What is Healthcare Insurance?

Healthcare insurance is an insurance that covers either a portion or the entire risk of an individual incurring personal medical expenses, spread over a number of persons. The risks covered are divided between different categories to suit the varying needs of customers. Most large hospitals also have small dental and healthcare practices. Thus the insured individual may not require coverage for both. A dental plan will provide coverage for a basic dental care like cleanings and checkups, x-rays and fluoride treatments. Click here for more information Disability insurance.

Healthcare insurance plans cover a large segment of the total health service sector in the United States, employing over 13 million people. A major portion of these people are children, aged 18 and below, women and senior citizens. The major source of income for healthcare providers is direct fees from services rendered. They receive payment when they have rendered services successfully and a percentage of the amount of actual charges is deducted from this amount to be paid by the insured. While there are different types of direct written premiums, common ones used are percent of the premium, flat premium, fraction of a percent, annual hike policy and refundable premiums.

Healthcare Insurance has been an area of concern since the mid 1980s. It was mainly a function of managed care where providers set their own rates, despite government intervention to keep them in line. However, as direct written premiums became more popular and they attracted more patients, providers soon challenged the level of regulation. They soon started providing PPO and HMO managed care plans, thereby gaining a firm foothold on the healthcare market.

Today, Medicare and Medicaid are two popular schemes, providing around a billion market share. But both these schemes are limited to providing health services only. Healthcare Insurance provides a wide range of services beyond that, in an indirect manner. Some of the direct coverage schemes may benefit employers or business owners, who provide healthcare facilities for their employees. This is not the case with other types of healthcare coverage.

There is an active debate ongoing in the US about the regulation of healthcare costs. Proponents of Health Care Reform, mainly consisting of physician and industry groups, want to see a reduction in the number of healthcare covered entities, and force insurers to cover the same costs through a pay-for-service system. Their main platform is the billions of dollars that the US spends each year on health plans. They argue that the current system, which they describe as a pay for service plan, is costing American business thousands of dollars, on average. They also claim that the government must provide a control on healthcare costs or the country will suffer from a “worker’s compensation deficit”, which would lead to job losses.

On the other side of the debate are those who believe that employment is the key to economic prosperity. They argue that employment will keep people healthy, prevent sickness and reduce healthcare expenses by providing direct written premiums for healthcare services. They also believe that employers have the legal right to deny healthcare benefits to an employee if the employee files a lawsuit. One of the arguments put forth by these opponents of healthcare reform is that it will destroy the country’s economy, leading to fewer jobs and consequently, higher unemployment. The debate will continue until a compromise is reached.

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