Healthcare Insurance

Currently, the United States of America does not have a single payer insurance system. It is surprising given that most advanced countries embraced the method of insurance. It is surprising that this system receives low political support in the country. Experts indicate that its failure in some countries might be the reason that policy makers in the US are opposed to the formula (Bodenheim, 2010). Research indicates that the systems increase the average wait thereby decreasing the morale of medical practitioners. The system in addition to this seems to favor those in the urban areas at the expense of the rural dwellers. An example of the same is the single system that Australia offers to its citizens. Hence, the fear of Americans according to studies is that there will be a replica of the same in the country (Henry, 2006). This has the meaning that though the general population supports a government intervention, they oppose a single payer system.

Another fear by the population is that the payer will interfere with other industries. Since the payer will have to pay for most medical bills, it bound to check on healthy living among the individuals it covers in this case the citizens. Accordingly, it will move to have the government ban any adverts related to unhealthy living or smoking. The consequence of this is that such businesses will perform poorly and more Americans have a probability of losing their jobs. Though there are countries that have been registering success in insuring the entire population, most have had challenges and most cases it leads to crises in the healthcare insurance. In Australia, physicians are retiring earlier, due to the lack of morale because of increasing pressure with constant pay (Schultz, 2010).

Private healthcare especially employer-based seems to be a normal occurrence in the life of Americans. The fact is that financing has undergone major changes since its introduction only a century ago. Less than 100 years ago, there was no form of healthcare insurance present in the country. Arguably, fewer people required the cover at that particular time. Afterwards, there was an increase in the forms of insurance offered. Specifically, in the nineteenth century many employers in industry started offering medical cover to their employees. This was through the employment of company physicians that would treat the employees during eventualities (Henry, 2006). During the great depression, pressure mounted on companies to cut on spending and such privileges were no longer part of the organization policy leading to the death of that practice. Another mode of insurance was physicians charging corporations rates such as $4 dollar an individual per year.

The first full hospital based insurance was in Dallas to schoolteachers. In 1929, a hospital that had its base in Dallas rolled out a program in which it covered 1500 teachers from the city at a rate of $6 each year (Bodenheim, 2010). This was immediately after the great depression and was attractive to other medical centers. Accordingly, many hospitals in the country started similar programs to different groups of individuals. This led to the birth of Blue Cross System whereby individuals covered could choose the medical facility that they desired. Thereafter after some years, Blue Shields kicked off with its plan to cover physicians both in medical and non-medical expenses. Accordingly, the healthcare insurance industry started developing slowly and in later years would become a necessity to all citizens of United States.

During the entrance of the blues, that is Blue Shield and Blue Cross, most of the coverage was individual as opposed to having the basis of employment. Currently, most of the United States population cover is through the private funding with around 60%benefiting from the system. The two insurance companies intensified their competition by rolling out incentives that would attract workers. This practiced became common in the country and with the support of organizations such as American Medical Association; private healthcare insurance became popular in American households. Consequently, more companies began offering health insurances to their employees and were able to attract healthier employees through the offering of lower premiums. The Blues changed tact by shifting from the use of community ratings to experience ratings in order to increase their relevance. This was to the disadvantage of the individuals not covered in the employer schemes.

Access of medical services before the introduction of public insurance was relatively low. It is because of the introduction of this scheme that led to the rolling out of Medicaid by the government. The result of this is that it was affordable for higher number of individuals to access some form of medical care (Mullan, 2002). Accordingly, many individuals have the capability of having access to healthcare either through the government-funded system or through private one. A large number of citizens are under the coverage of employer-funded scheme. Hence, the implication of private healthcare is an increase access. In addition, the blues had the mandate of ensuring that there is coverage of populations from all the corners of the country. Insurance means that it becomes affordable to seek medical services increasing the frequency of hospital attendance.

Private insurance schemes have led to escalation in the price of coverage. With increasing coverage throughout the country, the result has been an increase in the prices of healthcare. Reports indicate that growing insurance covers throughout the country lead to spiraling healthcare costs. An example is the period between 1950 and 1970, during this period country’s expenditure on healthcare rose by 586%, which was more than the entire gross national product of the United States that grew by 347% (Mullan, 2002). Hence, the cost of medical services did increase significantly due to the increasing medical cover. Currently, there is a general opinion among the public that the government has to intervene in order to protect the normal citizens from the skyrocketing healthcare prices. Generally, the effects on the cost of healthcare with the introduction of the private healthcare are it scaling upwards, which is a growing concern among the general population.

Insurers have limited options to contain the increasing cost. Healthcare cost is a direct responsibility of the healthcare centers and their physicians. With the government seeking to intervene into the healthcare system, there will probably be a reduction in healthcare inflation. Such escalating cost forced employers to increase the reductions of their employees to meet the costs. Blue Shield and Blue Cross have little effect on the providers since they only deal with the insured individuals (Schuetz, 2010). Cost escalation has large attribution to the increase in demand of the services due to the employer-based insurance. More people could now afford to receive treatment and following the demand supply curve, the prices were bound to increase with increase in demand with a reflection of the same on the supply.

When the health insurance was starting, the impression was that it would eradicate cost barriers to medical services (Morone, 2010). It is now having a big impact on the quality and the service delivery of these services. Employee-based insurance is the most popular but Medicare and Medicaid cover individuals that are either older, physically challenged, impoverished, or cannot afford healthcare due to different reasons. Healthcare insurance impact on the quality of services offered by medical facilities is tremendous. Service delivery has been increasing steadily and certainly, research indicates that services will continue to improve even after the government intervention. There has been the opening up of communication channels between different channels and comparing services between countries without insurance systems with that of the United States, disparity is huge in favor of the later.

Health insurance schemes such as Medicare and Medicaid has been helping in the transformation of the healthcare image (Morone, 2010). Matter of fact is that insurance has allowed the government to prepare the future by understand past trends. Insurance either through employers, government, or individual funding is fulfilling the civil rights act. The right to lack of discrimination is part of the civil rights act and the fact that various groups are under representation in the scheme and can receive medical services is a vital achievement on the part of insurance. Labor development in medical facilities is another achievement of medical insurance. Studies indicate that with increase in affordability of the services, there was the grooming of newer professions in the field. Literally, pharmacies shifted from being at the corner of the streets to being part of the community. Nursing professional is also growing as the healthcare becomes more dynamic.

Though there are advantages of the healthcare insurance due to its cost effectiveness, there are also challenges. One among the drawbacks that insurance brings into the medical care system is the lack of profitability for hospitals. Many hospitals have been reporting that their profit margins are shrinking due to the intervention of many players that seek to have cheaper care. As competition among healthcare providers intensifying, more hospitals are closing mostly attributed to the managed healthcare insurance systems. Physicians are also feeling the effect of insurance in their profession. Over the years, physicians from the United States have always been the envy world over. This is changing due to the stagnation of their earnings and increasing premiums. Hence, more healthcare providers are seeking to retire earlier this is affecting the physician-patient relationship.

Concerns on the spending on the healthcare system are also real. A large portion of the Gross Domestic Product (GDP) goes to financing healthcare. According to studies, the major worry is that with the inflation of cost in medical services provision, its spending will have a negative effect on all the other indicators of growth. That is, currently the healthcare depends on insurance for funding. Accordingly, it will depend on government taxes and the funding coming from employers. Increasing medical care cost will prompt the government to increase taxes influencing negatively on the economy. Employers on their part will decrease the number of employees due to the rising costs. Investors will abstain from investing in the country and the impact of this is an overall fall in the economy. To prevent such a scenario government will have to formulate better policies.

References

Morone, J.A. (2010). Presidents and health reform: From Franklin D. Roosevelt to Barrack Obama. Health Affairs, 29(6), 1096-1100. Retrieved from the proQuest database.

Henry, M.S. (2006). Uncertainty, responsibility, and the evolution of the physician/patient relationship. Journal of Medical Ethics, 32: 321-333. Retrieved from http://tinyurl.com/283jor3.

Schuetz, B. (2010). Educating health professionals collaboratively for team-based primary care. Health Affairs, 29(8), 1476-1480. Retrieved from the proQuest database.

Mullan, F. (2002). Time-capsule thinking: The health care workforce, past and future. Health Affairs, 21(5), 112-122. Retrieved from the proQuest database.

Bodenheim, T. (2010). Primary care: Current problems and proposed solutions. Health Affairs, 29(5), 799-805. Retrieved from the proQuest database

Healthcare insurance refers to an insurance against incurring large medical expenses. With the development of the Affordable Care Act, every employee is expected to hold health insurance policy to facilitate a universal healthcare system in the United States. Through this policy, Americans are better provided with new benefits, healthcare rights, and protection in the various aspects of the healthcare system (LifeBenefits, 2014). Healthcare insurance involves a process through which a healthcare insurer estimates the total risk of healthcare and the likely expenditures on healthcare for a target group, and come up with a collective risk pooling initiative to provide insurance to the group through premiums or payroll tax payable on regular intervals. On this note, healthcare insurance is segmented into different packages whereby, employees are presented with a larger choice on the type of care they need. Such a move has led to increased consumer choice whereby, employees have the right to choose their desired coverage and incur costs on insuring related risks in the exclusion of others. This has also led to decreased cost of insurance as the insurance cover offers compensation to the specified risks and excludes other low-probability risks. This essay shall discuss the various types of employee insurance programs.

Group term life insurance is an insurance coverage that helps the family of the bereaved especially when he/she was the breadwinner (State of Delaware, 2014). Group term insurance policy is offered to a group of people and allows the beneficiaries of the bereaved to enjoy benefits if the insured dies in the specified period. This type of insurance coverage enjoys the benefit of being a cheaper option as compared to individual coverage. The group term life insurance is one of the employee provisions in the benefit packages as it is affordable. It can be serviced by the employer or employees through group contributions. This cover also compensates the insured in the event of permanent incapacitations that may result from the loss of a limb or a major accident causing incapacitation.

Group universal life insurance is an insurance coverage that incorporates a death benefit to the family of the bereaved, an over-time, tax deferred amount that on accumulation can be used as retirement. The policy also provides for children’s education and other emergencies such as illnesses. The policy is often offered in a group setting where; employees gather and on a collective initiative, purchase a cover. The business entity might also purchase the coverage for their employees to cater for any emergencies and unfortunate loss of life or impairment in their period of employment.

Term life insurance is an insurance cover that covers a policyholder for a specified period and expires at a set date (Insure | Investors Group, 2014). Once the expiry date is reached, it is up to the policyholder to consider if he/she wants to renew the policy. In most instances, such policies covers are sought after when employees engage in a particularly dangerous job outside their routine. In contrast to the life insurance policy, this cover runs for a specified limited time, for example, 26 days and expires thereafter. This policy is cost friendly for people who wish to obtain a short cover, as they cannot afford a life assurance cover. AIDitionally, it provides all the benefits that a life insurance cover would, but in the period limitation.

Cancer and specified disease insurance schemes are also a major trend in modern healthcare insurance. Such policyholders are assured of payment of a benefit amount in aIDition to other compensations held on other insured risks. The compensation can be used in the compensation of cancer-related treatment alongside other specified diseases. Lately, HIV /Aids coverage schemes have cropped up to enable people to insure themselves against costs arising from after-HIV infection life. This enables individuals to seek appropriate medical care and take care of themselves from the compensation. AIDitionally, these individuals are equipped with the ability to seek interventions through this fund as well as pursue other expensive medical options (Bovbjerg, 2007). This fund has a major advantage in that; it provides a platform with which people can afford expensive medical care in the event of such illnesses. For families that have a history of such illnesses, one may obtain the cover to ensure that they can afford the care when the disease sets in.

Accident insurance (with expanded benefits) is a policy that provides compensatory benefits to policyholders who may have on and off the job accidents. The compensation helps the insured to pay for the costs of treatment that may not have been paid by the primary insurer. The level of coverage can be negotiated between the insurer and the insured. This is in the light that, coverage may be in the silver, gold, platinum, or basic level of coverage options (Colombo and Tapay, 2004). The benefits are set to make compensations in the event where the policyholder suffers loss of life or a physical permanent impairment, a dislocation or fracture, medical expenses, permanent disability, as well as hospital confinement. For covers that insure outpatient services, policyholders stand to benefit from this scheme.

Hospital indemnity insurance refers to a policy that pays for hospital confinement, ICU, and waiver premium. The policy is available for both, individual, and the entire family. It is also referred to as ‘shop’ (Colombo and Tapay, 2004). It is available in the various classes, among them: gold, platinum, silver, and other user-specified packages. Heart and stroke insurance is another cover that helps a policyholder to cover for the medical expenses incurred in the course of treatment for heart and stroke-related complications. Disability income insurance lastly is an insurance policy that assures an individual policyholder of an income when the insured suffers a sickness or an off-job accident.

As noted earlier, term life insurance policyholders stand to benefit from limited coverage for risks accruing to a certain activity. Policyholders pay a cheaper premium due to the limited time of coverage and tailor-make the policy to suit the inherent risks. Universal whole life insurance aIDresses the financial needs of the bereaved family after the departure of their breadwinner. When it is in a group setting, it is often cheaper, and the premiums are lower (Bovbjerg, 2007). Another major advantage is that It covers many risks among them incapacitation and death among others. It also covers for emergencies and educational demands of the dependents left behind. Accidental death & dismemberment insurance is a policy that pays compensation where the cause of death is an accident. This amount provides an extra benefit on top of the life insurance cover and covers many accidents among them, homicides, exposure, traffic accidents, and drowning among others. Long and short-term disability insurance is advantageous as it aIDresses the needs that may result from the disability. This includes further disability development, treatment needs, and rehabilitation charges.