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Health Insurance – from Wikipedia
Health insurance
Health insurance is a type of insurance whereby the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes, or due to accidents. The insurer may be a private organization or a government agency. Market-based health care systems such as that in the United States rely primarily on private health insurance.
Contents
1 History and evolution 1.1 Inherent problems with private insurance 1.1.1 Adverse selection 1.1.2 Moral hazard 1.2 Other factors affecting insurance price 1.3 Common complaints of private insurance 2 Health insurance in the United States 2.1 Medicare 2.2 Medicare Advantage 2.3 Medicaid 2.4 The shift to managed care in the U.S. 3 Types of Medical plans in the United States 4 Common Medical Insurance Terms [8] [9] 5 Health Insurance in Canada 5.1 Insurance Waiting Lists and Comparisons to US Health Care 6 Health insurance in Australia 7 References 8 See also
History and evolution The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, early health insurance was actually disability insurance, in the sense that it covered only the cost of emergency care for injuries that could lead to a disability[citation needed]. This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.[1] Patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case
A Health insurance policy is an annually or monthly renewable contract between an insurance company and an individual. With health insurance claims, the individual policy-holder pays a deductible plus copayment (for instance, a hospital stay might require the first $1000 of fees to be paid by the policy-holder plus $100 per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum, or the upper limit of what the insurance company will pay over the covered individual's lifetime.
Prescription drug plans are a form of insurance offered through many employer benefit plans in the U.S., where the patient pays a copayment and the prescription drug insurance pays the rest.
Some health care providers will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay, as the insurance company pays according to "reasonable" or "customary" charges, which may be less than the provider's usual fee. The "reasonable" and "customary" charges can.
Health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider.
Health Insurance companies are now offering Health Incentive accounts (HIA)[2], to reward users for living health and making healthy choices, like stop smoking and/or losing weight, may get you funds added into your Health Incentive Account, which may lower your out of pocket costs. The health incentive accounts also carry over from year to year but once you leave the program you lose those benefits in the HIA.
Inherent problems with private insurance Any private insurance system will face two inherent challenges: adverse selection and ex-post moral hazard.
Adverse selection Insurance companies use the term "adverse selection" to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $400 (example figures).
The fundamental concept of insurance is that it balances costs across a large, random sample of individuals (see risk pool). For instance, an insurance company has a pool of 1000 randomly selected subscribers, each paying $100 per month. One person becomes very ill while the others stay healthy, allowing the insurance company to use the money paid by the healthy people to pay for the treatment costs of the sick person. Adverse selection upsets this balance between healthy and sick subscribers by leaving an insurance company with primarily sick subscribers and no way to balance out the cost of their medical expenses with a large number of healthy subscribers.
Because of adverse selection, insurance companies use a patient's medical history to screen out persons with pre-existing medical conditions. Before buying health insurance, a person typically fills out a comprehensive medical history form that asks whether the person smokes, how much the person weighs, whether the person has been treated for any of a long list of diseases and so on. In general, those who look like they will be large financial burdens are denied coverage or charged high premiums to compensate. On the other side, applicants can actually get discounts if they do not smoke and are healthy.
Starting in 1976, some states started providing guaranteed-issuance risk pools, which allow individuals who are medically-uninsurable through private health insurance to be able to purchase a state-sponsored health insurance plan, usually at higher cost. Minnesota was the first to offer such a plan, and there are now 34 states which do. Plans vary greatly from state to state, both in their costs and benefits to consumers and to their methods of funding and operating. They serve a very small portion of the uninsurable market -- about 183,000 people in the USA [citation needed]-- but in best cases do allow people with pre-existing conditions such as cancer, diabetes, heart disease or other chronic illnesses to be able to switch jobs or seek self-employment without fear of being without health care benefits. Efforts to pass a national pool have as yet been unsuccessful, but some federal tax money has been awarded to states to innovate and improve their plans.
Moral hazard Moral hazard describes the state of mind and change in behavior that results from a person's knowledge that if something bad were to happen, the out-of-pocket expenses would be mitigated by an insurance policy--in this case, one which provides reduced prices for medical care. In most cases the carriers have a 2 year window to go back and consider a condition pre-existing.
Other factors affecting insurance price Because of advances in medicine and medical technology, medical treatment is more expensive, and people in developed countries are living longer. The population of those countries is aging, and a larger group of senior citizens requires more medical care than a young healthier population. (A similar rise in costs is evident in Social Security in the United States.) These factors cause an increase in the price of health insurance.
Some other factors that cause an increase in health insurance prices are health related: insufficient exercise; unhealthy food choices; a shortage of doctors in impoverished or rural areas; excessive alcohol use, smoking, street drugs, obesity, among some parts of the population; and the modern sedentary lifestyle of the middle classes.
In theory, people could lower health insurance prices by doing the opposite of the above; that is, by exercising, eating healthy food, avoiding addictive substances, etc. Healthier lifestyles protect the body from some, although not all, diseases, and with fewer diseases, the expenses borne by insurance companies would likely drop. A program for addressing increasing premiums, dubbed "consumer driven health care," encourages Americans to buy high-deductible, lower-premium insurance plans in exchange for tax benefits and utilization of Health Incentive accounts.
Common complaints of private insurance This section is missing citations and/or needs footnotes. Using inline citations helps guard against copyright violations and factual inaccuracies. This article has been tagged since June 2007.
Some common complaints about private health insurance include:
Insurance companies do not announce their health insurance premiums more than a year in advance.[citation needed] This means that, if one becomes ill, he or she may find that their premiums have greatly increased (however, in many states these types of rate increases are prohibited). If insurance companies try to charge different people different amounts based on their own personal health, people may feel they are unfairly treated.[citation needed] When a claim is made, particularly for a sizable amount, insureds may feel as though the insurance company is using paperwork and bureaucracy to attempt to avoid payment of the claim or, at a minimum, greatly delay it.[citation needed] Health insurance is often only widely available at a reasonable cost through an employer-sponsored group plan and online for individuals.[citation needed] In the United States, there are tax advantages to Employer-provided health insurance, whereas individuals must pay tax on income used to fund their own health insurance, although a small number of pre-tax health plans exist.[citation needed] Experimental treatments are generally not covered.[citation needed] This practice is especially criticized by those who have already tried, and not benefited from, all "standard" medical treatments for their condition.[citation needed] The Health Maintenance Organization (HMO) type of health insurance plan has been criticized for excessive cost-cutting policies in its attempt to offer lower premiums to consumers.[citation needed] As the health care recipient is not directly involved in payment of health care services and products, they are less likely to scrutinize or negotiate the costs of the health care received.[citation needed] The health care company has popular and unpopular ways of controlling this market force.[citation needed] Some health care providers end up with different sets of rates for the same procedure. One for people with insurance and another for those without.[citation needed] Unlike most publicly funded health insurance, many private insurance plans do not provide coverage of dental health care, or only offer such coverage with additional premiums and very low dollar-amount coverages. Insurance Companies can influence the type or amount of treatment that the insured receives by setting limits on the number of visits, types of treatment, etc., it will cover.
Health insurance in the United States The neutrality of this article is disputed. Please see the discussion on the talk page. Please do not remove this message until the dispute is resolved.
Main article: Health care in the United States According to the latest United States Census Bureau figures, approximately 85% of Americans have health insurance. Approximately 60% obtain health insurance through their place of employment or as individuals, and various government agencies provide health insurance to over 29% of Americans.[2] In 2005, there were 41.2 million people in the U.S. (14.2 percent of the population) who were without healthcare insurance for at least part of that year.(ibid) For many people, however, this does not boil down to a simple question of affordability. Part of this population might include young and healthy individuals with low risk of serious illness who don't believe that health insurance would be cost-effective. In fact, approximately one-third of these 41.2 million live in households with an income over $50,000, with half of these having an income of over $75,000.[3] Additionally, one third of these 41.2 million are eligible for public health insurance programs but have not signed up for them.[4] People living in the western and southern United States are more likely to be uninsured.[2]
Medicare In the United States, government-funded Medicare programs help to insure the elderly and end stage renal disease patients. Some health care economists (Uwe Reinhardt of Princeton and Stuart Butler among others) assert that (the third party payment feature) these programs have had the unintended consequence of distorting the price of medical procedures. As a result, the Health Care Financing Administration has set up a list of procedures and corresponding prices under the Resource-Based Relative Value Scale.
Starting in 2006, Medicare Part D provides a program for the elderly to buy insurance for the purchase of prescription drugs.
Medicare Advantage Medicare Advantage plans expand the health care options for Medicare beneficiaries. The option for Medicare Advantage plans is a result of the Balanced Budget Act of 1997, with the intent to better control the rapid growth in Medicare spending, as well as to provide Medicare beneficiaries more choices.
Medicaid While Medicaid was instituted for the very poor, beginning in 1972, the number of individuals in the United States who lacked any form of health insurance for any period during the year increased each year, every year with the exceptions of the years 1999 and 2000.[citation needed] It has been reported that the number of physicians accepting Medicaid has decreased in recent years due to relatively high administrative costs and low reimbursements. [5]
The shift to managed care in the U.S. Through the 1990s, managed care grew from about 25% of U.S. employees to the vast majority.
Rise of managed care in the U.S. Year Conventional plans HMOs PPOs POS plans HDHPs 1998 14% 27% 35% 24% ~ 1999 10% 28% 39% 24% ~ 2000 8% 29% 42% 21% ~ 2001 7% 24% 46% 23% ~ 2002 4% 27% 52% 18% ~ 2003 5% 24% 54% 17% ~ 2004 5% 25% 55% 15% ~ 2005 3% 21% 61% 15% ~ 2006 5% 20% 60% 13% 4%
[3]
According the Centers for Medicare and Medicaid Services, nearly 100% of large firms offer health insurance to their employees.[6] Although much more likely to offer retiree health benefits than small firms, the percentage of large firms offering these benefits fell from 66% in 1988 to 34% in 2002.[7]
Types of Medical plans in the United States On December 8, 2003, President Bush signed The Medicare Prescription Drug, Improvement and Modernization Act of 2003 into law, creating tax-deductible Health Savings Accounts. This gives consumers a new alternative to pay for health care expenses. The HSA is a private bank account which is un-taxed and only penalized if spent on non-medical items or services. Because it must be part of a high deductible insurance plan, the HSA insurance generally has a reasonably priced monthly premium and allows mostly healthy people to bank money for their own healthcare expenses rather than give it to the insurance company.
Common Medical Insurance Terms [8] [9] Deductible - The fixed amount you have to pay before your insurance starts to pay. Co-insurance - Generally expressed as the percentage that you pay of any covered medical services after you have paid the deductible and co-pay. Co-insurance limit - The dollar amount you have to pay with Co-insurance before the insurance company begins paying your bills at 100% for the remainder of the plan year. Out Of Pocket Maximum - The total dollar amount paid out by a subscriber (deductible plus coinsurance). Co-pay - A fixed fee you pay for services rendered. Most plans cover 100% after the co-pay for services rendered, however this can be adjusted to any amount depending on how the plan is set up. Life time maximum - The total your policy will pay out. Many plans have a yearly restoration amount which will replenish the total so that after the policy money is exhausted there will still be some money in the following plan year for new claims. Co-ordination of benefits or COB - How your plan pays when it is second to another plan. There are three principle methods in US health plans. Health Incentive Account (HIA) - A account used by health insurance carriers to hold reward and incentive monies for the consumer to use as needed with in a HIA plan. Monies carry over but if you leave the company you lose your account, it does not transfer. Maintenance of benefits - If the other plan pays the same amount or greater than your plan, then your plan pays nothing. If the other plan pays less, your plan pays only the difference between what it would have paid and what the other did pay. 100% allowable - The secondary plan pays the patient responsibility up to the full allowed amount by the plan. Government Exclusion - In general these plans take the patient responsibility remaining from the primary plan and treat it as a brand new claim and pay it under the normal plan benefits. Self-Insured - Many major U.S. and world corporations hire insurance companies as administrators to manage a pool of money held by the company. Many state and federal laws do not apply to these plans. Fully Insured - The insurance company collects the premiums and pays claims from its own money. Reciprocity - Most insurance plans deal with networks of doctors. If for example you have an HMO plan that allows you to see any HMO provider anywhere in the country, it is called Full Reciprocity, but if it only allows you access to local area networks of providers it is called Limited Reciprocity and if you can only go to select networks that your company has purchased access to, it is called No Reciprocity. Experimental/Investigational - Most insurance companies will deny coverage for any procedures or tests which have not been medically verified by clinical trials conducted by recognized bodies of physicians or scientists. Many medical providers use tests which they believe in but have not been clinically validated. No-fault - This is generally for automobile insurances, however if your auto policy is no-fault and you are injured, the medical insurance will become a secondary payer and will not be able to process claims until explanation of benefits are received from the auto insurance carrier. The Birthday rule - many insurance companies have adopted this rule to determine which parent is primary payer when both parents cover the same dependents. Who ever has the earlier date of birth, excluding the year, is designated primary insurance carrier. Exceptions to this rule usually arise when there is a court order for one of the parents to be the primary carrier. Subscriber - The primary member on the insurance policy. In-Network/Participating/Par Providers - Medical providers who have an established relationship with an insurance company Out-of-Network/Non Participating/Non-Par Providers - Medical providers without an established relationship with an insurance company.
Health Insurance in Canada Most health insurance in Canada is administered by each province, under the national law that requires all people to have free access to basic health services. Collectively, the public provincial health insurance systems in Canada are called Medicare. Private health insurance in Canada cannot cover the same services provided by the universal Medicare services paid by the government. Private health insurance in Canada is allowed only for services the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Canadians also must use private insurance for medical services such as Lasik surgery, plastic surgery such as liposuction, and other non-basic medical procedures. Private health care cannot cover physician fees which are covered by Medicare. Private sector services not paid for by the government accounted for nearly 30 percent of total health care spending [Canadian Institute for Health Information: National Health Expenditure Trends, 1975-2003 (2003)].
In 2005, the Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that the prohibition on insurance for health care already insured by the state constitutes an infringement of the right to life and security. It is yet to be seen if this ruling will change the overall delivery of health insurance across Canada.
Insurance Waiting Lists and Comparisons to US Health Care Waiting lists in Canada are essentially different for each hospital system. There is no true system-wide average wait time, as wait times change on a daily basis as patients come in to receive services, and waiting lists are different for each hospital. A Canadian patient has the choice to visit a different hospital system if the primary care they received at the original hospital is found to be unacceptable. For example: If hospital A has a waiting list of five weeks for a surgery, the patient can go to hospital B that may have no waiting list at all. It is important to note that only elective surgeries, such as hip replacement, have waits associated with them. Emergency procedures are performed as soon as medically necessary, based on doctor opinion. This triage system is essentially the same as used in American hospitals where PPO, POS, and HMO managed-care plans may schedule elective surgeries several weeks or months out, but emergency procedures are carried out as soon as medically necessary based on doctor opinion. The American and Canadian systems are more similar than many people realize, and in effect only different in how the majority of insurance claims are paid.
Both the Canadian and American health systems are undergoing major debate for each respective system in order to get more access to health care for the people who need it, in order to lower mortality rates. Each system has unique problems that need attention, mostly dealing with funding and insurance issues.
Canada has a slightly lower mortality rate on average, particularly when involving HIV mortality. The US rate for HIV mortality is approximately 4x higher; however, there are not 4x more HIV cases per capita in the United States.
Sources: http://www.amsa.org/studytours/WaitingTimes_primer.pdf
http://www40.statcan.ca/l01/cst01/health30a.htm
http://209.217.72.34/HDAA/ReportFolders/ReportFolders.aspx?CS_referer=&CS_ChosenLang=en
Health insurance in Australia The public health system ensures free universal access and is funded by a system similar to the US Medicaid called Medicare. The private health system is funded by a number of health insurance organisations the largest being Medibank which is government owned. The remainder of the private health insurers are 'for profit' enterprises with the notable exception of HCF Health Insurance which is a non-profit organization.
References ^ See California Insurance Code Section 106 (defining disability insurance).[1] In 2001, the California Legislature added subdivision (b), which defines "health insurance" as "an individual or group disability insurance policy that provides coverage for hospital, medical, or surgical benefits." ^ a b "Income, Poverty, and Health Insurance Coverage in the United States: 2005." U.S. Census Bureau. Issued August 2006. ^ Income, Poverty, and Health Insurance Coverage in the United States: 2005. U.S. Census Bureau. ^ According to Dr. David Gratzer, senior fellow at the Manhattan Institute. Interviewed in the Sun, in the article Momentum Grows on Health Care. ^ Cunningham P, May J. "Medicaid patients increasingly concentrated among physicians." Track Rep. 2006 Aug;(16):1-5. PMID 16918046. ^ http://www.cms.hhs.gov/TheChartSeries/downloads/private_ins_chap4_p.pdf ^ http://www.cms.hhs.gov/TheChartSeries/downloads/private_ins_chap4_p.pdf ^ Navigating your health benefits for dummies. Charles M Cutler MD Tracey A Baker CFP (c)2006 ISBN-13:978-0-470-08354-3 ^ R Adams, CSR Aetna Ins. Tampa fl
See also COBRA Economic capital Government ownership Health economics Health maintenance organization Healthcare reform Health Insurance Portability and Accountability Act Self-funded health care List of insurance topics Public health RAND Health Insurance Experiment Sicko (film) Social security Social welfare AHIP Applications Retrieved from http://en.wikipedia.org/wiki/Health_insurance
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