The Pros and Cons of Health Care Insurance Systems

Health Care

Health care is the care or enhancement of health through the diagnosis, prevention, cure, treatment, or recovery of illness, disease, injury, and other mental and physical impairments in individuals. Health care providers deliver health care to individuals in hospitals, nursing homes, home health care agencies, private clinics, government and not-for-profit organizations, and public hospitals. There are different types of health care systems that include general, hospital-based, assisted living, skilled nursing care, palliative care, disaster and trauma, maternity care, health maintenance organization (HMO), and catastrophic health insurance plans. Some health insurance companies also offer short-term or prepaid health insurance plans for individuals who have an urgent need for health care but cannot find it in their individual health insurance plan.

Each health system has its own payment policies and procedures for claims processing, disbursement of payment, and recovery of payment from providers of medical services rendered. Short-term health plans usually cover catastrophic health insurance plans, HMOs, and PPOs, while catastrophic health insurance systems often require prior approval, pre-certification, and payment of a deductible. Some insurance companies offer guaranteed issue or guaranteed renewal of certain health systems and payment policy options for those unable to maintain an HMO or PPO.

In addition to health care system policies, there are also a variety of sources of financing. One way is through direct patient care global payment (DPCG), an electronic benefit transfer program offered by many health systems. Another is through Medicaid, which pays a portion of the cost of skilled nursing facility (S RN) services for qualified needy patients with a Medicare coverage. The third source is private health insurance premiums paid directly by the insured for routine primary care visits, surgical procedures, emergency care visits, and preventative services. A few insurance companies offer "fee for service" plans that require no medical exam and offer a monthly premium payment option. These plans have become very popular in recent years, but are generally considered risky for consumers due to lack of medical underwriting and possible disqualification for preexisting medical conditions.