Chapter 14: Health Care System: Function

Health Care System: Function

Health care provided in the United States is arguably the best in the world, however the services offered in the United States aren’t available to everyone, because of the cost. An alarming concern is minorities in the United States often receive a “lower quality of care than do their white counterparts.” There are several ways to gain access to the health care system, even with all the different ways to gain access to the health care system, 46.6 million Americans were uninsured in 2005. The chance of being uninsured goes up for younger people, people with less education, people with lower incomes.

Payments for the U.S. health care bill comes from four sources, the consumers themselves, private insurance companies, public or government insurance programs, and a small portion are paid by private funds. There are two ways of payment, fee-for-service and prepaid health care. Fee-for-service the more traditional of the two is an arrangement based on the “assumption that services are provided in a set of identifiable and individually distinct units such as doctors office visit or a specific medical procedure.” In this process the consumer selects a provider, receive care from the provider, incur a expense for the care, the provider is reimbursed for the covered services, and the consumer is responsible for the remaining.

The language of a health insurance policy can be very confusing, and there are several terms everyone should be familiar with. Deductible is the amount of expenses the consumer must pay out of pocket before the insurance company will pay for covered services. Fixed indemnity is the maximum amount an insurer will pay for a certain service. Exclusion is written into a policy, and it means that a specified health condition is not included in the coverage.

Health care is a very controversial topic, and the debate about it can get very heated. Should everyone be giving insurance even if they can’t afford it, how good should their coverage be? How much should people who can afford coverage have to pay? When lives are at risk as seen in the movies Johnny Q we watched in class, insurance policy can change without notice and the consumer can be left in the dark.