The United States healthcare system is not a single unified system. It is a complex network of public programs, private insurers, employers, hospitals, physician organizations, pharmaceutical and medical-device companies, pharmacies, investors, regulators, state governments, federal agencies, technology companies, and patients. Executive decisions in healthcare are therefore shaped simultaneously by clinical outcomes, reimbursement rules, insurance design, labor economics, regulation, capital markets, competition, technology, population health, and public policy.
Medicare, Medicaid, employer-sponsored insurance, individual-market coverage, and other public and private arrangements operate through different financing and administrative structures. Medicaid in particular is jointly shaped by federal requirements and state administration, so program design and coverage vary among states. The individual Health Insurance Marketplace provides another major coverage channel, while eligibility for Marketplace subsidies can interact with the availability and affordability of employer-sponsored coverage.
U.S. Healthcare System & Policy is an advanced Junior MBA course designed to develop managerial judgment about this complex system rather than repeat introductory descriptions of Medicare, Medicaid, insurance, or healthcare organizations. Students examine how money moves through healthcare, how incentives shape provider and payer behavior, how reimbursement affects organizational strategy, how consolidation changes markets, how healthcare policy alters enterprise economics, and how leaders make strategic decisions when regulation and payment models are continuously evolving.
Particular emphasis is placed on the transition from traditional fee-for-service reimbursement toward arrangements that increasingly connect payment with cost, quality, coordination, and outcomes. Accountable care remains a significant component of Medicare policy; CMS reported that an estimated 14.3 million Medicare beneficiaries were receiving care coordinated through Medicare ACO initiatives as of January 2026. Students therefore examine value-based care not merely as policy terminology, but as a fundamental managerial challenge involving clinical integration, risk assumption, data infrastructure, physician alignment, cost management, and organizational capability.
The course is built around practical executive questions: Who pays? Who bears financial risk? What incentives does the payment system create? Where does an organization actually make or lose money? What regulatory authority matters? How do state and federal policies interact? What happens when hospitals, insurers, physician groups, pharmacies, technology firms, and investors pursue conflicting incentives? And how should managers position their organizations when healthcare policy changes?
Course Objectives
By the end of this course, students will be able to:
• Analyze the U.S. healthcare system as an interconnected economic, regulatory, and organizational ecosystem.
• Distinguish the strategic roles of Medicare, Medicaid, employer-sponsored insurance, individual-market coverage, and other major financing channels.
• Understand how federal and state responsibilities interact in healthcare policy.
• Evaluate provider, payer, employer, patient, government, and investor incentives.
• Interpret major healthcare reimbursement models from a managerial perspective.
• Evaluate fee-for-service, capitation, shared-savings, bundled-payment, and other value-based payment arrangements.
• Understand how insurance benefit design influences utilization, access, and organizational economics.
• Analyze hospital, physician, insurer, pharmacy, pharmaceutical, and health-technology business models.
• Evaluate healthcare consolidation and vertical integration strategically.
• Understand how healthcare regulation can alter market structure, investment, pricing, and operating models.
• Analyze healthcare workforce shortages, labor economics, and productivity challenges.
• Evaluate cost, quality, access, and equity as interconnected management problems.
• Assess health-system financial performance and reimbursement exposure.
• Integrate population health into payer and provider strategy.
• Evaluate healthcare technology, artificial intelligence, interoperability, and digital-health strategies.
• Understand pharmaceutical and medical-product economics from an enterprise perspective.
• Assess state-level healthcare variation and its implications for national organizations.
• Incorporate healthcare policy uncertainty into strategic planning and capital allocation.
• Develop executive judgment for operating within a heavily regulated and politically sensitive industry.
