US HEALTHCARE RESOURCES ~ the system and where to find help!

2007-07-31T20:54:00.000-07:00

The United States, like other countries provide both private and public health insurance, but there is far more private than public healthcare. It is the only industrialized country that does not have publicly mandated government-funded coverage for all citizens (apart from South Africa). At the same time however, healthcare expenditures in the US total over 15% of the GDP, which is greater than any other developed country.
Most people in the US obtain insurance through their employer or on their own. Unfortunately almost 17% of the population are uninsured and have to pay upfront which leads to delay in medical care, missed tests, treatments and follow-up. Almost 20% of the uninsured population is able to afford insurance, almost 25% are eligible for public coverage, and the rest (56%) need financial assistance (8.9% of the US population).

Private Health Insurance:
There are over 1000 private health insurance companies and most offer a fee-for-service insurance plan (with higher premiums) and at usually more than one type of managed care plan (health care delivery system with restrictions on provide choice and referrals, and with lower premiums, eg HMO, PPO, and POS). Some insurance plans cover medications while others do not. Cost-sharing (co-pays and deductibles) is also variable. 60% of the population obtain insurance from employers, while just above 9% buy their own.

(See below for resources)

Summary of different types of plans

HMO (Health Maintenance Organization) - You are required to select a Primary Care Physician (PCP) from the network. There is no coverage for non-emergency services received from providers outside of the network.
POS (Point of Service) - You must seek treatment from a physician within the network of preferred providers. If you circumvent your personal physician and go directly to a specialist, you may be responsible for all of the costs of those services.

PPO (Preferred Provider Organization) - You may seek treatment from any physician you choose; however, your out-of-pocket expenses will be higher if you receive treatment from an out-of-network physician.

EPO (Exclusive Provider Organization) - You must seek treatment from a physician within the network of preferred providers. If you seek treatment from a physician not in the EPO network, you are responsible for all of the costs of those services.

Indemnity / Traditional / Fee-for-Service - You may seek treatment from any physician you choose. After meeting a deductible threshold, the policy will pay a percentage of covered services. Most plans have an out-of-pocket maximum.

CDHP (Consumer Directed Health Plan) - This type of plan couples a high deductible health plan (HDHP) with an account such as a Health Reimbursement Account (HRA) or Health Savings Account (HSA) to pay for first dollar medical care expenses.

Of the many insurance providers, Blue Cross/Blue Shield is a nonprofit carrier that is regulated by insurance agencies in each state. It is an insurance provider for 30 %-50% of working people in the US. Blue Cross caters to hospital costs, while Blue Shield pays for medical tests.

Government-funded Insurance:
Almost 30% of the population is covered by public health care, much lower than other developed nations.

Medicare is provided by the Federal government (through social security) and is for those >65 yo regardless of income and people of any age with chronic disabilities or debilitating illnesses. It covers inpatient hospital costs, home health care, nursing home care for up to 3 months post-hospitalization, hospice care, dialysis, physical therapy, laboratory tests, outpatient care, physician bills, ambulance service and medical equipment. Note that the latter 7 services listed are optional and have a 20% copayment and at least a $100 deductible.

Medicaid is managed by both the federal and state governments. Eligible people include those with very low income (indigent) except childless adults, with 1/3 of the medicaid budget allocated to nursing home care for indigent elderly people. It also provides for inpatient and outpatient hospital costs, physician bills, home health care, hospice care, laboratory tests, dialysis, medication and very importantly long-term nursing care that is not funded by medicare.

In addition, the Department of Veteran Affairs directly provides health care to injured U.S. military veterans and current servicemen and women through a nationwide network of government hospitals (non-injured veterans are often not covered). It baiscally offers extremely affordable and sometimes free care to veterans.

Other public systems include S-CHIP: The State Children's Insurance Program (S-CHIP) covers children whose familes make too much income to qualify for Medicaid but have too little to buy private health insurance.

Although many states have discussed an overhaul of the US health system, only a few states have really attempted to provide universal health care coverage, eg Minnesota and Massachusetts (Massachusetts 2006 Health Reform Statute). Other US states (in particular New Jersey) help to cover many people (but not all) by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme.

Charity and Free Clinic facilities:
These centers offer healthcare for free or for a small fee and generally limited to those with lower income and no health insurance, including those not eligible for Medicaid and Medicare. They primarily treat acute, non-emergency conditions and some primary care for prevention and chronic conditions. There are a few that have pharmacies and dental services.
The staff are usually volunteer healthcare professionals and the facilities rely heavily on private donations, foundations, the United Way, and local goverments. There have been some student-run clinics (eg Stanford University Arbor Clinic, and San Jose's Pacific Free Clinic) that provide for the underserved community and help provide training for medical students.The Bureau of Primary Health Care is a site that a will help you find a clinic for medical care, even if you are lacking medical insurance or money.

CA: Berkeley Free Clinic , Haight-Ashbury free clinic (SF), Los Angeles free clinic http://www.rotacare.org/ (SF Bay Area), Free Clinic of Simi ValleyVA: Harrisonburg Rockingham Free ClinicNY: Free clinics in New York cityNYC: EHHOP - Free Clinic in El Barrio, New York CityOR: North By Northeast Community Health Center

Other health provision sites

Medical conditions/disease Information:
Since 1996, Medifocus has been the largest provider of medical information reports to consumers in North America. The management team, supported by a highly experienced group of medical research professionals, along with the assistance of the Medical Advisory Board, are dedicated to providing the latest and most comprehensive detailed information about specific medical conditions. The Guides are updated regularly using the most trusted peer-reviewed medical information sources. Medifocus has medical information Guides for over 120 medical conditions, including cancer, heart ailments and women's health issues.

Health Insurance resources:

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Supplements and dietary:

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References

Fadem, B. High Yield Behavioural Science (2001). Lippincott Williams and Wilkins.
http://www.amsa.org/uhc/HealthCareSystemOverview.pdf
http://www.healthaffairs.org/RWJ/Dubay2.pdf
http://www.census.gov/hhes/www/hlthins/usernote/usernote3-21rev.html
http://usliberals.about.com/od/healthcare/i/MassHealthIns.htm
http://www.va.gov/healtheligibility/eligibility/epg_all.asp
http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
http://www.huppi.com/kangaroo/L-healthcare.htm
http://en.wikipedia.org/wiki/Health_care_in_the_United_States
http://en.wikipedia.org/wiki/Free_clinic