The rapid pace of medical development in the United States has been remarkable, but it has not been easy to make the new advances in medicine available to all patients. If you don't have health insurance, an average worker's monthly income is often just enough to pay for a day's hospitalization, let alone the use of expensive new drugs. If you don't pick the right health insurance, medical bills can also wipe out your family in the event of a serious illness. People who apply for health insurance get a Medicare card, and hospitals bill the appropriate insurance company based on that card and number.
Introduction
The U.S. has a wide variety of health insurance programs, often confusing first-time applicants, ranging from student health insurance for students to unlimited, reimbursable private insurance for the wealthy. The U.S. health insurance system, the federal government's health insurance coverage is also very broad, there are for the elderly over 65 years of age and disabled people to provide "medical care" insurance, there are also low-income families set up for the "poor health care" program. In the United States, rich people can have several private doctors, and the cost of seeing a doctor anywhere in the world is fully "reimbursed", provided that they pay an expensive monthly premium. The poor are forced to seek out health insurance providers with lower premiums and go to designated hospitals. Those who can't make ends meet may not be covered by any health insurance, and when they have to be seen, they have to wait in long lines at public hospitals and fill out lengthy and cumbersome declaration forms in order to get a free prescription.
Three, a variety of medical profile
1, GHI
GHI is a popular health insurance in New York, New Jersey and Connecticut, was founded in 1937 and now covers the West Coast. It is a self-described nonprofit insurance plan. 1995 enrollment was about 2.7 million people. About 1.35 million medical professionals of all types are enrolled. Although it is a non-profit insurance company, it received $1.3 billion in premiums in 1995.One of the benefits of GHI is that the insured can choose their own personal physician. This is very important to many foreign immigrants. Many Chinese are not yet fluent in English, so it is not uncommon for them to choose a Chinese doctor to see. The patient pays a flat fee of five dollars per visit, and the insurance company covers the rest.
But that doesn't mean the doctor can charge whatever the patient wants and prescribe whatever the patient wants; the GHI insurance system requires that the doctor join the program, which means he or she is bound by the program. The GHI insurance system requires doctors to join the program, which means that they are bound by the program. There are strict rules on what kind of medication should be prescribed for what kind of illness, what kind of treatment should be used, and there is a cap on the final cost of treatment. Insurance companies won't cover a penny more than that.
Another type of insurance requires patients to pay for their own medical care up to a certain limit, called a deductible, and the insurance company pays for anything beyond that. In some cases, the patient has to pay a **** co-payment.
The goal of insurance plans is to reduce waste and increase efficiency. Because most emergency room visits are reimbursable, insurers have a strict definition of what constitutes an emergency: how high the fever is, and whether or not a trauma has stitches, are all criteria for identification. Insurers also have strict rules about paying for hospital rooms, medications, medical equipment, tests and X-rays.
Some policies also specify the number of days of hospitalization allowed per year, usually within a cumulative total of 60 to 100 days, beyond which the insurer will no longer pay. Insurance companies and experts*** work together to set standards for what kind of illnesses should be hospitalized for the longest period of time, and for how long a person should be transferred to a rehabilitation hospital for care.
2, medical savings account
Medical savings account is the United States just last year began to pilot another new type of insurance. As soon as it was introduced, it was welcomed by many low- and middle-income people.
Participants in the program in the bank to establish a special personal account, only $ 138 per month, can be set up below $ 2,250 out-of-pocket except for the gold plan. The family enrollment fee is $431, and the insurance company covers the entire year's medical expenses for the whole family if they add up to more than $4,500. Visits to the general dentist, orthodontist, and psychologist are also reimbursable. Currently, the average health insurance premium for an individual is at least $200 per month. In addition, with regular health insurance, even if you don't see a doctor or get admitted to a hospital, you can't get your premiums back once you've paid them.
But the feature of the medical savings account is that each year an individual only needs to put 65 percent of his or her deductible, and a family only needs to put 75 percent of its deductible into the bank, and only deducts it from the account when it needs to see a doctor or be hospitalized, and when it doesn't see a doctor, it's naturally placed in the bank as a demand deposit, which not only pays interest, but also doesn't have to pay taxes on some of that interest.
But with only 750,000 acceptances nationwide this year, it's still a drop in the bucket. Only one bank is currently offering the program, and two insurance companies are accepting them.
3. Medical care programs
Even with "medical care" programs for the elderly, seniors still spend more than 20 percent of their average incomes on health care as their illnesses increase, according to one statistic. And Medicare was the first program to be targeted. Clinton proposed a seven-year cut of $270 billion, which was opposed by many, and then a five-year cut of $100 billion. *** and the GOP have proposed turning more of the health insurance for seniors over to the private sector. As a result, a growing number of seniors are concerned about the quality of health care.
The Medicare program Medicare also has strict limits on hospitalization. First, there must be a doctor's note stating that the patient needs to be hospitalized for treatment or care. Second, the hospital must participate in the Medicare program. And it must be approved by the hospital's Utility Performance Review Committee (UPC), or PRO, the hospital's reevaluation organization.
Usually, participants also have to prepare an "advance directive" that tells the hospital what services you want and what you don't want, since some services will be at their own expense. "The Advance Directive is meant to be a reference for doctors in the event that a patient loses the ability to communicate during a medical emergency.
4. Blue Cross and Blue Shield
Finding the right kind of insurance is even more important for older people. The government's "Medical Care" or "Medical Care for the Poor" programs do not cover some of the things that the government does not cover. But premiums for these supplemental policies alone can run as high as $1,000 a year.
Empire Blue Cross and Blue Shield is a long-established insurance program under the Blue Cross and Blue Shield Association of America, and is one of the more desirable types of insurance to help seniors. It is better known in the New York area. Its benefits seem to be quite a lot: no need for patients to pay "out-of-pocket expenses", as long as it is medically necessary to bear 100 percent of the hospitalization costs, there is no limit to the length of hospitalization; each visit to the doctor pays only $ 10; laboratory fees are free of charge; and 24-hour telephone telephone consulting services. The most attractive thing is that it is anywhere in the world to see a doctor, emergency treatment is reimbursed.
The "contract hospitals" include many large hospitals such as the New York Medical Center, and are open to anyone over the age of 60, but one of the conditions is that they need to be enrolled in a "medical care" plan first.
5, health care organizations gradually improved
The United States in recent years the emergence of health care organizations (HMO) is another model of management of health insurance, by the federal government to promote, but also more and more people with lower and middle incomes to accept. Sixteen million Americans are now enrolled in the program.
A HMO is not a specific organization, but rather the main type of managed care. It consists of designated hospitals, insurance companies and government agencies *** with a large network of medical services, the insured have a corresponding fixed "primary care doctor", unless the primary care doctor agreed, or must go to the network of designated hospitals. In this way, those who wish to seek treatment from more specialists will feel that they are subject to too many constraints. In addition, the government's premiums for HMOs are on a downward trend, so health insurance organizations are worried about "shrinking" services and a loss of patients.
Point-of-service (POS) plans are a typical improved form of HMO care. Enrollees pay 10 to 15 percent more in premiums and about 30 percent more in medical bills to see any doctor, anywhere. Of the nation's 630 HMOs, 50 percent have such plans, up from 20 percent in 1990.
6, Oxford health insurance
Established in 1984, the United States Oxford (Oxford) health insurance company is the eastern United States is extremely successful company of its kind. In 1996, the United States "Fortune" magazine listed the nation's fastest-growing companies, ranked fifth. The company has more than 37,000 physicians in its network and nearly 2 million members, about 30,000 of whom are Chinese, who have grown in the last three years.
The company offers a variety of programs that allow insured people and their families the freedom to choose the services of any doctor or medical organization inside or outside the network. The difference: In-network visits usually cost members only $5 to $10 in registration fees. For out-of-network visits, the first $200 must be paid by the member, which is the "deductible" portion. Any excess is shared with the company at a sliding scale.
The Oxford Advantage Senior Insurance Program is also a special type of insurance for seniors 65 and older. Under the government's "Medical Care" program, the patient pays 20% of all hospital fees on the first day of hospitalization, and the government pays 80%. Seniors who are members of Oxfam do not have to pay a single additional premium if they join Oxfam's Privilege Program. But all of the above hospitalization costs are waived.
The company also covers seniors for emergency medical expenses worldwide. If they don't need to stay in the hospital, they pay only a $50 flat fee for emergency care.
Targeting the growing number of small businesses, the company also offers a group insurance program that allows a company to enroll as few as three employees. In addition, the company's various customer service centers hold regular health seminars for the community, which are popular with seniors.
The wildly rising cost of health care in the United States has forced the federal government to look for ways to reduce the government's commitment. The nation's spending on all kinds of health care has increased from $172.6 billion 20 years ago to $900 billion today. Less than one-third of that amount is covered by government health programs.
But under such a system, 40 million people, including at least 3 million children and adolescents, are still left out of the Medicare program. When the government's commitment is insufficient, it is natural for the private sector to step in. The intensity of competition in the U.S. insurance industry is also evident in the variety of forms of health insurance.