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Re: US health care systemFrom: Jamie (ajfields@pine-net.com)Sun Mar 11 08:20:07 2007
There are two publicly funded medical programs. Medicare is for the elderly and certain disabled persons, regardless of income. One piece is provided without cost to the patient, other pieces can be purchased (fairly costly, but this population would find it difficult to purchase private insurance at all). It was created at a time when care was most likely to be done inpatient, and is weighted in that direction a bit (hospitalization covered in that part that is provided free, patients have to pay for coverage for outpatient and prescriptions). Until recently, it provided for no medications. Now, prescription coverage is one of those pieces that can be purchased. Medicaid is income based, and available to pregnant women, children, and elderly and disabled persons, to cover the gap between Medicare and the care they actually need. All recipients have to meet income guidelines (and have no significant savings or other assets). The availability and quality of providers who accept Medicaid vary according to location. In my area, most providers accept it b/c it's a poor area and they wouldn't have enough private patients to survive. Most things are covered at near 100%, but there are some restrictions-mostly IME some medications that aren't covered. Medicaid patients sometimes face a negative attitude when they seek care, especially if they attempt to make choices about their care. Both Medicare and Medicaid are now largely or wholly (depends on the state) managed by private insurance companies. Patients can choose from a few different plans in some cases. Anyone not covered by one of these programs must have private insurance or pay out of pocket. Private insurance varies a lot. It tends to be connected to employment for most of us, b/c employers provide all or more often part of the cost as a benefit. The cost to the employee, both in terms of their part of the premium, and in their part of care, varies a lot as well. Buying insurance directly from the company is cost prohibitive for many. Employers tend to choose plans based on cost to them rather than service to their employees, so quality and availability of care varies a lot. My husband once had a job that provided insurance we basically couldn't use b/c there were no providers within several hours' drive. Low wage employees may be unable to afford their part of the premiums, so may opt out of coverage. (If that's the case their children may qualify for Medicaid, but the adults will often just forego needed care). There's a fairly large group of uninsured in the U.S. They either can not afford or can not obtain private coverage, and do not qualify for Medicaid. They tend to go to the emergency room for nonemergent care (b/c they don't have to pay upfront) or wait until the situation has become truly emergent. The care, of course, is substandard b/c emergency rooms are not meant to provide primary care. And the cost is huge. A lot of those emergency room bills go unpaid-the hospitals eat the cost and the patients end up bankrupt. You asked about cost of private insurance. My husband's company provides what are considered excellent benefits. We pay about $200/month to cover the entire family (excellent rate b/c we have a large family). Physician copay is $15, ER copay is $50, hospitalization $250, outpatient surgery $35, presciptions from $10 to $40 depending on the medication. We are extremely fortunate. Some families pay hundreds more in premium, and have higher copays.
At Sun, 11 Mar 2007, Melissa wrote:
>
-- JFields, RN, BSN
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