Health insurance is a term that explains a form of coverage that meets ones medical expenses. This form of insurance pays for medical expenses and sometimes may encompass insurance on disability and long-term nursing needs. There are two ways that one may get access to services of health cover firms, one of them is that, insurance may be offered by the government subsidized program i. e. the Social Insurance Program or the second alternative is by private medical insurance firms. The package may be obtained collectively e. g. by a company to insure its employees etc or may be obtained individually by customers.
However in either case, the covered persons pay premiums to get protection from high or unpredicted medical care expenses. The government may offer such benefits of paying healthcare costs via a Social welfare program. Universal Coverage is described as the affordable medical care insurance that extends its coverage to all eligible residents of the country. It’s sometimes called Universal Healthcare. The coverage of such programs are greatly varied in terms of funding mechanism and organizational structure especially the extent to which they are funded by the public.
Normally, the general public always has to pay their medical care expenses through health insurance schemes that are a compulsory requirement. Some pay through taxation and at times both tax and medical insurance programs may be used to meet the healthcare bill. According to the Institute of Medicine, The United States of America has been confirmed to be the only developed regime that doesn’t offer the Universal Coverage. Otherwise, many other developed nations and the developing countries offer the Universal healthcare coverage system of health insurance and it’s the trend all over the world.
Introduction Health insurance is coverage that takes care of medical bills. Governments have come up with policies that regulate this health insurance programs. The Medical care insurance policy is a contract that binds a health insurance company and the person in question. The contact may be renewable annually or upon the agreed period of time. The contract usually described the type and the amount of medical expenses to be covered in the agreed duration and is usually paid in advance as evidence of coverage in the booklet.
The Universal Coverage as mentioned earlier describes a situation where everybody is covered for the basic medical care services as per the government policy as long as one is an eligible resident of the region in question. Universal medical care coverage has been mistakenly likened to ingle-prayer; a type of medical cares where the government pays all the healthcare expenses. Most governments in the world currently provide Medical care universally with Singapore having the most efficient and successful medical coverage in the world.
Probably t due to this reason that it has the country records low infant mortality rates and long life expectancies. The U. S is the only country that does not offer Universal coverage. The U. S government has established policies that recommend reforms in the healthcare by the year 2010, based on the per capita expenses. The situation in the country is that per capita expenses on medical care services is almost twice as much as other developed countries, but still has high infant mortality rates and short life expectancies.
Health Insurance in the U. S In 2005, a bill was presented to the House of Representatives of the U. S proposing the introduction of a Universal health care coverage that would combine both public and private coverage. The discussions in the U. S on universal coverage are usually confused with the concept of single prayer scheme which is sometimes called socialized medicine. This perception usually becomes a major hurdle for the enactment of the universal coverage (Lerberghe 2005) Many of the medical service providers in the U.
S will concur to charge the insurance Companies if the clients are willing to assent his signature to an agreement that the amount not paid by the insurance company would be their responsibility. Medical care in the U. S is provided by different legal entities and it has been noted that the U. S is highest spender on health care services. (Porter & Teisberg 2006) A greater percentage of the U. S population have some form of medical insurance cover individually or through employers while others are granted by the government.
There are certain publicly financed medical care schemes that are meant to provide assistance to the elderly, disabled, children and the poor. Federal law authorizes the general public to access emergency medical services despite their ability to meet the expenses. The health care coverage in the U. S depends so much on the private sector and the non-profit insurers and is the main source of medical coverage for the Americans. Public programs provide coverage services to older people and low-income earners including families that meet certain requirements to be entitled to this cover (Lerberghe 2005).
Some of the public programs are Social insurance, Medicare, Medicaid and SCHIP. In 2006, it’s estimated that over 47 million people did not have any medical care cover for some part of the year (Anderson 2007). In 2004, the United States medical cover providers employed almost 471,000 workers directly. Since 2001, the health insurance costs in the States are rising at a very alarming rate that there is need to re evaluate the effectiveness of their system of healthcare payment. In the year 2007, most of the low-income earners and unemployed did not have medical cover.
Those without medical insurance that year, summed up to about 15. 8% of the total population. The efficiency and the quality of the U. S medical care system raises questions on whether its worth the million of shillings that the government spends each year. A research by the world Health Organization in 2000, found out that the U. S was the highest spender on healthcare services yet it lagged far much behind in effectiveness of its performance (Haley & Deevey 2001). Since universal coverage has proved to be more effective, there have been many proposals presented to the U.
S administration to encourage transformation process of the current system to enable it to extend its coverage universally, rather than via a complete restructuring of the entire system. Considering that, most Americans covered by private insurance companies receive their benefits through employer sponsored schemes, it has been suggested that the employer ‘pay or play’ be used to expand coverage. However analysts have suggested that the proposed pay or play plans will be restricted in their capacity to include the working poor.
Other observations made included the fact that this proposed plan basically excludes small companies, do not differentiate individuals who may be able to access other forms of healthcare insurance, from those who do not, and may cause the overall employer compensation expenses to rise. Universal Coverage As defined earlier, universal health coverage is the situation where by the government covers everyone’s basic medical care services as long as the people meet eligibility requirements of the region. Only America does not provide the universal coverage to its citizens of all the industrialized countries (Mayes 2005).
This has seen America’s health care coverage system collapse! Almost a third of the Americans are not insured at some time of the year, this according to the research by Commonwealth Fund with the number of those supposedly covered dangerously under insured (Baker 2000). There arises situations when the insurance companies fail to meet the expenses of the medical services provided to their clients, in such cases, the affected persons may face a serious and tough decision making moment that they have to choose between healthcare services and other life necessities. As many as about half of the bankruptcies reported in the U.
S are contributed to by medical debts and more than three-quarters of them are due to the medical debt the insurance had at the beginning of the sickness (Mayes 2005). The population that is covered collectively by employer is steadily loosing the benefits as more and more charges are being pushed towards the employees, while the young and unemployed minority are suffering for being under insured and usually pays disproportionate split of their income to the insurance coverage (Emanuel & Fuchs 2005) Several issues have been raised to solve the problem of healthcare expenses and analysis made for the best possible alternative.
In many occasions of discussions, universal coverage has been confused with “single payer” healthcare system. The Single-Payer healthcare system is the U. S’s term that describes the payment of all players in medical care service from single fund. The players here, being doctors, hospital and other related trades like pharmacies. The Canadian medical care system, the British, and the Australia’s Medicare are all single payer systems. The U. S’s Medicare and Medicaid are also described as single payer systems. The single payer system has only one financial source for paying all the medical service providers.
Some people have argued that the single fancier of the single payer system is the government, but in Countries such as the U. S the matter is left for analysts and the patient never bears the individual accountability for all the expenses (Mayes 2005). The single payer system has been proposed to help transform the current and collapsing system of health insurance in the U. S. It is different from the Universal health care system where the government has total control of the healthcare systems including administration, employing doctors and other staff, despite the fact that logically all these are single payer systems!
Meanwhile, when the term is used to imply these differences, the stakeholders in medical care industry remain independent and may confer with the government for funding. The single payer has been proposed to change the current system of the Americans, however critics oppose the fact that it would offer better quality of healthcare at a cheaper expense by saying that this would affect the quality of medical care and discourage innovations and therefore give free market approach and tax incentive as the better options (Emanuel & Fuchs 2005)
Some organization support universal coverage, these organizations that advocate for the implementation of the universal coverage do so due to its efficiency and advantages. The main supporters are; doctors, nurses and organizations such as Healthcare for everyone, Physicians for a National health Program and National health Insurance. The supporters argue that medical care is a basic human right and everyone is entitled to it, provision of medical care to the whole nation would profit the country economically, and that the profit motivation could negatively affect the quality of the healthcare services provided.
Cutting costs is the main issue that raises concerns in the healthcare service provision. It would be much better to cut down costs rather than maintaining since the current economic crisis does not call for increased expenses. Currently, the U. S government has sacrificed its healthcare service industry to financial plan cuts. Communities especially those living in the poor neighborhood are needlessly vulnerable to diseases that otherwise could have been corrected or prevented. Cost cutting demands have lead to humiliating of occupations of medical care service providers like nurses and home-care workers.
Processes such as screening, early diagnosis, and prevention measures that are efficient cost cutting methods have been short changed. Though cost cutting is very important, it should not sacrifice the quality of healthcare services to be provided. For the health care crisis in the American system and cost cutting pressures that are mounting on the budgetary allocations, have caused the quality of health care to be compromised in the name of cutting costs. Human rights activist argue that the sanctity of life should be respected and life protected no matter the cost.