This session provides a practical, high-level overview of the U.S. healthcare system to help patient advocates better navigate the complex environment their clients face. Participants will explore the structure of healthcare delivery, the roles of providers, payers, and regulators, and the fundamentals of public and private health insurance, including benefit design, utilization management, and appeals. The session also reviews key healthcare laws and patient protections, equipping advocates with practical strategies and resources to help clients overcome barriers, make informed decisions, and navigate the system more effectively.
Learning Objectives:
- Describe the structure and key components of the U.S. healthcare system, including the roles of providers, payers, regulators, and care delivery settings, and explain how these components influence access to care and patient outcomes.
- Differentiate among major health coverage options, including employer-sponsored insurance, Marketplace plans, Medicare, Medicaid, and other public programs, and interpret core insurance concepts such as network status, prior authorization, formularies, appeals, and cost-sharing.
- Apply practical healthcare navigation strategies by identifying key patient protections, relevant healthcare laws, and available community and system-based resources that support informed decision-making, continuity of care, and effective advocacy.
Course Details:
Title: Understanding the United States Healthcare System
Components: 1 lesson, 1 evaluation
Cost: $29 (Basic Level Course) (APHA member coupons available)
Pre-Requisites or Requirements: Use of a desktop computer or mobile device.
Amount of Time to Complete: about 1 hour
CEs: 1 General CE