Kidney Cancer Assignment Discussion Paper
Topic 1: Disease Process Choose a payer type that is different from your choices in our discussions this week. Compare the costs of covering healthcare services provided by this insurance in your area. What insurance type is best suited for healthcare coverage of your hypothetical patient’s disease type?
There are three payer types in health care delivery. First, government health insurance payers to include TRICARE, Medicaid and Medicare. Second, private health insurance payers that include Blue Cross Blue Shield. Third, commercial health insurance payers that include United Healthcare, Cigna and Aetna. The prices set by the three payer types differ; this is in part because of the differences in how the set prices are determined. The prices that commercial and private health insurers pay for services (to in-network health care providers) for their beneficiaries result from negotiations between the providers and payers. These payers can at times negotiate for and obtain lower prices by excluding some providers from their networks, but in most cases, this ability is limited. On the other hand, the prices that government health insurers pay to providers are administratively set through regulations and laws such that the providers can either accept the prices or leave the, but cannot negotiate prices. This results in a situation in which the private and commercial health insurance payers pay higher prices for provider services than government health insurance payers do.
ORDER YOUR PAPER HERE
In addition, private and commercial health insurance payers pay hospital much higher than the hospital costs. This is intended to slow growth of ways, increase federal government subsidies for health care (foregone revenues from federal tax preferences from health benefits and government spending on health care), and increase payer spending on claims, leading for greater cost-sharing requirements and higher premiums for patients (Beik, 2021)Kidney Cancer Assignment Discussion Paper.
For our patient with kidney cancer, the government health insurance, particularly Medicare, would be best suited for health care coverage. That is because Medicare is a federal government single payer health insurance program that would result in the patient spending less on health care. Part B of Medicare covers medically necessary cancer and related outpatient services and treatment. This is appropriate as the patient could be admitted in hospital but still considered an outpatient if in for observation. Medicaid could also be used if the patient is from a low-income family or has disabilities (Smith, 2022).
Topic 2: Healthcare Profession Estimate the cost of education and training for the healthcare professional you selected. Research the earnings of such a professional at entry-level, at mid career, and at the top of the career. How is this professional paid, for example, fee for service, salary, health insurance payment, etc.?
The selected health care profession is oncology nurse, a specialty that starts at the master’s level of education in a program that takes between two and four years to complete for Master or Doctorate level programs, and six months to three years for residencies and fellowships. The cost of educating and training an oncology nurse practitioner varies depending on the program. Students enrolled in a residency or fellowship program do not have to pay any tuition fees. In fact, they can be offered employee benefits or a salary/stipend when part of the program. For students enrolled in a non-residency/non-fellowship program, the costs may vary from $20,000 to more than $100,000 for the degree. For instance, the University of North Carolina at Chapel Hill offers an oncology focus in the Adult-Gerontology Primary Care Nurse Practitioner program at a cost of between $58,001.88 (North Carolina residents) to $111,179.88 (non-resident students) with the rates covering fees and tuition for full time enrolment. The Texas Christian University offers a Post-Graduate Oncology Certificate program at a cost of $21,670, rising to $29,550 for students taking the Palliative and End of Life Care class option (NursingProcess, 2022). Oncology nurses earn an average of $101,280 every year as the base salary. In fact, the annual base salary ranges from $85,000 to $124,000 with the annual bonus ranging from $983 to $10,000. The total annual earnings can be between $85,000 to $125,000 (PayScale, 2022)Kidney Cancer Assignment Discussion Paper.
References
Beik, J. I., & Pepper, J. (2021). Health Insurance Today: A Practical Approach (7th ed.). Elsevier, Inc.
NursingProcess (2022). Oncology Nurse Practitioner Programs – 2022. https://www.nursingprocess.org/oncology-nurse-practitioner-programs/
PayScale (2022). Average Oncology Nurse Practitioner Salary. https://www.payscale.com/research/US/Job=Oncology_Nurse_Practitioner/Salary
Smith, L. M. (2022). Fordney’s Medical Insurance and Billing (16th ed.). Elsevier, Inc.