Health Insurance, Managed Care and Reimbursement
This course looks in detail at the societal and managerial issues precipitated by how the U.S. healthcare system is financed. The course considers types of managed care arrangements, the impact of managed care on service provision, risk arrangements, capitation, and the changing relationships between patients, payers, providers, and employers. This course is designed to explore in-depth the predominant provider payment systems in the United States. The structure and function of employer-based insurance, Medicare, and Medicaid will be studied. An introduction of the basic structure, pricing, and management of financial risks by private health insurance plans and the estimation of future expenditures for public health insurance programs will be explored. The course also examines the operation of health insurance plans from both the buyer and the insurer perspectives, how health plans employ actuarial estimates to project the cost of their benefit package and determine the premiums they will charge, and methodology as it pertains to the projection of costs in public health insurance programs.