Healthcare Insurance Issues

In an article on the Uninsured it states that “Lack of coverage increases the unpredictability of medical expenses and the potential for financial catastrophe, including bankruptcy” (Content.healthaffairs.org). The stress that is added when trying to plan financially can become overwhelming, “even for the majority of Americans who have coverage, maintaining it is not a sure thing, and the prospect of losing it can cause anxiety

it. Not everyone has access to health insurance and there are those that are underinsured. “ In

The lack of health insurance reached began to become a serious issue in the mid-1990’s reaching a crisis level in the 2000’s. Individuals without insurance turned to emergency rooms across the country to obtain care routine care, turning emergency departments into primary care facilities. In many instances, people who presented at emergency rooms for treatment could not be turned away due to various health and safety regulations; therefore, patients were seen without the ability to pay often leaving the hospitals with millions of dollars in uncollectable debt, subsequently leading to the insolvency of hundreds of hospitals across the United States.

Health care expenses are a never ending headache that create numerous liabilities. Liabilities are created when goods or services are purchased on credit and obtained through short- term and long- term loans. Health care expenses create liabilities such that payments are made late or no payments are made at all. In some cases, the cost of health care expenses are unaffordable resulting in those type of payments. To prevent large health care debt, many individuals seek health insurance. Health insurance is provided by private insurance companies or by the government. It covers health care expenses and provides the necessary health care. Although, health insurance is necessary it can also be very costly.

The judiciary, executive, legislature, at both state and federal levels, are the three branches of government primarily responsible for the formulation of healthcare policies in the United States. There are other non-governmental organizations such as professional and ethics bodies that provide rules and guidelines in some health care policies.

When contemplating health care policy changes, several economic issues in health care must be considered. These include the financial issues affecting the health sector and have an impact on health policies. Policy makers face unending challenges due to the health sector revenues that are always rising. Another challenge is decreased funding and failure of the health insurance services.

Impact to Healthcare organizations - These increases in cost raise questions of health care expenses at the hospital level. As higher profits are sought, the cost will become unstable for all, thus causing many to postpone going to the doctor. However, there are many complicated problems associated with our healthcare system. We will focus on main issues that can correct many related problems within the current structure. More importantly, we need to find ways to ensure all Americans have access to health care; and we need to hone in on how we can get the best value for the $2 trillion dollars we spend annually on healthcare.

I have chosen the topic “Examine the financial characteristics of health care delivery along with managing costs, revenues, and human

At the current moment, doctors’ offices can refuse care to any uninsured person, whereas an emergency room cannot. The hospital is required by federal law to adequately screen and stabilize a patient. This is where the uninsured tend to show up for care where they tend to seek emergency care for urgent medical conditions that might not have been there due to lack of insurance. This would include the screening tests such as a colonoscopy or a mammogram for preventative care. This can delay the diagnosis of a serious complication that might have easily been taken care of through preventative services. The uninsured and underinsured are generally not as healthy as the insured counterparts. There is also lack of follow up care and medication to make sure the disease is under control. This group of

When providers or patients submit false or misleading information intentionally to a health plan, this is fraud. Some examples of healthcare fraud and abuse include filing claims for services or medications not actually performed or obtained, billing for services for non-covered items using codes for billable services or items, altering medical records, waiving co-pays and deductibles, up coding and unbundling, using someone’s insurance card, billing Medicare patients at a higher fee than non-Medicare patients, and accepting kickbacks for referring patients, to name just a few. Fraud can be committed by hospitals, medical providers, laboratories, pharmacists, billing services, medical equipment suppliers, and even patients. Patients can protect themselves from healthcare fraud and abuse by knowing their healthcare benefits, reviewing the explanation of benefits, asking the doctor to explain the service that was given, report discrepancies, protect insurance cards and member identification numbers, beware of free services, report copayment and deductibles being waived, and never sign blank insurance forms.

The rising cost of health care has led companies to stop offering health insurance for employees, and private insurance is often too expensive for people to afford. Many families make too much money to qualify for Medicaid, but are unable to pay for private health insurance. Health care costs in the United States have more than doubled in the last twenty years. Insurance premiums are rising five times faster than wages, and Americans are spending more money on health care than people in any other country. The average amount one person pays per year for health care in the United States is 134 times higher than the average of other industrialized countries (“Health Care Issues”). Even people who have insurance aren’t guaranteed coverage. Many insurance companies find loopholes to avoid paying for expensive medical treatment, leaving people with massive debt from medical bills. Medical bills and illness cause over half of all personal bankruptcies in the United

When an individual or family does not have insurance, and can not or does not pay their medical bills, the cost of that care is "shifted" to patients who do have insurance. For example, a study done by Harvard University found that 50 percent of all bankruptcy filings were partly the result of major medical expenses. The average medical expenses in these bankruptcy filings were $12,000. And someone files bankruptcy every 30 seconds in this country. (National Coalition on Healthcare, 2005, Facts on health care costs). Most of those lost dollars are shifted to consumers in higher premiums and costs.

Currently, the issue of health insurance has been a bone of contention for the public regarding whether the United States government should provide this health plan or not. People often possess different perspectives and refer to pros and cons on both sides of the spectrum. While some believes a universal healthcare system will set a foundation for a lower quality of service, increasing governmental finance deficit, and higher taxes, others do not hold the same thought. A universal healthcare system brings enormous advantages rather than disadvantages, such as all-inclusive population coverage, convenient accessibility, low time cost, and affordable medical cost, all of which not only provide minimum insurance to the disadvantaged but also improve the efficiency of medical resources distribution.

Hospitals and insurance companies count on the fact their insured customers are not educated on their health insurance coverage and bill phenomenal amounts that most middle class people have no means of paying. People are fearful of being sent to collections, or do not understand how to read the document and just pay the portion under the title amount due and just pay the bill.

The healthcare system plays a key role in the economic stability of our country, as every year trillions are spent in attempt to combat disease and health issues that plaque humanity. As it makes up a significant amount of the expenditures in the economy, so the costs associated with health care of those in pain from illness and injury, including lost productivity, increased need of assistance in living and also the cost of death in some cases, is important to the economic stability and over all standard of living in our country. The key to economic prosperity is balancing the need for care with the costs of illness to keep as many people healthy and well without breaking the bank of collective society. The costs of healthcare have been increasingly problematic in recent years with so many issues surrounding the current system. With the “total health care spending in the United States expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970, meaning that health care spending will account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021” (Aetna). With this in mind it is apparent that as we look at the trillion-dollar industry of the medical community it seems that it needs to be a major focus of our nation as a whole and with the many issues come many creative solutions. First let us analyze the reasons behind the current cost and the major problems facing this industry and than discus what