Paying for Health Care

You can find some information in your textbook, but there are some great resources located in the Learning Materials under Unit 2 for you to use towards this Unit’s assignments. In addition, I posted additional websites in the Learning Materials general section to access. They are titled as such:

• Communication Models
• Models of Communication
• Conflict Resolution Methods
• Conflict Management Techniques

Paper #2 assignmentUnit: Paying for Health CareDue Date: Sun, 7/5/15Grading Type:NumericPoints Possible: 100Points Earned: 0Deliverable Length: 5-7 pages of content; min. 5 relevant scholarly/professional peer-reviewed references

Assignment Description

The funding and reimbursement aspects of health care delivery are complicated, transaction-oriented, and subject to applicable laws and regulations. The sheer volume of transactions and myriad nuances of patient care make the process of documenting services delivered and payments received even more complex. Unfortunately, motive and opportunity to commit fraud often find health care organizations an ideal target for criminal activities given this volume of complex transactions.You have been retained as a consultant by a large health care organization that wants to take a proactive approach to fraud prevention by increasing employee awareness. They have asked you to provide a report outlining how you would develop a training program for managers that will help them learn to do the following:

• Analyze health care fraud and the consequences of health care fraud on the following:
  • Patient
  • Health care provider
  • Institutions involved
  • Others
• Assess the concerns of a manager pertaining to the receipt of payment for services rendered.
• Evaluate the impact of payments or delays in payment on budgeting and planning.

Relevant Resources:Use the online library to search for the complete article athttps://mycampus.aiu-online.com/portal/5/library/pages/libraryhome.aspx. Article 1: Feder, H. M. (2010). New study examines health care fraud in the United States. Journal of Health Care Compliance, 12(1), 37–38. Database: Cybrary 2.0 Description: This article offers the author’s view on the new study published in context of the health care fraud in the United States by researchers. As stated, the study examines the variety of health care fraud that occurs in the public and private sectors. The study reportedly points to indictment of 53 individuals by the U.S. Department of Justice (DOJ), alleging kickbacks to Medicare beneficiaries. Article 2: McCellen, M. (2011). Reforming payments to healthcare providers: The key to slowing healthcare cost growth while improving quality? Journal of Economic Perspectives, 25(2), 69–92. Database: Cybrary 2.0 Description: This paper focuses on a broad movement toward a fundamentally different way of paying health care providers. The approach reaches beyond the old dichotomies about whether health care providers are reimbursed on a fee-for-service or a ‘capitated’ or per-person payment. Instead, these reforms seek to create direct linkages between payments to health care providers and measures of the quality and efficiency of care. After an overview of payment reforms for health care providers and their welfare implications, this paper discusses a range of empirical studies Article 3: Paschall, S. P. (2009). Health care, the price system and the conflict between access to care and cost-containment. Journal of Economic Issues, 43(2), 403–411. Database: Cybrary 2.0 ARTICLES ON PAYMENT 2 Description: Health care policy in the United States struggles with apparently conflicting purposes: (1) access to health care and (2) cost-containment. The failures of policy to resolve this apparent conflict have produced inequities in the health system and the perverse outcomes of high costs and poor access. The failures of policy are associated with the third-party payment system that has become a “rationing transaction” in John R. Commons’ hierarchy of transactions. The dominion of private interests over the payment system elevates the financial interests of insurers over the interests of patients. Commons’ approach to “reasonable value” as a means of resolving conflicts of interest through a process that engages all participants in the going concern suggests a strengthened role for the public sector in the payment system to achieve the public purposes of the health system. Article 4: Skeen, J.W. (2003). Health care fraud and industry structure in the United States. Social Policy and Administration, 37(5), 516–529. Database: Cybrary 2.0 Description: The cost of health care fraud and abuse is enormous. Not only is it costing a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole’s Compass Card of the four major ideas that have influenced political decision making as a guide, this paper recommends that current decision making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.

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