Finance and Business

You want to insure your health and ask your insurance agent to offer you a good policy. You are given quotes and start thinking about buying a certain plan when the inevitable question is asked “What type of plan do you want to purchase?” This question has left many first-time insurance shoppers confused as they didn’t know about any plan types before. Too bad, because by choosing the type of insurance plan you will pay for determines how your coverage will be distributed as well as how your medical services will be provided. And as you may guess this is crucial when it comes to insuring own health.

But do not worry, this article will explain the essence behind each coverage plan type you can get in the US so the next time you will be asked the question of plan types you would choose the perfect plan to meet your requirements.

Health Maintenance Organization

HMO plans are the most popular type of managed care distribution these days. They provide a wide spectrum of healthcare services you can receive for a reduced fee or free of charge. But the main catch is that you can receive them only at specific locations and from specific professionals. And you will have to choose a primary care physician (PCP) who will refer you to other professionals when needed. Without your PCP’s affiliations you won’t be able to receive coverage for the services you took. Neither will you be covered for the costs if you address someone outside the network. Read the rest of this entry »

Looking at the title of this article again, it seems a little strange. Surely it goes without saying that having a company insure your health is a good thing? How can it not be good? Surely people who are insured have better health and live longer? One of the more interesting things about the so-called scientific method is that everyone knows how it is supposed to work. You have to start with a hypothesis. In this case, it would be: people with health plans enjoy better health. You then devise an experiment involving a statistically significant number of people. One group, drawn randomly from the population have health plans. The other group (the control group) do not have health plans. Researchers then monitor their health for, say, ten years. Data is collected and analyzed. Results are published in a peer reviewed journal. Human knowledge is increased. Except, the US has been running this experiment for decades. Millions of people across the age range and with differing levels of health are uninsured. Millions more pay for private coverage. The remainder have plans provided by their employers. The data over the years shows that uninsured people have a lower life expectancy. In fact, the poor on average die seven years earlier than the rich. By a coincidence, many of those without insurance are poor. Now that is bad news for this research. There are many factors contributing to death. They are directly related to the social class and lifestyles of the individuals involved. In this, lack of access to medical care is not a major contributing factor. Put another way: there has never been any research to answer the question posed in the title to this article.

We need to consider two contradictory statements: when they fall sick, the poor go to an emergency room and, if they are lucky, receive treatment that keeps them alive; when they are insured, the rich receive care that gives them better health. Except the international statistics show the US has higher mortality rates than most of the other developed countries. To help you understand, we need a comparison with Europe where there is a completely socialized healthcare service and better life expectancy. Both at a European and individual state level, there are panels of experts who decide what treatments and which drugs represent good value for money. States will only pay for treatment proven effective and safe, and will not pay drug companies the retail price they claim. Instead, the states will only pay for approved drugs at prices agreed in negotiations. In the US, insurance companies happily pay for a battery of medical tests and procedures even though there is no evidence any of this work is effective. This adds to the irony. Sometimes the rich die young even though they have received multiple treatments. This is because their expensive treatments are ineffective. Read the rest of this entry »