Article Abstract:
Americans need a better health insurance system, and one which costs less for administrative overhead and management. Costs of health insurance could be decreased by eliminating the cost of advertising and marketing, which are associated with a competitive free-market system. Except for 30 million Americans who use a Health Maintenance Organization (HMO) or other form of prepaid medical coverage, most individuals are covered by plans that rely upon a traditional fee-for-service approach. This method of payment is inherently inflationary and lacks a responsible fiscal control. The system responds neither to costs of private practice nor to the costs of institutions, and one result is a growing gap between the quality of care afforded to the rich and to the poor. What is needed is a simplified insurance system, which offers more incentive for efficiency. One proposal is for insurance to be rapidly converted to a prepaid coverage system that uses a not-for-profit model and is controlled by both physicians and subscribers. Individuals who can afford and wish to can still be free to provide their own insurance, which would not be tied to government or employment. Providing universal coverage for all Americans is a praiseworthy goal, but the ability of current insurance payers to afford the continued rise in costs that would come from universal coverage is doubted. Increasing the pressure on doctors to become part of particular groups would encourage them to increase the quality of their performance, and encourage a more conservative practice without the pressure of fee-for-service. The mix of generalists and specialists would also change to one where more generalist primary care practitioners would attend to most routine medical issues. This will necessitate changes in medical education and allocation of postgraduate training as well. Unless such policies are soon initiated, we will remain tied to an ever-growing inflationary spiral. A final issue is the conversion of an entrepreneurial American medical system, which now operates like any other commercialized system, to a socially managed, nonentreprenurial model. Only a comprehensive change is the medical system can be successful. (Consumer Summary produced by Reliance Medical Information, Inc.)
User Contributions:
Comment about this article or add new information about this topic:
Article Abstract:
Many US residents do not have adequate health care insurance, and many do not have any health insurance. Those that have health insurance fear losing it. Many health insurance plans do not provide enough coverage if an individual or one of their family members develops a serious illness. Over 60% of group health insurance plans have a special clause that excludes coverage for an illness that existed before the plan went into effect. Other group insurance plans do not pay for prenatal care, well baby care, childhood vaccinations, office visits or physical examinations. Many have large deductibles and copayments. Medicare does not provide enough medical coverage for the elderly, and many spend their life savings before qualifying for Medicaid. Individuals who are underinsured often receive inadequate health care, or have an increased risk of unnecessary complications and dying.
User Contributions:
Comment about this article or add new information about this topic:
Article Abstract:
Cost sharing in the emergency department may be effective as long as the copayment is not too much. Many insurance plans require patients to make a copayment when they visit an emergency room. However, these copayments may prevent many low-income patients from seeking medical care. Studies have shown that many patients cut back on preventive care when they have to co-pay. A 1997 study found that a copayment of $25 to $50 did not delay patients with chest pain from visiting an emergency room. However, these patients belonged to an HMO and the results may not apply to uninsured patients.
User Contributions:
Comment about this article or add new information about this topic: