The health care system in the US is comprised of a multitude of subsystems with significant interstate variation. There is no universal health care coverage; there is a significant number of people without health insurance. Health insurance can be funded by the state (ie.g., Medicare), employers, or individuals.
Government-funded health insurances
- Subdivided into 4 parts: based on the extent of coverage
- Part A: hospital care, for terminal patients, skilled nursing facility care (if services are needed daily after a minimum 3-day stay in a hospital)
- Part B: doctor’s fees, emergency department visits, diagnostic tests, rehabilitation
- Part C: all services covered by parts A and B, including preventive care
- Part D: prescription drugs
Jointly funded by the state and federal governments
- Eligibility: individuals with low income
- Coverage: hospital care, laboratory tests, diagnostic tests (such as x-rays), doctors' visits, skilled nursing care, vaccinations, home health care
Eligibility: uninsured children of families with low income, but not low enough to qualify for Medicaid
- Used by more than half of the American population
- It can be employer-sponsored (most common), college-sponsored, or individually purchased.
- Patients pay for each service received.
- Payment depends on the quantity, not quality, of care delivered.
- Preferred provider organizations (PPOs) may offer discounts (i.e., discounted fee-for-service).
- Poses risk for overtreatment
- Bundled payment:
- A fixed payment for each enrolled person, per period of time for specified medical services
- Payment made whether or not the person seeks care
- Providers focus on preventive medicine and saving money
- Poses risk for undertreatment
|Common health insurance plans||Health care delivered through||Coverage||Specialist care|
|Health Maintenance Organization (HMO)|| || || |
|Preferred Provider Organization (PPO)|| || || |
|Point-of-Service (POS)|| || || |
|Exclusive Provider Organization (EPO)|| || || |