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HLT 205 Reimbursement - notes

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This is a comprehensive and detailed note on reimbursement for HLT 205. Essential!!









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August 18, 2024
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Written in
2019/2020
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HPSM 6268 Health Services Administration and Management
Prema Bhattacharjee

Date due: Tuesday, September 20 at 2:30 pm
Assignment must be submitted via e-mail ( )
Note: Your assignment must be submitted in Microsoft Word or PDF format. It must include class title,
assignment number, and student name (e.g. HPSM 6268 Homework1_AngelaChiu.doc).
Please answer the following questions:
1. (15 points) Explain how the U.S. has both market & social justice aspects of healthcare.
The U.S. healthcare system is comprised of both market and social justice aspects of healthcare,
in which social justice is concerned with providing healthcare services that is objectively distributed by a
government-run national health care program, while market justice is concerned with providing
healthcare services that are objectively distributed through the market forces of supply and demand,
rather than the involvement of government services.
The market justice characteristics of the U.S. healthcare system include (a) viewing healthcare
as an economic good, (b) assuming free market conditions for health services delivery, (c) assuming that
markets are more efficient in allocating health resources equitably, (d) production and distribution of
healthcare are determined by market-based demand, ( e) medical care distribution is based on people's
ability to pay, and lastly, (f) access to healthcare services is viewed as an economic reward of personal
effort and achievement. The social justice characteristics of the U.S. healthcare system include (a)
viewing healthcare as a social resource, (b) requiring active government involvement in health services
industry, (c) assuming that the government is more efficient in allocating health resources equitably, (d)
allocation of medical resources is determined by central planning, (e) the ability to is inconsequential for
receiving medical care, and lastly, (f) equal access to medical services is viewed as a basic right.
Besides the characteristics of both market and social justice, there are also important
implications that are involved in the development of the healthcare system as well. The implications of
market justice are based on (a) individual responsibility for health, (b) benefits being based on
individual purchasing power, (c) limited obligation to the collective good, (d) emphasis on individual
well-being, ( e) private solutions to social problems, and (f) rationing based on ability to pay, while
social justice implicates (a) collective responsibility for health, (b) everyone is entitled to a basic
package of benefits, (c) strong obligation to the collective good, (d) community well-being supersedes
that of the individual, (e ) public solutions to social problems, (f) planning rationing of healthcare.
For example, the
U.S. healthcare system includes market justice with private healthcare organizations in which
individuals will use their own money to choose which insurance company they wish to invest in without
the involvement of the government to interfere with their personal choices. Individuals have the choice
to pay for the type of coverage/plan they want, as well as the services provided are between the patient
and doctor, not the government. Social justice of the U.S. healthcare system is need-based, in which the
government will decide the type of services that are necessary, and should be covered.

2. (20 points) Some people view increases in health care spending as a response to consumer
demand, whereas others see these increases as potentially wasteful spending. When other
industry sectors assume a rising share of gross domestic product (GDP), it is viewed as a
positive development. Should we be concerned about the rising costs of health care and its
share of GDP? What types of health care spending might be classified as valuable? Wasteful?
We should be concerned with the rising cost of health care and its share of GDP. It is projected in 2019
that health care expenditures will be 19.3% of the GDP of America. The largest portion of that
percentage comes from hospital stays. With health care being such a large portion of the GDP, it is
important to ask how much of those expenditures are actually aiding the US economy. Health care
spending that should be considered valuable would be things like technology, new facilities, supplies,

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