HSCI 3340 Third Party Payment Systems
This course includes the history of healthcare systems in the United States. The emphasis is on insurance systems including quasi insurance systems like PPOs. Emphasis is placed on the history of various payment systems such as FFS, RBRVS, DRGs, and how each of these systems impact traditional insurance systems, HMOs, PPOs, and POS systems. This course will also explore the differences between fully-funded insurance and self-funded insurance systems. Students will also learn about various public insurance systems including Medicare, Medicaid, and Tricare systems. Discussion on how health insurance systems impact the providers systems like hospitals and physicians by employing peer review, utilization management and other systems to influence behavior changes. Discussion will center on how a various insurance systems interact with various stakeholders including regulatory, employers, individuals and healthcare providers. We also will explore the current healthcare regulatory environment and the impact of the new healthcare reform program on various healthcare insurance organizations.