Accountability in Healthcare Finance

Accountability in Healthcare Finance

Accountability and finance is a significant issue facing healthcare. Accountability entails that process and procedure is justifiable and undertake responsibility for its activities. This paper aims to provide a history of private health insurance and managed care and how they involved in healthcare, discussion of federal laws protecting individuals enrolled in private health insurance, analysis of consumer-driven healthcare, and the empowerment of healthcare consumers. The fourth section explores emerged opportunities for nurses in the private insurance market.

History of Private Health Insurance and Managed Healthcare

The history of managed care dates back in the 19th century when small numbers of healthcare physicians in various us cities started offering prepaid medical services to members of the unions, workers association, and fraternal orders. Each participating member in the association was required to pay a fee on an annual basis to physicians to have unlimited access to healthcare services.  At the beginning of 20th-century lumber, mining and railroad companies contracted with medical groups to offer health services to their workers. By the 1930s, when there was a great depression, there were many prepaid contracts between employers and employees. In the 1970s, the federal government and private companies started encouraging people to join prepaid healthcare. Despite the collective encouragement, the prepaid group practice was growing very slowly. In the mid of 1980semployers embraced managed care to contain the cost of providing healthcare benefits to workers (Sommers et al., 2017). Managed care enrollment soared in the 1990s. Today, most of the sizable fraction of government-sponsored Medicare and Medicaid programs and the privately insured Americans are covered by managed care.

The main development of health insurance in the USA began in the 1930s.  The earliest were ones developed by railroad from the West. Companies used organized hospitals association to offer comprehensive care to employees. Employees paid fixed periodic payments that were deducted from their salaries.  For example, Southern Pacific, Missouri, Pacific, and northern pacific organized their care in 1876, 1869, and 1881 respectively. In 1930, 27 stream railroad provided medical care to 500, 000 employees.  Blue Cross and Blue Shield plans are regarded as the first private insurance companies.  Blue cross plans are traced in 1929 to an experiment in Texas at Baylor University Hospital (Sommers et al., 2017).  The hospital evolved a plan that provided care for three weeks to teachers in return of annual fee of $6. The experiment become so successful to an extent other employee groups requested similar plans. The first citywide plan was offered in 1932 by Sacramento hospital in California, followed by Hospital of Newark in 1933. By the end of 1934 there were 26 plans 54000 and 59 plans and over four million participants in 1939.

The backers of the plan from New York proposed for implementation of a legislation that will protect them from insurance law which was passed in 1934. Blue Shield plan involved provision of comprehensive medical coverages with choice of choosing their physicians. After that various company started providing similar services. Various Blue shield and Blue Cross merged to form current companies we know today. Healthcare costs continued to increase over years and employers decided to provide health insurance that are of benefits to employees.  United Healthcare was developed in 1970 (Sommers et al., 2017). Currently, United Health is the largest health provider in the US.  Today, health insurance are multi-billion dollars companies and they continue to grow. With the current boon of healthcare cost, many people have joined private insurance and managed care.


Federal Laws that Protect Individuals Enrolled in Health Insurance

Most of American citizens have private insurance covers. All the private insurance sold to individual or group of individuals need to comply with the federal laws. The Department of Health and Human Services implement policies that require to be followed strictly by all insurance providers by overseeing health issues that concern all individuals are properly addressed.  One of the federal that protect individuals enrolled in private is Employee Retirement Security Act of the 1974 is a federal law that protect health plans from the private industries to protect individual enrolled in these plans by establishing minimum standards for majority of the retirement and health plans.

The second federal law that protect individuals in private insurance is Health Insurance Portability and Accountability Act of 1996. The purpose of the law was to increase portability, renewability, and access of private health insurance.  The law has implemented various safeguards that protect health information and sensitive personal information of patient enrolled to private health insurance. (Teitelbaum & Wilensky, 2016) The policy enables individual covered to change their jobs and at same time retain their insurance coverage. Secondly HIPAA prevent individuals from individuals from discrimination by employer health plan.

The third federal law is the affordable care act.  According to the law, employers using private health insurance must ensure that the healthcare provided is affordable, implying that the cover provided to single person must be a single-person plan with premium that is less than the overall household income of employees. Therefore, ACA protect enrolled individuals in private health insurance by ensuring there protected and all worst practices in health industry are eliminated such as extra charging individuals with pre-existing health conditions.  Fourth is Consolidated Omnibus Budget Reconciliation Act which enables individual enrolled in private health insurance to benefit from financial security to employees who would otherwise lose their coverage after job loss (Teitelbaum & Wilensky, 2016). The COBRA act apply to private sectors with more than twenty employees.

Consumer-Driven Healthcare and the Empowerment of the Healthcare Consumer

Consumer-driven healthcare was first introduced in year 2000 and ensuring that time it was unsuccessful.  The consumer driven healthcare is a process in which low premiums, saving accounts, and high deductibles are set up for employees.  The aims of the consumer-driven healthcare plan is to prompt employees to make educated decision, and reduce cost for employers who have access to insurance. The CDHPs have poor track records for the first seven after implementation and employees reported low satisfaction rate by 25% compared to traditionally-managed healthcare plans (McNair et al, 2018).  Consumer- driven healthcare has empowered healthcare consumers by reducing overall employer spending on healthcare, saving employees money by enabling the employees to save money due to lack of regular doctors’ visits and hospitalization. The entire philosophy of the consumer-driven healthcare plan is to empower employees.

Consumer driven healthcare keeps on changing to align with the key trends that drive consumers’ decisions.  Today, consumers of CDHPs who include Medicare greatly influence wellness and healthcare. Some of the key consumer driven trends are choices that are driven by prices.  Increase in healthcare cost has enabled consumers to forgo care until when the health issue has escalated thus becoming more expensive. Consumers require more empowerment on issue of their healthcare needs and thus transparency and accountability are crucial as they helps consumers to access information to make informed decisions.  Nowadays, consumers are actively engaged in their health decisions and that of their family members focusing more on patient centric care. The last trend is kindred experiment McNair et al, 2018).. The kindred experiment requires healthcare to meet changing demands of consumer needs such as providing full time consumer resources, partnering with high profile hospitals, developing quality setting across healthcare setting, and testing modern payment methods at home initiative through independence.

Emerging Nurses Opportunities within Private Insurance Market

Private insurance markets are encountering many changes in healthcare ranging from delivery of patients and technology. The changes in private insurance market in the last seven years was considered with employer-based coverage especially in private insurance market. Due to current changes in provision of quality health care to patients, nurses in private care have the opportunity of engaging in career development to have skills and expertise to provide quality healthcare required. Private health market is dramatically evolving from free-for-service contracts, nurse’s needs to advance their skills and competencies to a high mixture of capitation requiring provision of quality health services.

Private insurance market is now hiring employees with high educational requirements due to high demand of quality care. Nurses has the opportunity of working as a communicator in healthcare to ensure that there is an effective collaboration in healthcare that lead to provision of coordinated and cohesive care that improves patient’s outcome.  Nurses has opportunities of being a holistic care giver by addressing the spiritual, cultural, and mental needs of patients. Due to the current trends in nursing, nurses working in private healthcare has opportunity of working as leaders/ instructors by helping other nurses to use healthcare machines and educating patients about medical apps available in healthcare.  The multifaceted health conditions in health market will help nurses to work as specialist in their professional medical specializations.  Lastly, due to high demand of quality patient care, nurses have opportunities of working as researchers to pinpoint best health practices and facilitate patient care.


The history of private health insurance can be traced back by 1930s due to development of Blue shield and Blue Cross plan which later merged to a healthcare industry widely known today. Consumer-driven healthcare plan prompts employees to make educated decision, and reduce cost for employers who have access to insurance. Lastly, opportunities of nurses in private health market are: engaging in career development, providing a holistic care, working as leaders, and communicators in private health market.


McNair, J., White, B., Miller, C., Ferguson, W., & Coustasse, A. (2019). Potential Savings from Consumer-Driven Health Plans.

Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health — What the recent evidence tells us. New England Journal of Medicine377(6), 586-593.

Teitelbaum, J. B., & Wilensky, S. E. (2016). Essentials of health policy and law. Jones & Bartlett Publishers.

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