Commission. (2016).

Medicare Payment Basics: Hospital Acute Inpatient Services Payment System. Available at: Medicare Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at Centers for Medicare and Medicaid. (2010). Hospital Outpatient Prospective Payment System.

The Medicare Learning Network Payment Systems Fact Sheet Series. Available at (Retrieved 11/21/2012) Centers for Medicare and Medicaid. (2009). Acute Care Hospital Inpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at (Retrieved 11/21/2012) Medicare Payment Advisory Commission. (2014).

Physician and Other Health Professionals Payment System. Available at Centers for Medicare and Medicaid. (2014). Medicare Physician Fee Schedule. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at Guterman, S., Davis, K., Stremikis, K., & Drake, H. (2010).

Innovation in Medicare and Medicaid Will Be Central to Health Reform's Success. Health Affairs , 29 (6), . Retrieved from ProQuest on 11/21/2012. Lesser, C., Fineberg, H., & Cassel, C. (2010). Physician Payment Reform: Principles That Should Shape It.

Health Affairs , 29 (5), . Retrieved from ProQuest on 11/21/2012. Wilensky, G. (2009). Reforming Medicare's Physician Payment System. New England Journal of Medicine , 360 (7), . This item is available in full text via the University library.

Paper for above instructions

Introduction

The U.S. health insurance landscape is multifaceted, involving various forms of coverage such as employer-sponsored plans, Medicare, and Medicaid. Each of these types has its own implications for healthcare access, costs, and quality. This paper summarizes critical insights on U.S. health insurance, focusing primarily on the findings presented by notable scholars in the field. It leverages specific modules of readings provided by various sources to highlight the myths surrounding health insurance, the role of Medicare, and Medicaid, and the trends influencing the healthcare system today.

Myths and Misconceptions about Health Insurance

Baicker and Chandra (2008) tackle several pervasive myths related to U.S. health insurance, emphasizing that misconceptions hinder the effectiveness of health policy reform. They illustrate that many individuals uninformed about the realities of insurance believe that merely expanding insurance coverage will yield better health outcomes, ignoring crucial factors such as the quality of care provided. This belief is mirrored in other research, demonstrating that insurance does not inherently translate to adequate healthcare access or improved health status (Blumenthal, 2006).
In evaluating the financial aspects, it is critical to note that the U.S. spends substantially more on healthcare than other developed nations. According to Bodenheimer (2005), the high costs can often be attributed to a plethora of factors including administrative overhead, inefficient delivery systems, and a propensity for expensive technology and services as opposed to cost-effective preventative care.

Employer-Sponsored Insurance

Employer-sponsored insurance has been a traditional pillar in the American healthcare system. Blumenthal (2006) provides insights into its historical evolution and presents the implications of relying on employer-based insurance. The roots can be traced back to World War II when wage controls led employers to offer health benefits to attract and retain workers. This arrangement has produced significant unintended consequences, including job lock—where workers remain in undesirable jobs for fear of losing health coverage—thereby stifling the labor market's dynamism.
The Kaiser Family Foundation (2009) highlights the critical role employer-sponsored insurance plays in maintaining access to healthcare for millions of Americans. However, with rising costs, many employers have begun passing on expenses to employees through high deductibles and cost-sharing, which can deter them from seeking necessary medical attention (Claxton, 2008).

Medicare: Structure and Implications

Medicare, established in 1965, serves a vital role in providing healthcare to seniors and certain disabled populations. As of 2010, developments around Medicare reflect significant changes driven by national health reforms (Kaiser Family Foundation, 2010). The Affordable Care Act (ACA) has sought to improve Medicare’s efficiency by focusing on value-based care, emphasizing cost control while ensuring quality service delivery (Eibner, Hussey, & Girosi, 2010).
The Medicare Payment Advisory Commission (2016) lays out payment policy frameworks that influence quality improvement and cost reduction strategies. With the advent of bundled payments and Accountable Care Organizations (ACOs), the goal is to incentivize healthcare providers to focus on outcomes rather than the volume of services provided.

Medicaid: Expansion and Challenges

Medicaid plays a crucial role in providing coverage to low-income Americans. The program is often evaluated in the context of financial sustainability amid escalating healthcare costs (Kaiser Commission on Medicaid and the Uninsured, 2011). Reports indicate that expansion of Medicaid under the ACA has significantly increased coverage among previously uninsured populations, although states' inconsistent adoption of the expansion poses challenges (Mortensen, 2010).
Furthermore, the payment rates for Medicaid providers can affect care accessibility and quality. According to Decker (2009), states with higher Medicaid reimbursement rates often report better access to care for beneficiaries. However, in many regions, low payment rates discourage physician participation, leading to crowded emergency rooms and inadequate access to primary care (Sommers, 2010).

The Role of Policymaking and Future Directions

The interplay among Medicare, Medicaid, and private health insurance highlights the need for comprehensive policy reform. The ongoing discussions regarding healthcare delivery reform center around innovative models that prioritize patient outcomes while controlling costs (Wilensky, 2009). A multi-faceted approach that includes addressing socioeconomic determinants of health may offer pathways to improve the overall health status of populations while decreasing the financial burden on the healthcare system (Guterman et al., 2010).

Conclusion

Understanding the complexities of the U.S. healthcare insurance framework is paramount for policymakers, stakeholders, and the public. The interplay between employer-sponsored insurance, Medicare, and Medicaid requires nuanced approaches to policy reform that balance coverage expansion with cost management and quality of care improvements. As the landscape continues to evolve, sustained research and evidence-based practices will be vital in informing strategies that enhance healthcare accessibility and affordability in a manner that is consistent with the values of equity and efficiency.

References

1. Baicker, K., & Chandra, A. (2008). Myths and Misconceptions about U.S. Health Insurance. Health Affairs, 27(6), w533-43.
2. Blumenthal, D. (2006). Employer-Sponsored Health Insurance in the United States – Origins and Implications. New England Medical Journal, 355(1), 82-88.
3. Bodenheimer, T. (2005). High and Rising Health Care Costs. Part 1: Seeking an Explanation. Annals of Internal Medicine.
4. Claxton, G. (2008). How Private Health Care Coverage Works: A Primer. Henry J. Kaiser Family Foundation.
5. Eibner, C., Hussey, P., & Girosi, F. (2010). The Effects of the Affordable Care Act on Workers’ Health Insurance Coverage. New England Journal of Medicine.
6. Guterman, S., Davis, K., Stremikis, K., & Drake, H. (2010). Innovation in Medicare and Medicaid Will Be Central to Health Reform's Success. Health Affairs, 29(6).
7. Kaiser Family Foundation. (2009). Health Insurance and Access to Health Care: the Evidence.
8. Kaiser Family Foundation. (2010). Medicare: A Primer.
9. Medicare Payment Advisory Commission. (2016). Context of Medicare Payment Policy.
10. Mortensen, K. (2010). Copayments Did Not Reduce Medicaid Enrollees' Nonemergency Use of Emergency Departments. Health Affairs, 29(9).