Financial, Insurance & Regulatory Issues

Health Care Administration Certificate Program

HHC 470

Breyer State University

Instructor: MARK C. BARBAS, DHA

SYLLABUS

This course focuses on the major components of the Healthcare Delivery System. The materials for this course are focused in Chapters 5, 6, 7, 15, 16, 17 in Introduction to Health Services and Chapters 11, 12, 13, 14 in Health Economics.

COURSE CONTENT:

1). Healthcare Expenditures.
2). Medicare and Medicaid.
3). Origins of Health Insurance.
4). Benefit Structure.
5). Experience rating and Community rating.
6). Case Mix Index.
7). HMO's, PPO's.
8). Managed Care Theory and Principles.
9). Continuium of Insurance type.
10). Provider Concerns.
11). Medicare and Medicaid Managed Care.
12). Health Insurance as a group benefit- funding.
13). Blue Cross and Blue Shield.
14). Drug, Dental, Vision, Retiree and Long Term Care Plans.
15). Disability Insurance.
16). Health Insurance Industry changes.
17). Health Policy and the political system.
18). Federalism and Pluralism.
19). Policy implementation.
20). Measuring quality - benchmarking.
21). Outcomes and Health status.
22). Cost Containment and Quality.
23). Disease Management.
24). Ethical Issues in Public Health.
25). Ethical issues in Healthcare.
26). Government Intervention.
27). Special Interest Groups.
28). Price Ceiling and Supply and Demand.
29). Cost shifting.
30). Anti-trust laws- price fixing.
31). Medical Student Debt.
32). CHIP.
33). DRG's (DRG Creep), PPS.
34). BBA-1997.
35). Barriers to Entry.
36). Adverse Selection and Moral Hazard.
37). The Uninsured.
38). Physician distribution, employment and expenditures.
39). Physician reimbursement - trends.
40). Supplier induced demand - Manipulated by physicians.
41). Self-referral.
42). Defensive Medicine.
43). Physician Income.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1). Analyze Healthcare Expenditures.
2). Understand the origins of Health Insurance and benefit structures.
3). Differentiate Community rating and experience rating as related to group health insurance.
4). Discuss Managed Care Theory and Principles.
5). Review the Government's role in establishing Medicare and Medicaid programs including Managed Care.
6). Understand Health Policy Formation and the role of the political system.
7). Relate measuring quality to Benchmark, Outcomes and Health Status.
8). Identify ethical issues in Healthcare.
9). Discuss price ceilings, supply and demand, and cost shifting.
10). Understand DRG's and PPS systems.
11). Review physician reimbursement, distribution, employment and expenditure issues.
12). Relate what you've learned in this course to your work environment.

COURSE PROGRESSION: The course begins on the date of student enrollment. Students have 90 days to complete this course. Extensions are rarely granted, and the, only for extreme emergencies or active military duty. Students who do not complete the course within the 90 days time frame receive an "incomplete/withdrawal" and would have to re-register and pay tuition again if they desire to complete it.

This is a self-paced course. You may proceed at the pace that is right for you. It is acceptable to accelerate in this course and complete it in less than 90 days.

As you progress through the course, always feel free to contact your instructor to discuss issues, questions, etc. related to the course. Your instructor is there to be a mentor to you as you proceed with learning.

EXAMS: There is only one examination for this certificate program. The examination may be taken upon successful completion of all of the assignments for Courses I, II and III in this certificate program. Assignments are graded on a Pass/Fail basis. The final examination is open book, and students have three (3) days to complete it. Your instructor will give you full instructions on accessing and taking the exam as you progress in the certificate program. The final examination covers the materials from all three courses in the certificate program. The final examination consists of objective type questions. The grade scale for the final examination is provided above.

ASSIGNMENTS: All of the assignments for this course are detailed in the classroom. Go back to the classroom page and click on "assignments".

INFORMATION: If you have any questions regarding this program, you may address them to adm@breyerstate.com. An administrative faculty member will respond to all questions.

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