· 7.4 Assignment: Comparing Between-subjects and Within-subjects Research Design or locate a published study that illustrates application of between and within subjects design. Explain the merits of each and the limitations of each (between and within). Indicate which you believe is more informative of the results. · Demonstrate understanding of the task and be able to address requirements using creativity and application of research design knowledge. · Must demonstrate ability to analyze existing research to compare strengths and limitations of between-subjects and within-subjects analysis. 1 Course Learning Outcomes for Unit I Upon completion of this unit, students should be able to: 1. Compare and contrast health services organizations within the healthcare system. 1.1 Explain the primary organizational components of the healthcare system and the commonalities and differences among health services organizations. Reading Assignment Chapter 2: Why and How Health Care Organizations Need to Change, pp. 13-34 Chapter 11: Leading Change: First Steps in Employing Strategic Intelligence to Get Results, pp. 259-310 Unit Lesson The Ideal Health System Imagine you are now the Secretary of Health and Human Services; you have a magic wand and you can create the perfect healthcare system. What components would it have? Would it include: 1. improving health outcomes for individuals, families and communities, 2. defending your population against threats to their health, 3. protecting your population against financial the consequences of bad health, 4. providing access to all with equality and no disparity, and 5. making it possible for people to make decisions in their own plans of care as well as have input into the decisions that affect your country’s overall health system? If you answered yes to these components, your definition matches the World Health Organization’s Components of a Healthcare System (2010). How This Course & Content Have Real-Word Application We are witness to history and are living in one of the most active times in our country’s history for healthcare reform. In 1966, the Medicare Act was signed into law by President Johnson, the most significant piece of healthcare legislation in our country to that point. Fast forward from 1966 to 2010 and the passing of the Affordable Care Act, which arguably is the second most impactful piece of legislation on U.S. health care since the Medicare Act. Medicare has grown significantly since 1966 and is now about 14% of our national budget, covering 47 million Americans (Kaiser Family Foundation, 2015). Government health plans (Medicare, Medicaid, Tri-Care, Veteran’s Administration) are growing and are on pace to insure more lives in the near future than lives covered by commercial plans (Cigna, United, Blue Cross, etc.) Speaking of this growth, Sylvia Burwell, Health & Human Secretary Director, announced that by 2018 the Centers for Medicar.

1. · 7.4 Assignment: Comparing Between-subjects and Within-
subjects Research
Design or locate a published study that illustrates application of
between and within subjects design. Explain the merits of each
and the limitations of each (between and within). Indicate which
you believe is more informative of the results.
· Demonstrate understanding of the task and be able to address
requirements using creativity and application of research design
knowledge.
· Must demonstrate ability to analyze existing research to
compare strengths and limitations of between-subjects and
within-subjects analysis.
1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Compare and contrast health services organizations within
the healthcare system.
1.1 Explain the primary organizational components of the
healthcare system and the
commonalities and differences among health services
organizations.

2. Reading Assignment
Chapter 2:
Why and How Health Care Organizations Need to Change, pp.
13-34
Chapter 11:
Leading Change: First Steps in Employing Strategic Intelligence
to Get Results, pp. 259-310
Unit Lesson
The Ideal Health System
Imagine you are now the Secretary of Health and Human
Services; you have a magic wand and you can
create the perfect healthcare system. What components would it
have? Would it include:
1. improving health outcomes for individuals, families and
communities,
2. defending your population against threats to their health,
3. protecting your population against financial the consequences
of bad health,
4. providing access to all with equality and no disparity, and
5. making it possible for people to make decisions in their own
plans of care as well as have input into
the decisions that affect your country’s overall health system?
If you answered yes to these components, your definition
matches the World Health Organization’s
Components of a Healthcare System (2010).
How This Course & Content Have Real-Word Application

3. We are witness to history and are living in one of the most
active times in our country’s history for healthcare
reform. In 1966, the Medicare Act was signed into law by
President Johnson, the most significant piece of
healthcare legislation in our country to that point. Fast forward
from 1966 to 2010 and the passing of the
Affordable Care Act, which arguably is the second most
impactful piece of legislation on U.S. health care
since the Medicare Act.
Medicare has grown significantly since 1966 and is now about
14% of our national budget, covering 47 million
Americans (Kaiser Family Foundation, 2015). Government
health plans (Medicare, Medicaid, Tri-Care,
Veteran’s Administration) are growing and are on pace to insure
more lives in the near future than lives
covered by commercial plans (Cigna, United, Blue Cross, etc.)
Speaking of this growth, Sylvia Burwell, Health & Human
Secretary Director, announced that by 2018 the
Centers for Medicare/Medicaid Services (CMS) will have up to
50% of its payments be value-based (Bundled
Rates, Accountable Care Organizations, Pay for Performance,
etc.) (Bresnick, 2015). This growth and this
shift to value-based reimbursements are causing significant
change within our healthcare delivery systems.
UNIT I STUDY GUIDE
Componentsof a
Healthcare System
2

4. UNIT x STUDY GUIDE
Title
It is crucial for you to understand that change is on our
doorsteps and that we have our feet in both the past
payment world of Fee for Service and the next generation of
payment method of Pay for Value. In this new
value-based payment landscape, providers realize we need to do
things more efficiently and with better
outcomes. Your ability to master efficiency and quality
improvement skills are key to your success.
Let’s focus into two vital areas:
1. explaining the primary organizational components of the
healthcare system, and
2. understanding the commonalities and differences among
health services organizations.
Explaining the Primary Organizational Components of a
Healthcare System
Let’s explore different organizational components and
stakeholders which comprise our healthcare system.
1. Federal Government:
ironically exempted themselves from the
Affordable Care Act (Korte, 2013).

5. o The Centers for Medicaid & Medicare Services (CMS) are in
the Executive Branch. They
create regulations for healthcare industries and have
administrative oversight for all Health
and Human Service programs.
o The President is the Chief Executive and has strong sway in
our healthcare system, including
powers to veto a law, to appoint the Health and Human Services
Secretary, and to promote
new healthcare laws.
into
the Affordable Care Act, deeming
that the individual mandate for a citizen to carry health
insurance could constitutionally be upheld
if it was a tax, thus the IRS code was amended and we now pay
a tax penalty if we do not have
qualifying health insurance.
2. State Government:
Human Services (DHHS), which takes
its direction, in part, from CMS and its state legislature.
ensure providers are complying
with federal and state laws and regulations. Examples include
the state’s DHHS, Office of
Inspector General (OIG) and Attorney General (AG). These
state agencies and departments have
many tools at their disposal to enforce compliance including:
o Civil Money Penalties (CMPs)
o Ban on New Admissions for a health facility until the

6. deficient practice is resolved. In some
cases, owners can be excluded from participating again in
Medicare or Medicaid programs.
See that Exclusion List at
http://oig.hhs.gov/exclusions/background.asp
between what they want for their
state citizens and what the federal laws and regulations demand.
There is often strong
negotiation between states and CMS and the White House on
matters. For example, high level
negotiations took place between state governors and CMS on
how the Affordable Care Act is
rolled out in a given State, i.e. what CMS will allow under
interpretation for the State Exchanges,
etc.
3. Providers:
and services. Click here to see a
list of providers, which can serve as inspiration for you if you
have not yet decided on your
healthcare career path or where you want to specialize.
4. Employers:
system. Most countries simply have health
insurance offered by the government and it is paid for by
income taxes, but in the United States,
we often pay our health insurance premiums through our
employer’s group health plan (EGHP).

7. 5. Associations:
associations to have a stronger voice.
Associations such as the American Association for Retired
Persons (AARP) are a major
component and large voice for healthcare advocacy.
6. Payers:
where insurance companies (Blue
Cross, United, Cigna, Aetna, etc.) play a significant role. Some
feel that third party payers are an
http://oig.hhs.gov/exclusions/background.asp
https://online.columbiasouthern.edu/CSU_Content/courses/Busi
ness/MHA/MHA6501/15G/UnitI_ListofProviders.pdf
3
UNIT x STUDY GUIDE
Title
extra layer of cost, while others feel they help keep downward
pressure on providers to keep
costs low.
7. Suppliers:
pharmaceutical companies, and
supply companies. The role of “Big Pharma” cannot be
understated as a component and an
impact on our healthcare system.

8. 8. Patients (you and me):
heart of policy and law making.
Some suggest that our elected officials sometimes have the
interest of large corporations at heart
more than its citizens. Below are two thoughts on how our
congressmen affect health care and
can be affected by large companies.
o One example is FDA officials becoming well paid executives
at big pharmaceutical
companies, on whose behalf they just made a decision. Some
suggest that a law requiring a
“Cool Off” period for former government employees would help
solve this ethical issue.
o Some suggest that term limits on senators and congressman
would help solve issues of
legislators passing laws that favor large corporations which
contribute to their reelection
campaigns.
Understanding The Commonalities and Differences Among
Health Services Organizations
Health Service Organizations include every type of health
facility and service you can imagine, including
hospitals, clinics, medical groups, nursing homes, assisted
living facilities, home health agencies, hospice
agencies, and dialysis clinics. Each organization has
commonalities but naturally strives to differentiate and
enhance its service to be the provider of choice in that market.
Your ability to add value to your health service
organization will be key to the positive impact you will make.

9. This course and the future units will explore advanced
healthcare strategies to enhance your knowledge
and skill.
References
Bresnick, J. (2015). Medicare will be 50% accountable care,
bundled payments by 2018. E.H.R Intelligence.
Retrieved from https://ehrintelligence.com/news/medicare-will-
be-50-accountable-care-bundled-
payments-by-2018
Kaiser Family Foundation. (2015). The facts on Medicare
spending and financing. Retrieved from
http://kff.org/medicare/fact-sheet/medicare-spending-and-
financing-fact-sheet/
Korte, G. (2013, September). Why congress is (or isn’t) exempt
from Obamacare. USA Today. Retrieved from
http://www.usatoday.com/story/news/politics/2013/09/27/is-
congress-exempt-from-
obamacare/2883635/
World Health Organization. (2010, May). Key components of a
well functioning health system. Retrieved from
http://www.who.int/healthsystems/publications/hss_key/en/