Whether you are self-employed, have one or two jobs or retired, you need a good health insurance plan for yourself and your family. It is important to get good health insurance coverage against unexpected medical expenses in order to avoid to be buried in debt. However, a plan that is good for someone else may not be the right one for you. In industrialized countries like the US, where the health insurance companies constantly change their policy, it is necessary that you have adequate information before choosing a health insurance plan. This article explains the different types of health insurance, their advantages and disadvantages so that can choose wisely if you shop for health insurance.

Individual health insurance

Individual health insurance is a form of individual contract between you and an insurance company to guarantee the repayment of all or almost all medical expenses. This may includes hospitalization, medications, dental care, seeing a specialist, and certain therapies (radiotherapy, chemotherapy, etc.). This service may be provided by a government-sponsored social insurance program (mostly for individuals with low income), or from private insurance companies.

What is the history behind health insurance?

Some hundred years ago, before the appearance of health insurance, all patients used to pay their health care costs. Around 1694, Hugh the elder Chamberlen (1630-1720) introduced health insurance. At that time, the idea was not widely known and welcomed by the public. Around the end of the 19th century, health insurance took an expansion, and other forms insurance such as accidental or disability insurance started being available in certain states in the United States.

Franklin Health Insurance Company of Massachusetts was the first company to provide accident insurance in the United States. However, it covered only injuries caused by railroad and steamboat. As the insurance industry grows, in 1866, there were approximately sixty companies offering accidental insurance in the United States. Today, there are more insurance companies than we can count.

Although there are numerous insurance companies, health insurance plans are grouped into three main categories:

Fee-for-service - also known as indemnity plans is a type of insurance plan where you, patient, have to pay all medical expenses out of your own pockets, and then request a reimbursement from your insurance company. These types of plans have their advantages and disadvantages.

Advantages: they offer more flexibility in choosing your own doctor. You can decide the time to see your health care provider, and what type of treatment you want; as long as you remain in the limit that your insurer will pay

Disadvantages: in indemnity plans, most doctors require upfront payment, so you have to submit claim forms to the insurance company to receive a reimbursement. That requires paper work, and sometimes many phone calls. Fee-for-service plans offer limit benefits; they do not cover annual physical exam and educational programs.

HMOs (Health Maintenance Organizations) - Health maintenance organizations (HMOs) are managed care plans that offer health care coverage to their members through hospitals, doctors, and other health care providers that are in their network. That is, having their service, you are limited to members of their network.

Advantages: unlike Fee-for-service plans, you do not have to pay up front; although some of them require a copayment. You do not need to submit forms after forms to receive reimbursement. In addition, HMOs usually charge a lower cost.

Disadvantages: you can use only health care providers who are associated with the organization. Most HMOs (Health Maintenance Organizations) tend to refuse to approve certain treatments. Although some HMOs accept their members to see physician or specialists who are not in their network, they often charge you additional costs.

(PPOs) participating provider organization, also known as Preferred Provider Organizations - is a form of managed care organization of physicians , hospitals, clinics and other health care providers that sign a contract with an insurer to provide health services to its member at reduced rates . Usually, PPOs cost more than traditional HMOs, but offer more options to their members.

Advantages: Preferred Provider Organizations provide more flexibility to their members; they have a bigger network of doctors and hospitals. You can take service from health care providers that are not part of their networks (certain charges often apply). You pay Lower copayments for care from primary care physicians. In addition, you do not need a referral to see a specialist.

Disadvantages: PPOs cost more than traditional HMOs. You will more likely to make co-payments (usually from $10 to $30) when you visit a health specialist.

Do some health insurance companies offer better service to their members than others?

Yes. Some insurers offer better service to their members. To learn more about health insurance companies that provide satisfying individual health insurance plan in the US, visit our top rated list individual health insurance plan



By: Raphael

About the Author:

The Primary Health Care (PHC) strategy has proved to be a turning point in the history of health care policy. PHC was defined as “essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of development in the spirit of self-reliance and self determination”. PHC was expected to form an integral part of both the country’s health system, of which it is the central function and main focus, and the overall social and economic development of the community. It would be the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people work and live, and constitute the first element of a continuing health

care process.

 

 

PHC comprises eight elements:

 

ü      education concerning prevailing health problems and the methods of preventing and controlling them,

ü      promotion of food supply and proper nutrition,

ü      adequate supply of safe water and basic sanitation,

ü      maternal and child health care, including family planning,

ü      immunization against major infectious diseases,

ü      prevention and control of locally endemic diseases,

ü      appropriate treatment of common diseases and injuries, and

ü      provision of essential drugs.

 

The ideology and principles behind PHC closely match what was and has since been advocated in human development such as social justice, equity, human rights, universal access to services, giving priority to the most vulnerable and underprivileged, and community involvement. It is a recognized fact that the promotion and protection of the health of the people is essential to sustained economic and social development and contributes to better quality of life and to world peace. These prioritized PHC as the main strategy for achieving health for all. Despite this commitment and several years of work, not much has been achieved.

 

There is a need to examine the implementation of primary health care and identify strategic interventions needed to cope with the new challenges facing health systems, as a contribution to developing an agenda for strengthening PHC in the 21st century.

 

 

 

 

 

 

 

 

 

Key ISSUES that may need TO BE REVIEWED/addressed for strengthening PHC’s are:

 

 

ü      PHC policy formulation: How was the PHC policy formulated? What was the process of formulating PHC policy, the content of the PHC policy etc.

 

ü      PHC policy implementation: How are the PHC policies being implemented? Aspects to examine include advocacy and marketing, actors and partners, structures and processes etc..

 

ü      PHC resources: What resources are available for PHC implementation, for example human and financial resources, as well as PHC physical resources and structures?

 

ü      PHC monitoring and review: How are PHC policy and strategies being monitored and reviewed?

 

ü      Health trends: What are the trends of the main health and health-related challenges?

 

 

 

 

 

PROCESS

 

Data for the review to be obtained from the following sources:

 

ü      Unstructured interviews with interviewees/informants that have intimate knowledge of PHC implementation, such as policy makers, implementers at all levels, other sectors involved, WHO and other partners.

 

ü      Discussions with a wider audience of people who have intimate knowledge of PHC implementation. These included policy makers implementers, NGOs, private sector, health related institutions, WHO and other partners

 

ü      A desk analysis of available documents and reports specific to the country and extensive analysis of all available published and unpublished documents and materials.

 

 

 

 

 

 

 

 

A Review of the Rural Health Care System in India:

 

 

 Rural Health Care System – the structure and current scenario

 

The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is based on the following population norms:

 

 

1.                  Centre

Population Norms

2.                  Plain Area

Hilly/Tribal/Difficult Area

Sub-Centre

5000

3000

Primary Health Centre

30,000

20,000

Community Health Centre

1,20,000

80,000

 

 

 

Sub-Centres (SCs)

 

The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community.  Each Sub-Centre is manned by one Auxiliary Nurse Midwife (ANM) and one Male Health Worker MPW (M) (for details of staffing pattern, see Box 1).  One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-Centres. Sub-Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programmes.  The Sub-Centres are provided with basic drugs for minor ailments needed for taking care of essential health needs of men, women and children. The Department of Family Welfare is providing 100% Central assistance to all the Sub-Centres in the country since April 2002 in the form of salary of ANMs and LHVs, rent at the rate of Rs. 3000/- per annum and contingency at the rate of Rs. 3200/- per annum, in addition to drugs and equipment kits. The salary of the Male Worker is borne by the State Governments.  Under the Swap Scheme, the Government of India has taken over an additional 39554 Sub Centres from State Governments / Union Territories since April, 2002 in lieu of 5434 number of Rural Family Welfare Centres transferred to the State Governments / Union Territories. There are 146026 Sub Centres functioning in the country as on September, 2005 as compared to 142655 in September, 2004.

 

 

 

 

 

Primary Health Centres (PHCs)

 

PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services Programme (BMS). At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff.  It acts as a referral unit for 6 Sub Centres.  It has 4 - 6 beds for patients.  The activities of PHC involve curative, preventive, primitive and Family Welfare Services.  There are 23236 PHCs functioning as on September, 2005 in the country as compared to 23109 in September, 2004.

 

 

 

 Community Health Centres (CHCs)

     

CHCs are being established and maintained by the State Government under MNP/BMS programme . It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff.  It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities.  It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on September, 2005, there are 3346 CHCs functioning in the country.

 

 

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By: Tafsirul Mazahir

About the Author:

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