HCMG204 Comparative HC System

Question Describe How Private Health Insurance Works Explain the role of private health insurance in the U.S. health care system Summarize what health insurance exchanges are and how they work in health insurance reform Describe the key elements of the ACA insurance reforms and alternative approaches Answer Private health insurance enables people to protect themselves from exorbitant financial costs of medical care and therefore ensure that the people have access to health care facilities in times of need. Health insurance plans cause pooling of excess medical costs and allows people to pay a premium cost of medical bills, therefore the medical costs become reasonable and affordable for people. Health insurance schemes are provided by various private and public insurance organisations. Heath insurance policies are formed between policy holder (one who avails the insurance) and policy provider (one who provides health insurance). Health insurance benefits are arranged by insurance plan sponsors (Barnett & Vornovitsky, 2016). They directly make health care related payments on behalf of policy holder. Sometimes a third party administrator is also involved; the insurance sponsor makes a contractual agreement with the health insurer and pays the health care costs with no premium requirement. In United States, medical costs are exorbitant; only wealthy people can afford to pay for their high medical costs. However, the condition becomes worse for poor people and also for people with average income. Therefore, in United States efficient health care delivery and accessibility depends largely on private healthcare insurance facilities as universal health care coverage is not included, therefore people depend on health insurance schemes to cover their medical expenses. United States health care facilities depend largely on private health insurance plans. People under age of 65 years mostly have private health coverage. Public health insurance in United States includes a payment of premium cost by public health insurance organisations. Majority of US individuals are under private insurance plans (Smith & Medalia, 2014). The employers make a contractual agreement with private health insurance companies to provide a universal health insurance coverage to all the employees, this is termed as group health insurance plan. These plans are based on customizable schemes; employees can select between plans according to their choices. The insurance companies receives a profitable proportion from both employees and employers. An increasing population in US is selecting group health insurance plans over individual insurance schemes. Health insurance exchanges are marketplace services which allow consumers or individuals to compare health insurance plans and therefore purchase health insurance plans. These services are available in every state to promote affordable health care facilities among public population. These health insurance exchanges bring about health insurance reforms in various ways. Insurance exchange causes a competition among consumer availability, thereby increasing affordability and acessibility. It allows for effective management of insurance risks and reduces cases of adverse selections (Jacobs & Skocpol, 2015). Health exchanges also help in reducing administrative costs through simplified marketing strategies. It ensures medical transparency and allows for consumer choice of insurance plans. The health insurance exchange has a regulatory effect; it functions to increase the accountability of the health insurers. This provides a guarantee that the health insurers play a fair role in considering consumers’ claims and complaints, therefore the insurers sell the insurance plans at a reasonable market cost. The Affordable Care Act (ACA) or Obama care is a law based on health care provision which was passed during the administration of former US president Barack Obama. The ACA provides a guarantee that Americans can efficiently buy or receive health insurance in order to access health care facilities to promote good health. The ACA aims to regulate health insurance coverage through health insurance reforms, thereby improving health care facilities among public. The key elements of ACA insurance reforms are expanding in Expanding health coverage, Reform of health insurance and System reform and Public health improvement. Expansion of health cove rage is central to ACA in that the States can expand medical health cove rage for those under federal poverty line. The changes in health insurance reforms include that the health insurers can in no way contradict or deny any health coverage based on previously existing situations. The insurers can no longer set an annual limit on essential health benefits. According to recent reforms, the insurers have to pay a greater proportion of premium costs on medical care services. More number of people have been included under health insurance. The insurance reform aims to provide minimum health benefits within the insurance plan. Reforms resulted in coverage of preventive services by insurers with no cost requirement from those who enrol for insurance plans (Obama, 2016). System reforms include providing health care incentives to insurance providers to promote coordination and collaboration in promoting quality health care. Alternative approaches need to be based on health care cost reduction. The cost reduction can be promoted through reduction in taxes in health insurance thereby allowing people to save medical expenses and resulting in medical transparency. References Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015. Washington, DC: US Government Printing Office. Jacobs, L., & Skocpol, T. (2015). Health care reform and American politics: What everyone needs to know. Oxford University Press. Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525-532. Smith, J. C., & Medalia, C. (2014). Health insurance coverage in the United States: 2013. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census.

HCMG204 Comparative HC System

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