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Chapter 18 Private and Government Healthcare Systems Private and Government Healthcare Systems In the United States, health insurance coverage is generally classified as either private (non-government) coverage or government-sponsored coverage. Healthcare Coverage vs. Uninsured The National Center for Health Statistics defines health insurance as public and private payers who cover medical expenditures incurred by a defined population in a variety of settings. In the United States, the risk of becoming uninsured increases significantly for those earning low wages, the unemployed, and when employers are unable to provide insurance to workers. Table 5-2 presents the trend of declining health insurance coverage. Private Health Insurance The concept of insurance is to combine the healthcare experiences of many enrollees in order to reduce expenses for any one individual to a manageable prepayment amount. Employment-Based Plans is coverage offered through one’s own employment or a relative’s employment. It may be offered by an employer or by a union. Private Health Insurance Continued Direct-Purchase/Fee-For-Service Plans are the traditional type of healthcare policy. The physician sets a price for each type of service delivered, and then the client or insurance company pays the fee. This type of health insurance provides the most choices of doctors and hospitals. Private Health Insurance Continued The two kinds of fee-for-service coverage are basic and major medical. Basic covers some hospital services and supplies, such as X-rays and prescribed medicine. Major medical insurance covers the cost of long-term, high-cost illnesses or injuries plus whatever basic did not cover. Private Health Insurance Continued Group Contract Insurance—to make hospitals and physicians products and services affordable to ordinary people in the United States. With unmanaged care (fee-for-service) payments, healthcare providers could increase the number of single services they deliver in order to increase profit. Private Health Insurance Continued Managed Care—manages the cost and delivery of healthcare services, the quality of that healthcare, and access to care. Managed care influences how much healthcare clients can use. Health Maintenance Organizations (HMOs) are prepaid health plans. The goal of an HMO is to provide affordable, well-organized healthcare by allowing clients to prepay (capitation payment) on a regular monthly basis for all services provided. Private Health Insurance Continued Including physicians’ visits, hospital stays emergency care, surgery, laboratory (lab) tests, X-rays, and therapy for all members and their families. There may be a small co-payment for each office visit, such as $15 for a doctor’s visit or $50 for hospital emergency room treatment. Private Health Insurance Continued Point-of-Service Plans (POS) offer enrollees the option of receiving services from participating or nonparticipating prov ...
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HUSC 3366 Chapter 9 Health and Disability Insurance
1.
Health and Disability
Insurance Chapter 9
2.
3.
4.
Health Insurance and
Financial Planning Lesson: 1
5.
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7.
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10.
Health Insurance Coverage
Lesson: 2
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17.
Health Insurance Trade-Offs
Lesson: 3
18.
19.
Private Health Care
Plans and Government Health Care Programs Lesson: 4
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24.
Disability Income
Insurance Lesson: 5
25.
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High Medical
Costs Lesson: 6
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