Premium Essay

Private Health Insurance

In: Social Issues

Submitted By sammgriff
Words 825
Pages 4
Issue description:

“The social organisation of health care, concerns the way a particular society organises. funds, and utilises its health services. A central focus on the dominant role of the medical profession, which has significantly shaped health policy and health funding to benefit its own interests” (Germov 2009, pg 18-19 para 5)
Doctors who support the medical profession for private health insurance benefit by maximising their profits with the “No Gap” incentive that private health insurance offers to their clients, Doctors are being encouraged to charge more then the scheduled fee however based on the marxism theory only those who can afford private health insurance benefit from such services. Low income workers are limited to health care options due to the rise in household bills, making private health insurance difficult to afford.

In private health doctors are able to charge their patients their own fee for services/medical consultations etc. Medicare will pay 75% which is known as the “schedule fee” , private health insurance will cover the 25% gap. However the AMA actually encourage doctors to charge more then schedule fee, allowing the doctors to make profit by those who can afford to pay for these consultations. Until recently private health insurance companies were restricted by law to cover the “gap” fee making the patient having to pay the 25% out of pocket. Now every health fund must offer at least one “no gap” or “known gap” policy. Gap cover is only available to claim if your doctor has agreed to be in this arrangement with the private health fund. This limits the choice of doctor you wish to see which in fact was a particular selling point of private health insurance. The client is still able to choose their choice of doctor however it must be from the pool of doctors who choose to cap their fees, making the choices limited. According to…...

Similar Documents

Premium Essay

Health Insurance

...Health Status and Health Care Services in Germany With Comparison to the United States Petra Stewart HSM 310 Tammy Cagle February 20, 2011 Health care Insurance is one of the most debated topics in the country today due to ever rising costs and the lack of coverage for the patient. The are halth plans in other countries which work for their population that the United States could take a look at to enquire if leaning towards their plans would be a step into the right direction for the United States. Germany for example has a well working social system and private insurance system that provides excellent care of their population. Germany is able to provide good health insurance to any citizen in the country from the moment they are born. The Insurance Company has a liaison in the hospital that will prepare all needed forms and paperwork to give to the mother the day after she gives birth to her child. The only thing “Mom” has to do is sign the paperwork and continue to rest. The hospital and the insurance company are taking care of the all the paperwork and fine print for the new mother. From this point forward, the newborn citizen can be treated like every other citizen in the country. Tests are being completed and immunizations are given as needed. When the new family goes home, there are no worries about outrageous hospital bills, and battles the insurance company over coverage. Health Insurance in Germany is part of the Social Security System and works......

Words: 2174 - Pages: 9

Premium Essay

Health Insurance

...have a better and secured future, in this direction life insurance services have its own value in terms of minimizing risks and uncertainties. Indian economy is developing and having huge middleclass, Societal Class and salaried persons. Their money value for current needs and future desires helps in generating the reason behind holding a policy. Insurance: in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss. An insurer: is a company selling the insurance; an insured Policyholder: is the person or entity buying the insurance. The insurance rate: is a factor used to determine the amount to be charged for ascertain amount of insurance coverage, called the premium . | HEALTH INSURANCE The term Health Insurance is used to describe a form of insurance that pays for medical expenses. It is used more broadly to include insurance that covers disability or long-term nursing or custodial care needs. In simple words, if you are covered under Health Insurance, you pay some amount of premium every year to an insurance company and if you have an accident or if you have to undergo an operation or a surgery, the insurance company will pay for the medical expenses. HISTORY ...

Words: 1153 - Pages: 5

Premium Essay

Concerns over Private Health Insurance

...Concerns over Private Health Insurance HCA: 305; The US Healthcare System Concerns over Private Health Insurance 1) A single payer system, private insurance company or US government, why is there so much resistance to this concept which is used in advanced countries? The resistance is because of economic power in the system, and who does not have the power. Yes, the governments will predictable raise taxes to pay for the growing demand for health care which people are afraid of. It is a big resistance over fear, on loss of power and money. “Vladeck, Bruce C, Rice, Thomas” (2010), wrote; As a result, it is this element of President Obama’s reform proposal led to strong opposition- by insurers, which do not want the single payer system, to compete against a public plan, and by providers who fear that growing monopsonistic power on the part of government. The United States citizens are very much resisting the new medical reforms, due to their disbelief in our governments system that they do not trust already. The citizens do not belief that the government will fairly and efficiently make these choices for the citizens. It is very hard to believe in good ethical quality of a health care program if the organizations are not a true ethical organization itself. Medical ethics as we know is......

Words: 649 - Pages: 3

Premium Essay

Private Health Insurance in Oecd Countries

...DELSA/ELSA/WD/HEA(2004)6 Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems Francesca Colombo and Nicole Tapay 15 OECD HEALTH WORKING PAPERS Unclassified Organisation de Coopération et de Développement Economiques Organisation for Economic Co-operation and Development DELSA/ELSA/WD/HEA(2004)6 ___________________________________________________________________________________________ _____________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS COMMITTEE DELSA/ELSA/WD/HEA(2004)6 Unclassified OECD HEALTH WORKING PAPERS NO. 15 PRIVATE HEALTH INSURANCE IN OECD COUNTRIES: THE BENEFITS AND COSTS FOR INDIVIDUALS AND HEALTH SYSTEMS Francesca Colombo and Nicole Tapay Francesca Colombo is with the OECD Health Policy Unit. At the time this work was conducted, Nicole Tapay was with the OECD Financial Markets Division. English text only Document complet disponible sur OLIS dans son format d’origine Complete document available on OLIS in its original format DELSA/ELSA/WD/HEA(2004)6 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS OECD HEALTH WORKING PAPERS This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a......

Words: 4256 - Pages: 18

Free Essay

Health Insurance

...Health insurance in Canada and US Name: Institution: Health insurance in Canada and US Antonia Maioni’s goal is to explain the development of health insurance in Canada and United States of America. She goes on to elaborate why the United States and Canada have different healthcare insurance systems even though these two countries are majorly similar in almost all other aspects for example they share the same economic, political and social attributes (Maioni, 1997 p. 411). She offers that the major contributing factor to this contrast is the fact that health reform was fostered by political institutions which formed party systems in the two countries. Institutions are, in her book, stated as the most significant challenge faced by health reformers. Organizations related to the health industry play a rather important role in shaping insurance policies within the United States and Canada (Martens & Roos, 2005 p.72). This is further explained to be as a result of the way the institutions condition the role of political parties in policies. Maioni analyzes the creation on the social democratic third party in Canada which was not present in the United States of America and the influence exerted on the development of health reforms by the third, left-wing party in Canada. Two institutional attributes; parliamentary government and federalism are used to explain the differences between Canada and the US. The......

Words: 1163 - Pages: 5

Premium Essay

Health Insurance

... Pre-launch Survey Report of Insurance Awareness Campaign SPONSORED BY Insurance Regulatory and Development Authority © National Council of Applied Economic Research, 2011 All rights reserved, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publisher. Published by Jatinder S. Bedi, Secretary & Head, Operations, for and on behalf of the National Council of Applied Economic Research, Parisila Bhawan, 11, Indraprastha Estate, New Delhi–110 002 Printed at M/s. Multiplexus (India), Delhi. Email: multiplexusindia@gmail.com Study Team Project Leader Anushree Sinha Core Research Team Rajesh Jaiswal Barun Deb Pal Kalicharan Shukla Consultant Ramamani Sundar Geetha Natesh Technical Support Sadhana Singh Contents List of Tables List of Annexure Tables Foreword Preface Acknowledgements Chapter 1: Background 1.1 Concept of Insurance 1.2 Importance of Insurance 1.3 Origin of Insurance 1.4 Origin and Development of Insurance in India 1.5 Important Developments in the History of Indian Insurance Business 1.6 Insurance Scenario in India and Other Countries 1.7 Insurance Penetration and Density in India 1.8 Why Awareness is Important Chapter 2: Methodology 2.1 Coverage 2.2 Sample Design 2.3 Selection of the Rural Sample 2.4 Selection of the Urban Sample Chapter 3:......

Words: 110757 - Pages: 444

Premium Essay

Health Insurance

...patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician relations, interpersonal skills, infrastructure, and availability of drugs have the largest effect in improving patient satisfaction. In this study patient refer to inpatient. Keywords: Health care system, Quality of services, Inpatient satisfaction INTRODUCTION A critical challenge for health service providers in developing countries is to find ways to make them more client-oriented. Indifferent treatment of patients, unofficial payments to providers, lack of patient privacy, and inadequate provision of medicines and supplies are common, yet are rarely acknowledged by traditional quality assessment methods. Assessing patient perspectives give users a voice, which, if given 1 2 systematic attention, offers the potential to make services more responsive to people’s needs and expectations, important elements of making health systems more effective (Krishna Dipankar Rao et al., 2006). The main beneficiary of a good health-care system is clearly the patient. As a customer of health care, the patient is the focus of the health care delivery system. Customers who are merely satisfied often do not come back and organisation operating under this discipline Department of Management Sciences, RVR & JC College of Engineering, Guntur-19, AP. Department of Management Studies, Sasi Institute of Technology and Engineering, Tadepalligudem-534101,......

Words: 6869 - Pages: 28

Free Essay

Health Insurance

...Adam Thompson Bryant & Stratton Research and Writing II - ENGL 250 – 551 Dr. Sharma July 26, 2014 Insurance is a two-way legal agreement between the insurer and the customer. The customer, which may be an individual, business, or other entity, agrees to pay the premiums as required, in exchange for monetary protection from the insurer for any possible substantial loss. Customers usually obtain insurance, not to cover the trivial incidents of life or business, but to cover the potential significant losses which could be a financial hardship for them. The premiums of all customers of the insurance company are pooled together. The insurance applies statistical analysis to determine the chance that a particular event might occur to one of their customers. From this analysis they can determine the premiums which must be collected and the claims. Insurance is a very important part of modern life and business. Three health insurance companies: Healthspan, Anthem Blue Cross Blue Shield and Apex. Breaking down plans and talking about what they cover, how much they cost and where they are accepted and attempt to answer the age old question “Is people’s healthcare better depending on how much one pays?” All these packages are based on someone who makes $25,000 per year and only looking to cover just them. The prices also change depending on when they want their insurance to start and if they have to prorate for the previous month and also if the clients are a tobacco user or......

Words: 1687 - Pages: 7

Premium Essay

Health Insurance

...Why do we need the health insurance industry? Need for health insurance The health insurance industry (XLV) mainly provides a risk management tool for an individual. People cannot predict the extent and timing of their future healthcare expenses. By paying regularly for health insurance, people can get protection against financial losses resulting from high health care expenses. It also enables them to better manage their cash flows as most health insurance plans specify the maximum amount an individual will need to pay in excess of the charge paid for buying the insurance, in a calendar year. Risk pooling According to study by the Congressional Research Service, the top 5% of the total population accounted for about 50% of the health expenses in 2011 and 2012. This uneven distribution of spending forms the basis of risk pooling, where people contribute an amount of money, at least equal to the per capita cost of medical services, expected to be used by the group of insured people. Risk pooling in insurance is essentially a cross-subsidy paid by low-risk members to high-risk members of the insurance plan. The above diagram shows that the performance of healthcare system or the efficiency of health insurance and effectiveness of risk pooling increases as the size of the group increases. However, the benefit of reduced risk resulting from the increasing size of the insured population reduces as the size increases a certain optimal size, S*. As size increases, the......

Words: 2759 - Pages: 12

Premium Essay

Health Insurance

...to seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; • Medicare alludes to a federal health insurance program that covers......

Words: 1164 - Pages: 5

Premium Essay

Health Insurance

...seek services from any health care provider. The members of this particular plan do not to limit themselves to either physicians or hospitals under a single network. Under the indemnity plan, the medical bill incurred by the users is sent directly to the health insurance company where a portion of the expenses is paid (LaTour, Maki and Oachs, 2013). For example, the insurance company may pay 80% of the total medical bill where the remaining 20% is paid by the member. Individuals under this plan pay a deductible sum, and once the member has reached the deductible phase, only a small portion is remitted under to the insurance company. The fee for the plan varies from one physician to another an aspect driven by government regulations. Managed care plans Managed care plans refer to a type of health insurance where members have contracts with specific health care providers and medical facilities at a reduced cost. Under this plan, the healthcare provider makes up a planned network of the portion the plan will incur as medical expenses according to the agreed contracts (Cleverley, Cleverley & Song, 2010). As a result of government regulation, managed care plans affect the health care delivery because of financial incentives directed to providers. Government sponsored health plans Under this health insurance policy, various policies cover individual’s health. The policies encompass the following; * Medicare alludes to a federal health insurance program that covers......

Words: 1176 - Pages: 5

Premium Essay

Health Insurance

...HEALTH Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners. HEALTH CARE SCENARIO Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line. Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country. CG: Central Government PH: Primary Health MCH: Maternal and Child Health. • Access to health care service providers and availability of physicians is one part of......

Words: 6539 - Pages: 27

Premium Essay

Health Insurance

...Health Insurance- Blessing for people with busy life The word insurance truly mentions security. Security against life, health, family,vehicle,homes, shops,etc. In earlier years, there was no need to this kind of thing for the protection. I am talking about days of our grandfathers or may be even before that. The life was so great and slow, nothing to worry about any future, would involve in their daily occupational jobs like farming and living life in their own way. But it is said that nothing is permanent. The time has change now. Today we live in a much advance world. The change is faster than time. The daily routine got so much fix that we cant even take out some time to enjoy. People work in office as well as in home too. Social life is like getting extinct from their life. No time to eat even hygienic food on time. Just grabs some cafeteria served items and forget about its effects. As “no time” kind of thing ruling our life. We almost neglect our health and when any weird kind of stuff happens! Doctor is the second word that comes in our mind. First is the expense if the condition got severe. We can’t change this situation, neither can we escape from it. We have to work, look at our family and their future, about your dreams, and so to earn this, we have to get a job that offers salary far from your expectation but if salary is well then the work load will also be high. In fulfilling your daily task, you forget about your health! So it’s better to have an......

Words: 4671 - Pages: 19

Premium Essay

The Private Health Insurance Market in Ireland

...Health Insurance Needs, Awareness and Assessment in the Bahraich District, Uttar Pradesh JANUARY 2008 This publication was produced for review by the United States Agency for International Development. It was prepared by Constella Futures, New Delhi ITAP is a three-year project funded by United States Agency for International Development under Contract No. GPO-1-01-0400015-00 beginning April 1, 2005_ The project is being implemented by Constella Futures in partnership with Bearing Point, Sibley International, Johns Hopkins University, QED, Urban Institute and Association of Reproductive Health Professionals (ARHP). For further information contact: Constella Futures 1 D-11, Parkwood Estates Rao Tula RamMarg New Delhi 1100 022 Health Insurance Needs, Awareness and Assessment in the Bahraich District, Uttar Pradesh JANUARY 2008 The authors' views expreseed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government Contents List of Tables List of Figures List of Abbreviations Executive Summary Chapter 1: Background and Methodology .......................................................... 1.1 Introduction... 1.2 Objectives of the Study ................................. 1.3 Study Design and Methodology ....................................................................... 1.3.1 Sampling and Sample 1.3.2 Study techniques ..............................................

Words: 14439 - Pages: 58

Premium Essay

Health Insurance

...Summary The health care in the United States has often been credited with being some of the best money can buy, though with the caveat that it does not provide health care to all its citizens, and millions are left with woefully little or no health care coverage. However, in Canada, universal health care serves its entire population, though there is also criticism that the care it does provide lacks the quality of the most expensive health care services in the U.S. This paper will examine the truth behind the quantity and quality argument between the universalized health care in Canada and the health care system in the U.S., while also taking into account the recent reforms made to the U.S. system and how it impacts such a comparison. Canada and the United States Comparison of the health care systems in Canada and the United States are often made by government, public health and public policy analysts. The two countries had similar health care systems before Canada reformed its system in the 1960s and 1970s. The United States spends much more money on health care than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was......

Words: 4813 - Pages: 20