Health Insurance in United States
The U.S. government lays great emphasis on health care system, which rests primarily on non-profit/private health insurance. These health insurance schemes encompass private as well as social insurance programs. After a long debate on public health care system for over seven decades, Unites States could see the light of a public health care proposal with the efforts of President Truman, the U.S. president. However, this proposal was not received well by the American Medical Association, and hence did not pass. Today, the scenario has changed altogether and with the crowning of Barack Obama as the new U.S. president, health care reforms have taken a new turn.
Anyone aware of the health insurance system of United States must have heard the name of one of the following big daddies such as Wellpoint,
UnitedHealth, Cigna, Aetna, Humana etc. These companies serve millions of American residents, and cover health insurance requirements of both individuals as well as their families depending on factors such as the state of health, age bracket, lifestyle attributes etc. These health insurance companies launch several schemes from time to time catering to the diversified health coverage requirements of U.S. demography.
Broadly speaking, the health insurance can be segregated into two groups namely, (a) Traditional Care Insurance and (b) Managed Care Insurance. These two broad health insurance categories address varied medical needs.
Traditional Care Insurance, also known as fee-for-service plan or indemnity plan, has been ruling the health care industry for a long time now, and is quite popular with doctors and hospitals since it fetches them more degree of freedom. Anyone, who chooses this plan, is permitted to seek the help of a doctor of one's choice and is not bound to act as per the guidelines of any organization or network. After having used the services, the insured pays for the same & can then claim the reimbursement from the insurer.
On the other hand, if one opts for the managed care insurance, one has a restricted area of choice more often limited to a specialist or network. These health insurance schemes pose limitations to health care expenses by limiting the scope of coverage and amount. Also, one can be obliged to seek prior approval for specific medical procedures or getting admission in any hospital. Talking about managed care health insurance plans, these can be put under three different heads such as:
• Preferred Provider Organization (PPO)-It's a bunch of specialized doctors and some specific hospitals. This clustered unit forms an association, and there are specific charges for every service that are pre-estimated and not likely to change. In addition, there is no paper work involved in this health insurance scheme.
• Point of Service Plans (POS)-These plans give more room when it comes to making a choice of a doctor, who can be out of the network. However, the insured would have to pay a bulk co-payment but one can easily save great bucks by choosing a doctor from within the network.
• Health Maintenance Organization (HMO)-Under this health insurance scheme, the insured has to pay a monthly premium in return of the doctor's visits, surgical procedures, hospital expenses etc. No claim forms need to be filled up, and great emphasis is laid on preventive care in order to keep the cost of health coverage low.
Thus we see that unlike other parts of the world, U.S. witnesses conscious health care incentives as is also evident from the merger of approximately 400 mergers in the last decade. More health care schemes are likely to creep in the existing health care industry of U.S. in the times to come.
