Summary Of Module 7: Healthcare Finance And Private Health Insurance

Module 7: Healthcare Finance and Private Health Insurance One cannot accurately critique the failure of the American healthcare system without looking deep into the insurance industry. Set up as a private companies to offer healthcare for a nominal month fee, these plans have evolved, at times, into high profit corporation whose goal is may not be to put the patient first but to control costs. By following the flow of funds, one can identify abuses and inefficiencies with their systems. We will never have a perfect insurance process in America, many challenges bog the delivery of care. However, the nurse, by educating themselves regarding all aspects of the healthcare delivery, to include insurance, is better able to assist their patient in

They pay the actual providers of healthcare services for treatment rendered to the employee. The payments come from the monthly, combined premiums the employee and employer pay to the insurance company. The third party insurance may becomes inefficient due to insured patients lacking price sensitivity while physician lack incentives to understand the cost of providing services (Buff and Terrell, 2014). In fact, physicians can bill more for additional treatment and services rendered. As Americans get smarter in understanding their health, their knowledge is minute compared to their physician. Many times, patients ask for test and procedures that are not necessary. In the third payer programs, the gatekeepers are lacking to control unnecessary or duplicate treatment. The nurse can help prevent abuses and inefficiencies with keen awareness of the patient and the care needed. Quality care does not mean that every test imaginable is perform, it mean the best care available to treat a specific need of the patient. When the nurse recognizes abuses by the patient, education can assist to offer knowledge in this area. Duplication of test by the physician can be brought to their attention by the

As leaders, practitioners and researchers, nurses can easily assist in identifying clinical outcomes, wasteful practices and deter inappropriate care. Nursing coordinators, nurse navigators, transitional care specialists and nurse information specialist are new position in the private insurance industry that are ensuring that quality care if offered to all patients. The nurse navigator role coaches, tutors and provides direct care so as to help patients overcome barriers in their healthcare systems. Nurses are the link between quality outcomes and coordination of care strategies (Nickitas, Middaugh & Aries,