Health Care Payment
In the
Around 84.7% of citizens have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs (27.8%; there is some overlap in these figures). All government health care programs have restricted eligibility, and there is no national system of health insurance which guarantees that all citizens have access to health care. Americans without health insurance coverage at some time during 2007 totaled about 15.3% of the population, or 45.7 million people.
Among those whose employer pays for health insurance, the employee also usually contributes part of the cost of this insurance, while the employer usually chooses the plan and, for large groups, negotiates with the insurance company. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket 15%, federal government 34%, state and local governments 11%, and other private funds 4%.
Insurance for dental and vision care is usually sold separately, and prescription drugs are often handled differently than medical services, including by the government programs. Major federal laws regulating the insurance industry include COBRA and HIPAA.
Individuals with private or government insurance must generally find a medical facility which accepts the particular type of medical insurance they carry. Visits to facilities outside the insurance program's "network" are usually either not covered or the patient must bear more of the cost (usually waived for emergencies). Hospitals and doctors negotiate with insurance programs to set reimbursement rates; some rates for government insurance programs are set by law. The sum paid to a doctor for a service rendered to an insured patient is generally less than that paid "out of pocket" by an uninsured patient. In return for this discount, the insurance company includes the doctor as part of their "network", which means more patients are eligible for lowest-cost treatment there. The negotiated rate may not cover the cost of the service, but hospitals and doctors can refuse to accept a given type of insurance, including Medicare and Medicaid. Low reimbursement rates have generated complaints from providers, and some patients with government insurance have difficulty finding nearby providers for certain types of medical services.
Charity care for those who cannot pay is sometimes available from any given medical facility, and is usually funded by non-profit foundations, religious orders, government subsidies, or services donated by the employees.
The Emergency Medical Treatment and Active Labor Act requires virtually all hospitals to accept all patients, regardless of the ability to pay, for emergency room care. This does not provide patients who cannot afford to pay for health care access to non-emergency care, nor does it provide the benefit of preventive care and the continuity of a primary care physician. This is also generally more expensive than an urgent care clinic or a doctor's office visit, especially if a condition has worsened due to putting off needed care. Emergency rooms are typically at, near, or over capacity. Long wait times have become a problem nationally, and in urban areas some ERs are put on "diversion" on a regular basis, meaning that ambulances are directed to bring patients elsewhere.
Source:Wikipedia