Download Healthcare Policies and Programs in the United States and more Thesis Accounting in PDF only on Docsity! HCAD301 Planning, Managing, and Evaluating Healthcare Policies and Programs HCAD301 American Public University Healthcare Policy Healthcare consists of numerous things such as technology which is steadily growing, insurance sand payments of course and pharmaceuticals. Within healthcare, there are policies and procedures that are set forth. “Healthcare policy involves the creation and implementation of laws, rules, and regulations for managing the nations Healthcare system. The healthcare system consists of services provided by medical professionals to diagnose, treat, and prevent mental and physical illness and injury.” (BallotPedia, n.d.) Insurance is necessary for healthcare and it is used to pay healthcare organizations or the provider the majority of the cost of the care received. The healthcare system in the United States consist of both public and private and for-profit and nonprofit insurers. Some examples of each would be Medicare which is for adults over the age of 65 or that are disabled, Medicaid which is managed by the states and is for low-income families, and TRICARE which is used for veterans. These all receive funding from the federal government and are public insurance. (Roosa Tikkanen, 2020) Private insurance on the other hand is offered from an individual’s employer or could be purchased privately. Some examples of private funded insurance would be Blue Cross and Blue Shield plans, non-blue commercial plans, and HMOs. (Health Care Service Corporation, n.d.) Policies and procedures are an important aspect of healthcare. They are set in place so that there can be expectations in place and a guide for properly doing things. There is a specific process that must be followed when pertaining to changing healthcare policy. The legislative process is the process in which congress passes a law and then the president signs it is the most commonly used process. Then there is the regulatory process which consist of “federal agencies writing up rules for how laws are implemented.” (BallotPedia, n.d.) Lastly, healthcare policies can be changed lawsuits through the court system. The Social Security Act was signed into law on July 30, 1965 by president Lyndon B. Johnson. This act which is also known as the Medicare bill established a healthcare insurance program for both low-income families as well as elderly and disabled. According to Medicare resources, “Nineteen million individuals signed up for Medicare during the first year.” (March, 2021) Currently today there is over 60 million people that are enrolled in Medicare. Next on the timeline for health policies is the Health Maintenance Organization Act of 1973. This act was signed into law by president Richard Nixon. “A public or private entity organized to provide basic and supplemental health services to its members. The law further requires that plans provide insured individuals with basic healthcare in exchange for regular, fixed premiums that are established "under a community rating.” (Hayes, 2021) Individuals who are insured under an HMO pay a premium that is either monthly or annually. They are limited to only see providers that are within their network but in emergency situations they can be seen and still be covered. HMOs also require the covered individual to have a primary care physician for majority of their care and must obtain referral when wanting to see outside specialist. Along with HMOs there is also PPOs which is preferred Provider Organizations and allows patients more flexibility to choose their provider but does come with higher out-of- pocket cost. Exclusive Provider Organizations or EPO which allows patients the right to choose any health care provider with no referral but they will pay full cost for out of network providers. Lastly there is
