National Health Coverage

By: EconomyWatch Content   Date: 17 February 2010

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Private health insurance amounts to a big share of the national health coverage in the US. Employer sponsored plans cover both private and civilian public-sector employees. Approximately, 59.3% of the American population has employer sponsored health insurance cover under group coverage. Only 9% of the population has individual health care insurance cover. Many people leverage provider networks to reduce costs.

 

National Health Coverage: Private Health Coverage

Private health coverage in the US includes the following programs:

 

Consumer-driven Health Care: In this program, you are covered by a high-deductible health insurance policy that takes care of your high medical expenses. This program covers health insurance plans in which policy holders can pay for their health care expenses directly through their personal medical payment products, such as:

  • Flexible spending account (FSA)
  • Health reimbursement account
  • Health savings account
  • High-deductible health plan (HDHP)
  • Medical savings account.

 

Since 2003, the federal government has been providing tax incentives to people who are using any of the CDHC plans.

 

Health Maintenance Organization (HMO): Found in the US, this is a form of managed care organization. It provides health care coverage through its contracted network of hospitals and physicians. These health care providers treat HMO covered patients according to the guidelines and restrictions stipulated by the HMO. Apart from a fixed monthly fee, Consumers are only required to pay a small amount in the form of co-pay to the physician. Every employer with more than 24 employees is bound to offer federally certified HMO options under the Health Maintenance Organization Act of 1973.

 

Managed Care: The concept of managed care aims to streamline services, and provide cost effective and high quality healthcare. Under managed care programs, thorough supervision and monitoring is conducted and suggestions are given to maintain a certain standard of care, control costs and measure performance. It was after the Health Maintenance Organization Act of 1973 that managed care in the US started growing.

 

Preferred Provider Organization: This is a type of managed care organization and provides health insurance with a lot of flexibility and choices. This is a network of physicians, hospitals and other health care providers, who have agreed with customers to offer low cost health care. These customers can be individual insurers or third party administrators seeking health insurance for themselves or their clients. Unlike the HMO, PPO consumers are allowed to choose their preferred health care provider. Due to this, a PPO costs more than an HMO.


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