HLTH 4530 Walden University Impact of Healthcare Insurance & Reimbursement HW Learning Resources Required Readings Penner, S. J. (2017). Economics and fina

HLTH 4530 Walden University Impact of Healthcare Insurance & Reimbursement HW Learning Resources
Required Readings
Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.
Chapter 2, “Health Insurance and Reimbursement” (pp. 27-60)
Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015: Current population reports. Retrieved from https://www.census.gov/content/dam/Census/library/…
Glatter, R. (2017). In 3 states, if Anthem thinks you shouldn’t have gone to ER, it won’t pay. Retrieved from https://www.forbes.com/sites/robertglatter/2017/10…
Keith, K. (2018). Litigation update: Challenges to Kentucky’s Medicaid waiver, cost-sharing reduction, and risk corridors. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog2018…
U.S. Department of Health and Human Services, Office of Minority Health. (2016). Minority population profiles. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl…
Discussion: The Impact of Healthcare Insurance and Reimbursement

Healthcare economics are affected by the push and pull of three participants: the payer, the provider, and the consumer. Consider this example:

You work full time for your employer who provides vision insurance as a benefit. Your contribution is $5 a month or $60 a year. Your employer contribution is $10 a month for each employee enrolled.

You find yourself in need of new glasses and have fallen in love with the designer $600 frames. Your copay on glasses is 20% for one pair of glasses so your out-of-pocket cost is $120. For your new glasses, the insurance company has to pay the $300 difference between what they collected from you, your employer, and your copay.

Clearly, the insurance company cannot do this for every employee every year so they increase rates, which means your employer must increase your contribution as well. In addition, the insurance company adds purchase limits on the maximum it will pay for new glasses or how often it will do so, say once every 2 years.

Consider this scenario as it applies to other healthcare costs, copays, and contributions. If we can demand to have the most expensive healthcare solutions, and only pay our co-pay, that impacts insurance companies, employers, businesses, and other patients.

In this Discussion, you will consider the point of view of each party-the payer, the provider, and the consumer-and reflect on the impact of health insurance and reimbursement on behaviors.

To Prepare:

Review the Learning Resources for this week and consider the role of health insurance on reimbursement strategies, healthcare costs, healthcare access and utilization.
You will be assigned to one of the following three perspectives by your Instructor for this Discussion:
Healthcare payer * This the one I was assign to by my instructor for this discussion* *ELEGANCE***
Healthcare provider
Healthcare consumer
Reflect from the perspective of your assigned role, on how healthcare reimbursement programs, the demand to improve quality outcomes, and access to healthcare impacts utilization and under-utilization in the healthcare market.
BY DAY 4

Post a comprehensive response that includes the following:

Describe the perspective you were assigned.
Give at least one example of how health insurance may affect healthcare costs, reimbursement, healthcare access, and utilization. Be specific about how health insurance impacts each concept.
Explain how aspects of healthcare costs, reimbursement, healthcare access, and utilization might affect experiences with healthcare for the perspective you were assigned. Explain.
Be sure to support your Discussion with a reference to course materials or a reference within the last three years.
BY DAY 6

Respond to at least two of your colleagues (one from each of the perspectives to which you are not assigned). If you were assigned the payer, then respond to a patient and provider perspective, and expand upon or suggest an alternative to the perspective described by your colleague.

HERE IS THE TWO CLASSMATES I HAVE TO RESPOND TO LISTED BELOW

KRYSTAL WEST

RE: Discussion – Week 2

COLLAPSE

Discussion: The Impact of Healthcare Insurance and Reimbursement

For this discussion, I have been assigned the role of the consumer. “Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare.” (Jennings, Loan, Swanson, Heiner, & Hemman, 2005). A consumer wants more bang for their buck, so to speak. Most consumers do not go to the doctor for minor things unless they have excellent health insurance, such as Medicaid or Chip.

I am a 40-year-old woman in good health; therefore, I carry the cheapest insurance that my employer offers. I rarely go to the doctor unless I am in dire need to do so, that’s why I chose the more affordable health insurance. That being said, I do have an extremely high deductible. When I do have to go to the doctor due to illness, it costs me more out of pocket than someone who has a more expensive policy. I would rather pay less a month out of my paycheck and more for a doctor’s visit since I do not have to go that often. I feel a lot of the working population does the same if they are, for the most part, healthy individuals. Since the cost of medical care increases every year, the cost of health insurance must rise. “Insurance coverage and adequate insurance coverage are both serious concerns for many Americans.” (Penner, S.J., 2017).

Health insurance does affect health care utilization. Some insurance is not accepted at every healthcare facility, and not all healthcare providers accept all health insurance. In my hometown, for instance, we have two urgent care clinics. One clinic will accept Medicaid, and the other does not except that healthcare coverage. This limits the patients that have Medicaid or Chip insurance to receive care in one urgent care clinic unless they want to pay the cash price for treatment. Health insurance affects healthcare costs, reimbursement, healthcare access, and utilization for the consumer in a variety of ways.

References:

Jennings, B., Loan, L., Swanson, K., Heiner, S., & Hemman, E. (2005). What Really Matters to Healthcare Consumers. The Journal of Nursing Administration. Retrieved from https://www.researchgate.net/publication/7903452_What_Really_Matters_to_Healthcare_Consumers

Penner, S. J.(2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing.

Shasta Bland

RE: Discussion – Week 2

COLLAPSE

I was given healthcare payer As my role for the assignment. A healthcare payer takes care of the financial aspect. According to Patient Navigator Training Collaborative, there are two types of healthcare payers. There are private payers which are insurance companies and public payers which are federal or state governments. Insurance affects healthcare in general.The insurance companies are starting to only pay for certain procedures only if the patient has certain test done or has a certain diagnosis. Another example on reimbursements is Medicaid has a low reimbursement for healthcare facilities that are privately owned and in a low income community. Certain doctors are not credited with certain healthcare insurance companies due to reimbursement reasons. This makes it harder for patients to go to the doctor specially if they do not accept their insurance.

Reference

ASPE (2/22/2005). Effects of Health Care Spending on the US Economy. https://aspe.hhs.gov/basic-report/effects-health-care-spending-us-economy

Patient Navigator Training Collaborative (N.D) Module 2: Insurance. http://www.patientnavigatortraining.org/healthcare_system/module2/3_healthinsurancepayersplans.htm 403
The Political Geography of Nationalist
Protest in China: Cities and the 2012
Anti-Japanese Protests*
Jeremy L. Wallace† and Jessica Chen Weiss‡
Abstract
Why do some Chinese cities take part in waves of nationalist protest but not
others? Nationalist protest remains an important but understudied topic
within the study of contentious politics in China, particularly at the subnational level. Relative to other protests, nationalist mobilization is more
clustered in time and geographically widespread, uniting citizens in different
cities against a common target. Although the literature has debated the
degree of state-led and grassroots influence on Chinese nationalism, we
argue that it is important to consider both the propensity of citizens to
mobilize and local government fears of instability. Analysing an original
dataset of 377 anti-Japanese protests across 208 of 287 Chinese prefectural
cities, we find that both state-led patriotism and the availability of collective
action resources were positively associated with nationalist protest, particularly “biographically available” populations of students and migrants. In
addition, the government’s role was not monolithically facilitative. Fears
of social unrest shaped the local political opportunity structure, with antiJapanese protests less likely in cities with larger populations of unemployed
college graduates and ethnic minorities and more likely in cities with established leaders.
Keywords: protest; nationalism; cities; prefectures; mobilization; collective
action; Japan; biographical availability; students; migrants; leaders;
Senkaku/Diaoyu islands; East China Sea
In 2012, China witnessed the largest wave of anti-Japanese demonstrations since
the normalization of relations between the two countries in 1972. The protests
condemned Japan’s decision to purchase three of the Senkaku/Diaoyu islands
* The authors would like to thank Lizzie Shan for her assistance with the data collection, two reviewers,
Jean Oi, Andy Walder, Deborah Davis, Graeme Robertson, and audiences at Yale and Stanford for
their comments and suggestions. All errors remain our own.
†
The Ohio State University.
‡
Yale University. Email: jcweiss@gmail.com (corresponding author).
© The China Quarterly, 2015
doi:10.1017/S0305741015000417
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404
The China Quarterly, 222, June 2015, pp. 403–429
in the East China Sea. By our count, protesters took to the streets in 208 of
China’s 287 prefectural cities. Smaller waves of anti-Japanese protest occurred
after a maritime collision in 2010 and over Japan’s bid for a permanent UN
Security Council seat in 2005. Anti-American demonstrations erupted after US
planes accidentally bombed the Chinese embassy in Belgrade in 1999. Protests
against France took place after France publicly contemplated a boycott of the
2008 Beijing Olympics in the aftermath of riots in Tibet.1
China watchers have debated whether these waves of nationalist protest reflect
the spontaneous eruption of grassroots grievances2 or state-led orchestration in
order to gain diplomatic leverage3 or divert domestic discontent. Studies of
Chinese nationalism have been similarly polarized between “bottom-up” and
“top-down” approaches, with scholars differing on whether Chinese nationalism
is largely driven by genuine anger at foreign slights or manipulated to bolster
state legitimacy.4
We argue that explaining patterns of nationalist protest requires simultaneous
attention to state and societal factors. In a strong authoritarian state like China,
nationwide demonstrations do not take place without some degree of state acquiescence. However, nationalist protestors in the post-Mao era have generally not
been akin to “puppets” or “rent-a-crowd” mobs that form at the state’s behest.
Indeed, nationalist protest in China is far more risky than conveyed by terms
like “manipulation” or “state-sponsorship.” Nationalist activists and protest participants regularly run up against the limits of state tolerance and often risk
increased surveillance, detention or arrest.5 For the government, allowing nationalist demonstrations to take place risks creating a platform for other grievances to
mobilize, while repressing patriotic activities leaves the government vulnerable to
charges of hypocrisy and weakness.
In our view, variation in nationalist mobilization reflects both grassroots propensity to protest and state willingness to tolerate popular mobilization. Citizens
are galvanized by genuine anger at provocative foreign actions. Government
statements and media coverage raise the salience of foreign insults and signal
that nationalist outrage is politically acceptable. At the same time, government
authorities often fear the implications of street demonstrations for social stability
and diplomatic relations, particularly if nationalist protests threaten to spin out of
control and aggrieved citizens use the opportunity to mobilize for other purposes.
Most studies of nationalist mobilization have taken place at the national level,
tracing state responses to popular mobilization across time to shed light on the
repression as well as the facilitation of nationalist protest.6 These studies have
1
2
3
4
5
6
Weiss 2014.
Gries 2004.
Weiss 2013.
Wang, Zheng 2012; Ross 2011; Zhao, Suisheng 2004; He 2007a; Reilly 2012.
Zhao, Dingxin 2003.
An exception is Xu and Pu 2010, which illuminates state responses to the civilian compensation movement against Japan across six issue areas.
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The Political Geography of Nationalist Protest in China
405
advanced our understanding of how diplomatic and domestic objectives have
shaped opportunities for grassroots mobilization and participation, but their analytical leverage has been limited by relatively few observations across time and
space.
This paper represents the first systematic attempt to analyse subnational variation in nationalist protest in China. Using original data at the municipal level
concerning the 2012 anti-Japanese protests, we evaluate the impact of top-down
and bottom-up factors. After describing the utility of studying local variation in
nationalist protest amid the diplomatic crisis over the Senkaku/Diaoyu islands in
2012, we develop our hypotheses and their empirical implications by integrating
anecdotal evidence to ground, motivate and operationalize these expectations.
The third section introduces our city-level dataset of anti-Japanese protests, the
methods used to collect the data, and our results.
The 2012 Anti-Japanese Protests: The Importance of Local Variation
Nationalist protest is one of the few forms of social mobilization in China that
has successfully linked citizens across localities, with central authorities often
choosing to tolerate, channel, and even coordinate anti-foreign protests rather
than repress them. By using a national wave of anti-Japanese protests to analyse
local propensity to protest and government concern for “stability maintenance,”
we can “control for” the underlying issue, in this case Japan’s purchase of the
Senkaku/Diaoyu islands. Whereas most protests in China have local particulars,
such as the location of proposed petrochemical plants, focusing on nationalist
protests allows us to hold the perceived provocation constant and investigate
local variation in factors that make protests easier or harder to organize.
On 7 July 2012, the 75th anniversary of Japan’s full-scale invasion of China in
1937, the Japanese government announced its intent to purchase three of the
Senkaku/Diaoyu islands from their private Japanese owner. As China pressured
Japan to respect the supposed understanding reached by the two governments in
the 1970s to “shelve” the territorial dispute, blanket Chinese media coverage
praised Hong Kong activists who landed on the islands. On 15 August, two
dozen activists staged a half-hour demonstration in front of the Japanese
embassy.7 In addition, calls for anti-Japanese demonstrations to take place
over the weekend began to circulate online.8
Between 15 August and 9 September, nearly sixty demonstrations took place in
Chinese cities to protest against Japan’s proposed “nationalization” and the landing of Japanese activists on the disputed islands. Despite a warning from
President Hu Jintao 胡锦涛 on 9 September, Japan announced its decision to
7 “815 Beijing fanRi shiwei song dao cu Ye Tian xiezui” (15 August anti-Japan protests in Beijing offer a
knife, urge Noda to apologize), Kdnet, 16 August 2012, http://club.kdnet.net/dispbbs.asp?boardid=1&
id=8549359; http://www.cfdd.org.cn/bbs/viewthread.php?tid=82881.
8 See, e.g., http://www.cfdd.org.cn/bbs/viewthread.php?tid=82919; http://www.cfdd.org.cn/bbs/viewthread.
php?tid=82911. Accessed 19 July 2013.
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406
The China Quarterly, 222, June 2015, pp. 403–429
buy the islands on 10 September. By the end of September, 320 anti-Japanese
protests had taken place; on 18 September alone, there were anti-Japanese protests in at least 128 cities across China.
Why did anti-Japanese protests take place in some cities and not others? What
factors made some cities more likely to be early movers and see protests in
August, while others only had demonstrations in September as the movement
spread to nearly three-quarters of China’s cities? Existing scholarship has largely
focused on a handful of atypical cities, such as Beijing, Shanghai, Chongqing,
Nanjing and Xi’an. Tracing nationalist mobilization in key locales has been
invaluable for illuminating state–society interactions in the realm of nationalism
and historical memory, but these experiences may not generalize well to the larger
universe of Chinese cities. Although surveys have illuminated how nationalist
sentiments vary across socio-economic and demographic groups,9 we know little
about how nationalist behaviour varies across more “typical” cities such as Zibo
淄博, Hengyang 衡阳 and other municipalities where millions of Chinese live.10
Generalizing from a small set of cities may be problematic for policymakers as
well as for scholars. In 2012, for example, the Japanese prime minister, Yoshihiko
Noda, admitted that the scope of anti-Japanese protests in China had been
greater than expected.11 Some speculated that the Japanese government had
relied too heavily on information from first-tier cities, where thick police cordons
ensured that protests did not overrun Japanese diplomatic compounds. By contrast, anti-Japanese protests in several second- and third-tier cities escalated to
violence before authorities reined them in. For instance, in Qingdao 青岛, a
Panasonic factory was set on fire and a Toyota dealership destroyed.12
Subnational variation in anti-Japanese protests has not been limited to 2012. In
2005, Shanghai witnessed large-scale anti-Japanese demonstrations after protests
in Beijing had been curtailed, feeding speculation about dissent between supporters of Jiang Zemin 江泽民 and the Hu Jintao–Wen Jiabao 温家宝 administration.13 In October 2010, anti-Japanese demonstrations took place in roughly
two dozen second- and third-tier Chinese cities, despite the quiet in Beijing,
Shanghai and Guangzhou.14
Many factors combine to produce an outcome in a particular city, making it
difficult to conclude from anecdotal observations which explanations are more
generally influential. For example, Asahi Shimbun cited several potential
9 Johnston and Stockmann 2007.
10 As Bill Hurst notes, “We now know quite a lot about China’s coastal megacities, and much more than
we did 20 or 30 years ago about provincial capitals such as Wuhan and Guangzhou. Still missing, unfortunately, is much about ‘typical’ cities – those of prefecture-level status (dijishi), where the vast majority
of Chinese urbanites live.” Hurst 2006, 468.
11 Weiss 2014.
12 Johnson, Ian, and Thom Shanker. 2012. “Beijing mixes messages over anti-Japan protests,” New York
Times, 16 September.
13 On the link between protests and factional conflict in China, see Cheng Ming, No. 311, 1 May 2005;
McCurry, Justin, and Jonathan Watts. 2004. “China’s angry young focus their hatred on old
enemy,” The Guardian, 30 December; Shimizu 2006.
14 “Postmortem: official OK to anti-Japan rallies backfired in China,” Asahi Shimbun, 23 October 2010.
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The Political Geography of Nationalist Protest in China
407
arguments for the absence of anti-Japanese protests in Dalian 大连. One diplomat speculated that a large-scale protest in Dalian against a petrochemical
plant in 2011 had made local officials wary of allowing any demonstrations
that might turn against the government. A local news editor suggested that
anti-Japanese protests in Dalian could bring up the issue of re-evaluating Bo
Xilai 薄熙来, who as mayor of the city in the 1990s had attracted a lot of
Japanese investment and remained popular among locals. Others argued that
residents in Dalian had a better understanding of Japan and that the migrant
population in Dalian was relatively small.15 The case of Dalian illustrates the difficulty of disentangling the relative weight of different factors: fear of local
instability, the availability of potential participants (in this case migrants), and
the dampening effects of Japanese trade and investment. More systematic data
and analysis are needed to assess whether local observations are outliers or
part of a more general pattern.
Anecdotes and Expectations: Where Are Anti-Japanese Protests More
Likely to Arise?
We consider both citizens’ propensity to mobilize and local authorities’ willingness to tolerate potentially destabilizing protests.16 In the post-Mao era, nationalist protests have generally been managed rather than manufactured by the
state,17 with windows of opportunity opening and closing as the central leadership considers its diplomatic and domestic concerns and objectives, weighing
the risk of instability and the cost of repression alongside its desire to show
resolve or reassurance.18 However, central instructions on how to manage nationalist mobilization often trade specificity for principle by emphasizing, for
example, the “rational expression of patriotism” (lixing aiguo 理性爱国) while
“maintaining stability” (wei wen 维稳) above all. Central priorities must then
be interpreted and implemented by local authorities who retain a degree of discretion and fear being held accountable for the outcomes of their actions.
For protest propensity, we consider local variation in patriotic sentiment, both
grassroots and state-led, and the availability of resources that facilitate mobilization. Resources that facilitate protest and collective action include the biographical availability of potential participants as well as material and structural factors,
such as population concentration, that facilitate networking and the spread of
information. Although protests are comprised of individuals, “collective action”
is defined by its group nature. The likelihood that protests escalate depends on
15 “Dalian tingbudao fanRi zhisheng” (Sound of anti-Japan not heard in Dalian), Asahi Shimbun, 24
September 2012, http://asahichinese.com/article/news/AJ201209240089.
16 Tarrow 1998; McAdam, Tarrow and Tilly 2001.
17 The term “manufactured” implies that the government creates these protests and so can easily call them
off, without acknowledging either the risk that nationalist protests may provide a cover for dissent or the
costs of repression.
18 Weiss 2014.
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The China Quarterly, 222, June 2015, pp. 403–429
the distribution of preferences across the population and expectations about the
willingness of other citizens to participate.19 Shared grievances and resources
shape whether individuals judge that others will join in and shield them from
potential repression. Because the larger “political opportunity structure” for protest in an authoritarian state is shaped by local governments’ willingness to tolerate demonstrations, we also consider measures that may be used as a proxy
for official fears of instability.
Patriotic sentiment
Higher levels of patriotic sentiment may correspond to a greater likelihood of
anti-Japanese protest. Nationalist anger is costly for the government to quash,
particularly when citizens chant “patriotism is not a crime!” (aiguo wuzui 爱国
无罪) and rally behind emblems of state-sanctioned patriotism, such as monuments to fallen martyrs. Along with patriotic feelings inculcated by state education and propaganda, grassroots grievances may stem from the legacy of Japan’s
invasion during the Second World War.20 Assessing variation in the level of
grassroots anti-Japanese sentiment in a community is a complex task.21 As one
plausible proxy for variation in grassroots grievances stemming from the legacy
of the Second World War, we use data on Japan’s occupation and invasion.
Given the passage of time, however, few Chinese have first-hand experience of
the trauma of Japanese occupation. To instil patriotic sentiment among younger
generations of Chinese citizens, the Chinese government has, since the early
1990s, designated certain historical sites, relics, monuments and modern achievements as “patriotic education bases” (aiguo jiaoyu jidi 爱国教育基地) that students must visit, along with mandatory films and coursework in patriotic
education.22 A 1991 CCP Central Committee document outlined the rationale
for these sites: “Using the rich historic relic resources to conduct education on
the masses about loving our motherland, loving the Party, and loving socialism
has the characteristic of visualization, real, and convincing.”23
As a proxy for variation in state-led nationalism, we examine the subnational
distribution of patriotic education bases. The presence and proximity of such
bases may instil greater awareness of China’s historical humiliation, signal the
political correctness of expressing patriotic sentiments, and provide a focal
point for mobilization. During the 2012 anti-Japanese protests, for example, protesters in the city of Hengyang in Hunan province gathered at the local memorial
19 Kuran 1991.
20 Gries 2005, 847.
21 Ideally, we would have survey data on attitudes towards Japan, but these data are not systematically
available at the subnational level, even by province.
22 Mitter 2000; Reilly 2004; He 2007b.
23 Quoted in Wang, Zheng 2008, 794.
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