Posted by noa on April 6, 2003, at 13:37:31
In reply to Re: Medical Insurance - UK Members » noa, posted by photojenny on April 6, 2003, at 5:47:40
Generally, most people get their insurance through their employers. It is considered a "benefit" like paid vacation, etc. It used to be that employers paid all or most of the insurance premiums. Nowadays, the amount that the employee has to pay seems to have grown.
The type of plan you get depends on what options your employer offers, and what you can afford to pay for. Often, the better the plan, the less the employer chips in.
Many plans have some kind of "managed care" (or as one advocacy organization calls it, "managed cost"). This can be a Health Maintenance Organization (HMO) which in its "purest" form is like a self-contained clinic. Ie, you cannot choose which doctors or hospitals to go to. Also, usually managed care means that many treatments and procedures require pre-authorization. There is a lot of controversy about this, of course, as many patients and doctors say it gives too much power to the executives and not to the doctor and patient.
Because of the controversy, many managed care programs are not as severe anymore. Many are a network of doctors and hospitals you can go to, and the participating doctors and hospitals agree to take a reduced fee from the insurance company, when they sign up. Only with some insurance companies, the fees are really low and don't keep up with the real fees (and sometimes not even with the costs!), so then many doctors and hospitals decide not to renew their contracts. Around here, many pdocs no longer participate in managed care insurance.
So, if you have one of these network programs, you have a little more choice, but usually you still have to get a lot of pre-authorization. If you want to see a specialist, you might have to get a referral from your primary doctor, which can be a bit of a hassle, and you have to go to the specialists on the list.
Some of these programs also limit mental health coverage, although there are states that have "parity" laws (interestingly, though, this info is not always made that public, so a person may read the insurance information and think they are only entitled to 3 or 4 emergency sessions/year, though they may live in a state where covereage has to be on par with other medical coverage, but they may not know that because the insurance companies don't tell them!). I know that there was a parity law introduced in congress but I don't know what happened with it. Maybe someone else can say.
The other kind of option is more expensive (which is not a problem if your employer pays the whole thing or most of it, but is a problem if you have to pay a lot of it). It is one where you can basically go to any doctor or hospital. You pay less if you go to one in their network--usually only have to pay a small fee when you go. If you go out of their network, you pay up front and submit a claim to get payed back. It is a bit of a pain, but if you need care that requires choosing the right doctor who might not be in the plan, it is the best option (it is the one I have).
If you leave your job, you have a right to continue purchasing the group insurance for up to 18 months. This is called "COBRA" (I forget what it stands for). But you have to pay the entire premium yourself. But it gives you coverage until you get new insurance.
If you are on welfare there is insurance called Medicaid. Usually medicaid uses a managed care network, and they are notorious for paying ridiculously low fees so there are lots of doctos who don't take medicaid.
When you are older, you are elegible for Medicare, which is funded through payroll taxes that we all pay. This covers most health care, but not much, if anything, for prescriptions.
People who are unemployed, and many people who work but don't get medical benefits through their employers, are uninsured (I think the latest stat I heard is about 40 million + Americans are uninsured). They either go without, or use free clinics, or show up at the hospital (the public hospitals that won't turn them away) which of course, drains the funds of those hospitals. Many uninsured people don't get preventive care or early diagnosis, so when they do show up at hospitals, they are quite sick.
One of the bad effects of managed care is that many doctors' practices have become these huge bureaucratic group practices, becasue time has been taken away from care and given over to administrative tasks. I left my previous doctor because I did not like the way the practice was going--it grew huge (mergers) and each doctors visit was maybe 3 minutes and felt very rushed like I could not ask any questions. With the insurance I have, I am lucky to have the option of going to a smaller medical practice where the doctors (a young couple, actually) are respectful and take the time to discuss things.
A new thing on the scene, for the wealthy, is doctors who offer "concierge" service. This means, you pay a really hefty yearly fee, and the doctor only takes on a certain number of patients, and you are basically assured easy access to your doctor at any time. I think you still have to pay for the care you use, though. The yearly fee is just to reserve the space in the exclusive practice. But obviously this is only an option for people with substantial means.
I hope some other American will jump in to correct me if I described anything inaccurately, or to add info.
I'd also like to hear more about the British system, and the Canadian system, too.
poster:noa
thread:211823
URL: http://www.dr-bob.org/babble/social/20030401/msgs/216692.html