Overview

This course is best suited for individuals currently in the healthcare sector, as a provider, payer, or administrator. Individuals pursuing a career change to the healthcare sector may also be interested in this course. This course is the continuation of An Overview of the U.S. Healthcare System course . If you have not yet taken the introductory course, it is recommend that you complete that course prior to this course. The foundational knowledge from the introduction is carried through in this deeper dive into learning about how the U.S. Healthcare System operates. This course provides an insight into the payment architecture, cost and value of prescription drugs, spending, outcomes, and social accountability of the American Healthcare System. Throughout this course, you will be given the opportunity to evaluate your understanding through engagement in course discussions, application of course concepts to course assignments, and through completion of content quizzes along the way.

Syllabus

Payment Architecture for Healthcare Services

In this module, we will discuss the basic mechanics of paying for volume and how it affects physician payment. Looking ahead, in the U.S., traditional payment approaches for healthcare providers, such as fee-for-service and per diem payments, are being slowly phased out due to concerns about excessive and unnecessary utilization of healthcare services contributing to rising healthcare costs. Additionally, the US healthcare system is undergoing a slow shift from paying providers for volume to paying them for value, which means they are rewarded or penalized based on their quality of care and efficiency.In this module we will explore these traditional payment arrangements as well as the new methods and developments. We will examine the benefits and drawbacks to the different methods and how they affect provider performance.

Diffusion of Pricing and Prescription Medications

In this module, we will now focus our attention on the diffusion of pricing and prescription medications in the U.S. Prescription drugs account for over 10% of total healthcare spending in the U.S. and are increasingly important for managing chronic conditions. However, the regulatory process for approving new drugs has long been a source of controversy, with stakeholders contending it is inefficient and contributes to rising drug costs. To better understand these issues, we will explore how drugs are developed and regulated.We will also continue on in our exploration of initiatives addressing the cost and value of prescription drugs in this module. Rising drug costs have been a major concern for both the private and public sectors, with initiatives ranging from value-based contracts to federal and state laws aimed at negotiating drug prices and limiting out-of-pocket expenses for patients. While the impact of many of these initiatives is yet to be evaluated, the hope is that they will ultimately result in affordable access to prescription drugs for all Americans.

Comparative Analysis of Healthcare Systems Around the World

Healthcare financing and delivery vary across the globe, with different approaches to public and private sector involvement, as well as universal health coverage. The U.S. has a mixed model with both public and private sector involvement, but lacks universal coverage, while other countries rely predominantly on either the public-or private-sector with varying levels of out-of-pocket spending. In this module, we will explore the key differences between the U.S. healthcare system and the healthcare systems of other countries. We will examine the advantages and disadvantages of various healthcare systems models and evaluate the performances of these systems. How do you feel currently about your quality of care? Perhaps learning about different models of healthcare delivery around the world will give you a new perspective.

Social Accountability for Healthcare Delivery

In this module, we will examine the tax-exempt status of nonprofit hospitals in the U.S., which generate millions in annual revenue but are exempt from paying income, property, and sales taxes. We will also discuss the qualifications that allow these hospitals to enjoy this favorable tax treatment, and the community benefits they are expected to provide in return. Nonprofit hospitals in the U.S. face a unique challenge of providing community benefits while also competing in a highly competitive market for healthcare services. However, research has found that charitable spending can be a source of competitive advantage, leading to increased customer loyalty and financial benefits. We will reflect on the tax exemptions and community benefits as well as the social accountability for healthcare delivery more in this module.