Exactly What Is Health Insurance?
Do I really need health insurance or can I live without it?
This is a question which many people ask and it is not always an easy question answer. Indeed, the answer often depends on who you ask.
As with most form of insurance, it could be argued that you don’t really need it until you need it. For example, car insurance doesn't do you any good until you have a car accident and life insurance doesn't do you any good until you are dead. By the same token, health insurance doesn't do you any good until you a sick. However, if like many people you believe in Murphy's Law - that whatever can go wrong, will go wrong - then it would probably be a good idea to think about getting health insurance.
In many countries such as the United Kingdom, Canada, France, Norway and Sweden health insurance is not an issue since medical care is provided free of charge and doctors and hospitals are reimbursed by the government.
In the United States however most health care bills are met from insurance and there are three basic forms of health insurance:
- Self-Insured or Uninsured. Here an individual either has no insurance at all or has health insurance and is responsible for paying his own insurance premiums. It is estimated that at least 30% of the United States population falls into this category.
- Managed Care Plans. Managed care plans, which are networks providing contracted service by specified providers at contracted prices, fall into three categories:
- Health Maintenance Organizations (HMOs) are pre-paid health insurance plans for which members pay a set monthly premium. HMOs provide medical services ranging from visits to the doctor's office to hospitalization and surgery and you are normally required to seek treatment from a designated network of health care providers.
- Preferred Provider Organizations (PPOs) comprise groups of doctors and health care facilities which provide medical services to a specified group. Members of PPOs normally pay for services as they are used and are then reimbursed for the costs of treatment. In most cases services are provided at a price which has been negotiated between the health care provider and the PPO.
- Point Of Service (POS) is a type of managed health care system in which you pay a minimal co-payment and no deductible as long as health care is provided within your network. However, you are free to seek treatment outside of the network but, should you wish to do so, you will have to pay additional charges and possibly a deductible.
- Indemnity Plans. An indemnity health insurance plan allows the plan holder to seek medical treatment whenever and wherever they choose. The major benefit of an indemnity plan lies in the freedom of choice that it gives to plan holder but this freedom also makes indemnity plans the most expensive form of health insurance.
The form of plan that will best suit your needs will depend very much on your personal circumstances and choosing a health insurance plan is a time-consuming task. Nonetheless, health insurance is something which everyone needs to consider sooner or later.
Clinical status: A type of outcome measure that relates to improvement in biological health status.
Executive director: In a managed care plan, individual responsible for all operational aspects of the plan. All other officers and key managers report to this person, who in turn reports to the board of directors.
Market segmentation: The process of dividing the total market for a product or service into smaller, more manageable subsets or groups of customers.
QM committee: MCO committee responsible for oversight of the quality management program—including the setting of standards, review of data, feedback to providers, follow-up, and approval of sanctions—and for the quality of care delivered to members.
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