Describe the relationships among affordability, provider payment, and patient access to care.
Compare the distinct features of traditional Medicare, Medicare Advantage, Medicaid, and Medicaid Managed Care.
Identify and evaluate the effectiveness of common insurance design tools.
Compare the structural implications of different Medicaid funding models and how impact varies by state.
Predict the impact of different approaches of private insurance marketplaces on enrollment, premium trends, and consumer experience.
In the US Health Insurance System and Health Care Services, led by Benjamin Sommers, MD, PhD, you will examine how Americans obtain, use, and finance health insurance—and how this fragmented system shapes access to care, costs, and health outcomes. You’ll explore the major sources of coverage, including employer-sponsored insurance, Medicare, Medicaid, and ACA Marketplace plans, and analyze how factors such as income, age, employment, immigration status, and state of residence influence who is covered and who remains uninsured.
Building on this foundation, you’ll investigate how benefit design and cost sharing affect patient and provider behavior, the challenges posed by issues like moral hazard and adverse selection, and the tools used to control costs and stabilize insurance markets. You’ll then connect these dynamics to current policy debates around Medicaid financing, Medicare and Medicare Advantage, prescription drug pricing, and proposals for universal coverage, equipping you to assess the strengths and limitations of the US payer system and evaluate reforms aimed at improving cost, coverage, and equity.
