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Overview: In this milestone, you will submit a first draft of your open comment letter. An open comment is an informed opinion written in the form of a letter to counsel authors of legislation on the perceived benefits and consequences of the opinion. It should include background on the key health issue and your assumption of the risks inferred by the legislative action (i.e., unintended consequences, public reaction, loopholes, etc.). The economic analysis should be more complete than that of your executive summary, taking into account the nature of the U.S. healthcare system, socioeconomic factors, behavioral models of stakeholders that shape interpretations and outcomes. The document should not be based solely on emotion, though it should not be divorced of sentiment as it needs to rouse the proper energy needed to effect change. The goal of the document is to convince the reader that your suggestions for inclusion, exclusion, and adaptations to the legislation should be included in the final version of the action.

Specifically, the following critical elements must be addressed:

Open Comment Letter

a. Describe how the intended consequences of the legislation will positively and/or negatively impact the key health issue that it is tasked to affect once applied to a realistic environment.

b. Differentiate between the manner in which the major tenets of the legislation would be interpreted by a health economist, health practitioner, and/or consumer of healthcare services.

c. Summarize the logical interpretations of the legislation in a document with a member of Congress as the proposed audience.

d. Hypothesize the outcomes of the legislation in a document with a member of Congress as the proposed audience.

e. Decide whether the key health issueis being served by creating or subduing supply, demand, or cost of healthcare services and which stakeholder group (providers, consumers, or payors) bears the primary responsibility for its implementation.

f. Discern to what extent the legislation will impact the reimbursement and/or financial health of providersoperating as for-profit, nonprofit, military, or government-sponsored care financing models.

g. Propose changes to the legislation that could be adopted tofurther affect socioeconomic determinants of health such as poverty, education, and diversity.

h. Propose what tactics could be implemented to ensure that the initial intent of the legislation could be safeguarded against perversion by macroeconomic forces and agents looking to exploit those forces to their advantage.

Guidelines for Submission: Your paper should be no longer than five pages (not including references and supporting appendices) with double spacing, 12-point Times New Roman font, one-inch margins, and at least three sources cited in APA format.

Textbook: Economics for Healthcare Managers,

As you read these chapters, consider the following questions:

• How and why is demand for services important in healthcare?
• Why is demand complex in healthcare?
• What are the macro and microeconomic factors that have an impact on supply and demand?

Challenges for Improving Health Care Access in Rural America

This case, found on pages 60 - 65, provides a customary view of poverty in association with healthcare and focuses on the residents' ability to pay. Financial difficulty in a region has compounding effects on utilization and demand, extending from provider supply to access to insurance. This case will be used as a basis for the module discussion.

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