Module 2: Financing Health Care for the Elderly - Overview

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This module was developed by Carol Jorgensen Huston, MSN, MPA, DPA. For additional background on Dr. Huston, select the name.

Introduction

As a nurse, you are expected to help your elderly clients achieve their health care goals through the provision of high quality, cost-effective health care. To achieve this goal, it is necessary to have a basic understanding of health care economics and health care finance, and more specifically, with the unique health care resources available to and accessible by the elderly in this country.

This module then is organized into four topical areas. The first topical area provides an overview of healthcare economics; how health care is financed in this country and basic fiduciary concepts related to insurance and reimbursement. The second topical area examines how the elderly pay for health care in this country with special attention given to Medicare, Medicaid, and managed care insurance options. Gaps and overlaps in coverage are examined. The third topical area examines the settings in which elderly receive long term health care in this country with special attention given to skilled nursing facilities, community care settings, and care within the home. The final topical area examines current health care policies and proposed legislation affecting elderly individual's access to and consumption of health care resources. Issues related to reimbursement for advanced practice nurses are examined.

Objectives

• Define general fiduciary/insurance concepts and differentiate between provider payment mechanisms such as fee for service, prospective payment, capitation, and direct contracting.
• Analyze how the increasing elder population has influenced the American health care system and the availability/allocation of its health care resources.
• Identify how health insurance, co-payments, and out of pocket costs influence access to and utilization of health care resources for elderly Americans.
• Identify gaps and overlaps in health care coverage common to America's elderly.
• Describe the multiplicity of health care settings in which elder Americans seek health care including acute care, skilled nursing facilities, community health care settings, and in the home.
• Describe current policy and proposed legislation regarding the financing of health care for the elderly and reimbursement of APNs for elder primary care.
• Apply understanding of Financing Health Care for the Elderly to a presented exemplar.