PH 325 - Health Care Payment Systems

Units: 3
Fundamentals of health financing. Discussion of public and private funding mechanisms. Discussion of various payment structures, including value-based payments, fee-for-service, capitation, etc. Overview of funding streams for research, prevention activities, and education.

Prerequisites: PH 110.
Possible Instructional Methods: On-ground or Hybrid.
Grading: A-F grading only.
Course Typically Offered: Fall & Spring

Student Learning Outcomes - Upon successful completion of this course students will be able to:

Explain the impact of payment systems on various stakeholders: patients, providers, large purchasers and insurance companies
Summarize the basic financial structure of insurance and the different types of insurance, including different types of health insurance
Identify commonly used approaches to assess and manage financial risk and accountability in health care
Understand various reimbursement methodologies including public programs such as Medicare and Medicaid/Medi-Cal
Recognize the interrelationship between regulatory and market mechanisms in shaping payment systems
Explain various triggers of health care costs and proposals to contain those costs
Understand the financial impact of health-seeking behavior and the rationale for incentivizing primary prevention
Understand the impact of the Affordable Care Act on health payment system structures in the US.