Healthcare Reform Healthcare reform is a general rubric used for discussing major health policy creation or changesfor the
most part, governmental policy that affects healthcare delivery in a given place. Healthcare reform typically attempts to:
Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies Improve the access to health care specialists Improve the quality of health care Decrease the cost of health care
Kaiser Permanente Principles on Health Care Reform Health reform should address the social, cultural and physical environments that influence health by promoting public health programs, community health services, and workplace efforts to support healthier lifestyles. Universal Coverage through Market Reforms
All individuals should have access to coverage regardless of their health conditions. Such a guarantee requires the gradual elimination of medical underwriting, preexisting condition limitations, and considerations of health status in determining rates.
For guaranteed coverage to remain available and affordable to all, risk must be shared broadly across the population. Under a reformed market model, this is best achieved by means of an enforceable individual mandate to obtain coverage.
Coverage should be sufficiently broad to meet a national minimum standard of medically necessary, evidence-based services that include preventive care, coordinated chronic care management, and protection against the cost of catastrophic illness.
The burden of financing universal coverage should be credible, sustainable, and shared equitably across a broad range of stakeholders. It should also be sufficient to attract and retain high quality providers by ensuring stable and predictable reimbursement for services.
All individuals should have a choice of health care providers, plans, and accountable delivery systems in a market in which competition is based on quality and efficiency, with incentives for consumers to choose the most cost-effective plans and/or delivery systems.
Delivery System Reform through Payment Reforms
An affordable, sustainable, high quality health care system depends on a delivery system that lives up to the demands of the Institute of Medicines quality goals of safe, effective, patient-centered, timely, efficient, and equitable care.
Effective reform should promote delivery system integration and accountability through payment incentives that reward care coordination and collaboration among providers, particularly for patients with chronic conditions.
Provider payment mechanisms should encourage appropriate use of services while rewarding prevention, early detection, and improved chronic disease management.
Community/Public Health and Prevention Reforms
Health reform should ensure support for community-based and public health efforts that promote wellness and prevention by addressing the social, cultural, and environmental determinants of health.
Funding for community-based prevention and public health should be increased to reflect the value of these services in alleviating disease and improving the quality of life, and it should be consistent, sustained, and dedicated.
Improving social equity and eliminating health disparities should be explicit goals of health reform. The vital role of public hospitals, community health centers, and other parts of the health care safety net should be sufficiently resourced and closely aligned with the broader health care delivery system.
Essential clinical preventive services should be covered in all federally supported health plans including Medicare, Medicaid, CHIP and any new government subsidized plans. Health - Insurance Health insurance like other forms of insurance is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a governmentsponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.
By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. Understand Health Insurance Before we begin to talk about health insurance and the likes, lets briefly go over the concept of insurance. A form of risk management, Insurance is the transfer of the risk of a loss, from one person to another, in exchange for a certain amount (premium). In other words it is a kind of guarantee to combat any kind of losses in regards to health, property etc. There are two parties to an insurance contract.... Health India There are around 15-20 companies offering health insurance solutions in India. Most of them were public sector companies but with IRDAs permission many private companies have come up. They are offering health insurance at a low rate as compared to old private sector companies. List of operating companies in India: Apollo DKV Insurance Company Ltd, Aviva Insurance, Bajaj Allianz Insurance Co. Ltd, Birla Sun Life.
History and evolution
The concept of health insurance was proposed in 1694 by Hugh the Elder Chamber Len from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance. This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance. Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in the U.S. by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the U.S. effectively date from 1890. The first employer-sponsored group disability policy was issued in 1911. Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and most prescription drugs, but this was not always the case.
Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations. The predecessors of today's Health Maintenance Organizations (HMOs) originated beginning in 1929, through the 1930s and on during World War II
How it works A health insurance policy is a contract between an insurance company and an individual or his sponsor (e.g. an employer). The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health insurance company are specified in advance, in the member contract or "Evidence of Coverage" booklet. The individual insured person's obligations may take several forms Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan each month to purchase health coverage.
Deductible: The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
Co-payment: The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a copayment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
Exclusions: Not all services are covered. The insured person is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition,
some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
Out-of-pocket maximums: Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and the health company pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Capitation: An amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer. . Explanation of Benefits: A document sent by an insurer to a patient explaining what was covered for a medical service, and how they arrived at the payment amount and patient responsibility amount. Prescription drug plans are a form of insurance offered through some employer benefit plans in the U.S., where the patient pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan.
Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than the provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider. Health Plan vs. Health Insurance Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance".A health plan can also refer to a subscription-based medical care arrangement offered through HMOs, preferred provider organizations, or point of service [Link] plans are similar to pre-paid dental, prepaid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the
managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review)
Health Insurance for students Undergraduate and Graduate Health Insurance policies for College Students Most students (ironically even medical students) end up using their universitys healthcare clinic instead of opting for a student health insurance plan. It makes more sense for a student to be covered by a steady health insurance policy instead of relying on their colleges health clinic which may not provide extensive health care coverage. Lots... Maternity Health Insurance Ensure a tension free pregnancy with Alcare Global Maternity Health Insurance solution If youre planning on having a baby, it would be advisable for you to purchase a maternity health insurance before you conceive, to assist you through your pregnancy period. Ensuring proper prenatal care helps you to bring a healthy baby into your family. Though, this kind of prenatal care can become very expensive. Not having an... Health insurance schemes At present two important Health insurance schemes 1. Employee state insurance scheme Employee state insurance scheme was started in 1948 by an act passed in the parliament .this programme provides health care to industrial labors and their families .this gives safety at the time of delivery diseases accidents etc. This scheme was limited to those who gets salary below rs. 6;500 per month. 2. Central Government Health Scheme Central government health scheme was started in 1954. Objectives of the scheme 1. To give extensive medical facilities to central govt. employee and their family members . 2. To save government from heavy expenses on medical refund. Beneficiaries of scheme In the beginning scheme was only limited to central government employees and their family members. 1. Central government employees and their family members. 2. members of parliament 3. Judges of Supreme Court and high court.
4. Freedom fighters. 5. pensioners of central government semi autonomous units 6. Journalists. 7. governors and ex-vice president Faclities under the scheme 1. Outdoor treatment facilities in all medical systems.
2. Emergency services in allopathy systems. 3. Free medicines 4. Facilities for laboratory test and radiological investigation . 5. Treatment facilities for serious patients at their own homes . 6. Specialist consultation facilities . 7. Family welfare services. 8. Treatment facilities in government or government recognized private hospitals
where specialists are available.
9. Facility for 90% advance payment in case of need
Coverage Under the Scheme Schemes are started in Delhi in the beginning .at present the scheme is functioning in the following 17 cities;Nagpur, Hyderabad, Bangalor, Kolkata, Jaipur, Lucknow, Meerut, Pune, Ahmedabad, Mumbi, Allahabad, Jabalpur, Chennai, Patna, Kanpur, Trivandrum and Guwahati. Types of health insurance coverage Dental :Dental Procedure Disability:- Income when insured is unable to work because of a health problem hospitalization :- Inpatient hospital expenses including room patient care supplies and medicines . long term care:An umbrella term for an array supportive services to help people function in their daily living service may include but are not limited to nursing care personal care rehabilitation. Major medical :- Large medical expenses usually not covered by regular medical or dental coverage. Optical :- Non surgical procedure to improve vision . Regular medical :- non surgical provided by health care providers. Surgical :- surgeons fees.
