The Cost of Health Care Insurance - Admission/Application Essay Example

The Cost of Health Care Insurance Summary All health care systems are based on a national philosophy. In addition they function under a legal system of the particular jurisdiction. It is therefore necessary to make comparisons between different national systems. The challenge is to be able to use appropriate data and the correct interpretation of the data. This is the challenge of effective assessment. Introduction The United States is a relative young country. It is significantly les than three hundred years old. At the same time the united states has a health care system that attracts people from all other parts of the world. In addition the united states is a leader in biotechnology. This is the area of research and production. This area of activity produces devices, pharmaceuticals and related inputs. The United States spends more than three times that of any other country or group of countries in this field. This is based on the per capita income. The United States has the highest cost. At the same time is has the highest responsiveness when compared to other countries. Another significant fact is that it has the highest customer satisfaction. This means the recipients of the service (the patients) are very satisfied. This is against the back ground of no guaranteed health coverage or insurance. It would be helpful to find out why the WHO (World Health Organization) could rank such a system as last when evaluating nineteen other health systems. Governments There should be an attempt to make comparisons. However the comparisons should be based on similar conditions where ever possible. On the face of it, one may want to compare Canada, UK, and the USA. The logic is that they are English speaking. Then it is normal to consider the system in the UK. For this discussion this system will not be considered because it has a unitary system of government. In addition the UK has been in existence significantly longer The Canadian system can be considered because it has a federal system of government. The United States also has a federal system of government. Both countries are about the same age and have about the same land mass. In addition they share the largest common border in the world. Their economies are very similar and their economies are interdependent. The United States has the larger population. The Mechanism The delivery of health care has two major components. First is the financial contribution. This is what makes the system possible. Then there is the delivery of the benefits. The benefits have two important components. There is the availability of the care. Then there is the efficiency of the delivery of that care ( Lobianco, M., Mills, M., & Moore, H. 1996,) . All systems seek to bring these factors into an appropriate relationship. The challenge it to move from concept to the actual in the real life situations. Medicare Canada has the system which is publicly funded under an insurance program. It is, in general for all the residents. It guarantees medically necessary services without the co-pay. That means the person does not have to make any payment from their own resources as a patient. The problem her is who determines what is medically necessary. In addition is the question as to how it is determined. In the United States the Medicare is covers those patients sixty five years and older. Other persons are admitted who meet some specially designated standard. This is a single payer system (Lindberg, G., et al 1989). It is run by the United States government. The single payer is the united states government. Both systems started about the same time in history. They are both federal programs. Medicaid This was started in the United states around the same time. It provides for low income families. It provides service especially based on ones financial standing. It is funded by the individual states. The federal government provides about half the money needed. This is different from the Medicare mentioned. The Medicare program is an entitlement program. Insurance Industry The basis is insurance. It works by assessing risk. The risk has a financial cost component. It is called a potential loss. This component is applied to a pool of persons. The next step is to determine how much the relevant persons should pay to be protected by that pool service. The funds are received in advance. The loss occurs and the recipient of the funds makes a payment to compensate for the loss. The receipt and payment of the funds is based on a contract. Medical Profession This should be considered the main part of the health care industry. They maybe considered the gate keepers of the industry. In recent times there has been strong influence from the financial sector the health care sector and the legal sector. It is the result of the importance of meeting the needs of the patient. Economics The issuer of the contract hopes to collect more than is paid out. This is called a profit. The profit is necessary for the service to be offered. The cost of having the service should be a benefit to all the persons protected by the pool. Health insurance is this risk management applied to medical services (Curran, Connie R. 1996.). The challenge here is that health matters are related to pain and suffering and death. In this case it is not easy to choose to be excluded from the pool. In the case of car insurance one can choose not to participate. This is a simple decision, just do not own a car. Abuse and Fraud These are the same in nature. A good description may be the process of robbing another person. There is a distinction. The distinction is legal in nature. One may abuse the system by skillfully extracting a higher level of benefits than is appropriate. We would call that abuse. The distinction here is that the legal system says it is a crime. If the act is determined to be a crime it is handled differently. There will be a cost or some other legal process. Such may result in fines imprisonment or both. In many cases abusers may seek to have acts excluded from the legal code. Manipulation is possible due to government programs and private programs side by side. ********** Three reasons – non-insurance First there must be a party offering the service. Then there must be a participant wiling to be paid from that survive. Last here must be a recipient who is willing to be served by the service. All of this comes down to finances. The service will b provided by a private entity. It may be provided by government entity. There is also the possibility of a combination provider. In either case there must be an inflow of money. This can be from a group or an individual. Next is the service provider. The service provider is the health care professional. In this case the focus is on the physician’s service. The service provider has a financial interest. This means that the decision may not be based solely on the needs of the patient. Most important and last is the patient. The patient is the one at risk. The patient loss is the greatest. There is the matter of pain and suffering and or the loss of life. This last category has two components. First there is ignorance and the person may not have the coverage. The other is that of money. The patient may not be able to pay for it when the service is needed. . The challenge is to have the service available when it is actually needed. The loss of income for what ever reason is the difficulty. The future cannot b predicted with certainty. Loss of Coverage and Loss of Job. This is the weakness of a private payer system. The income is the means for the payment. The payment provides the coverage. The moment the payment goes the coverage goes also. This is true even for the self employed. The loss can be from a shift in the economy or from bankruptcy. In many cases it can be from the sickness’ itself. A good example is that of a deep sea diver. If the x-ray results show serious trouble in the lungs. There will be no more deep sea dividing. The income and coverage is gone. Skyrocketing cost This s due to many factors. First there is the general price level adjustment. It is called inflation. It is the result of money losing its value over time. This may be due to the decisions of the government of that country or that of other countries (Reutzel, T., Becker, F., & Sanders, B. 1987), . It can be seen from the present globalization of the economies. There is more economic activity. This results for the need to earn more. An example is the increase in cholesterol lowering drugs. The drug companies are in competition. Competition spurs innovation. It is also true that competition can increase duplication and waste. The delivery system is a source of waste. Duplication of records has an impact. The delivery system also has a legal component. The insurance provider seeks to avoid legal pitfalls. The healthcare provider seeks to avoid being charged with malpractice. The injured patient seeks redress. This intricate web provides the framework for the legal profession to be part of the health care system. Conclusion Our world operates on an allopathic medical module. Our present system is called a health care system. On analysis it will be seen to be caring for disease. There is little mention about prevention. Nutrition may have a positive outcome (Hood, L., Heath, J., Phelps, M., & Lin, B. 2004) As a result we have a process that seeks to diagnose conditions. Then it seeks to treat conditions. There is little thought about curing the condition. Such a system by its very nature seeks to have a pool of people in need of services. The service is provided in two ways. First there is the supply of drugs. Then there is the supply of procedures. Two examples of procedures are x-rays and surgery. The health prevention model will greatly reduce the need for such services. If that happens then a whole industry will decline. This will not happen. It is therefore necessary to continue to struggle with the need for insurance for those who are on a program to sickness. References Curran, Connie R. 1996. "Managing Managed Care: A Success Story." Nursing Economic$, November . 320-365. Academic Search Premier, EBSCOhost (accessed August 10, 2009 Hood, L., Heath, J., Phelps, M., & Lin, B. (2004, October 22). Systems Biology and New Technologies Enable Predictive and Preventative Medicine. Science, 306(5696), 640-643. Retrieved August 10, 2009, from Academic Search Premier database. Lindberg, G., Lurie, N., Bannick-Mohrland, S., Sherman, R., & Farseth, P. (1989, November). Health Care Cost Containment Measures and Mortality in Hennepin Countys Medicaid Elderly and All Elderly. American Journal of Public Health, 79(11), 1481-1485. Retrieved August 10, 2009, from Academic Search Premier database. Lobianco, M., Mills, M., & Moore, H. (1996, September). A Model for Case Management of High Cost Medicaid Users. Nursing Economic$, 14(5), 303-314. Retrieved August 10, 2009, from Academic Search Premier database. Reutzel, T., Becker, F., & Sanders, B. (1987, April). Expenditure Effects of Changes in Medicaid Benefit Coverage: An Alcohol and Substance Abuse Example. American Journal of Public Health, 77(4), 503-504. Retrieved August 10, 2009, from Academic Search Premier database. Read More