How does the healthcare work? We get it. When we have something that is not working, the first thing that comes to our mind is – How does healthcare work? The answer is – It’s complicated! Let us explain to you how it is really done. You may not be able to understand all the terms and jargon that they use but at least you know how doctors, nurses, hospitals, pharmaceutical companies and insurance companies make money from healthcare.
There are two types of people who are involved in the health care system in the United States – Patients and Providers. These are the ones who pay for their treatment and healthcare. The rest of us, the professionals are providing quality service to the patients and the insurance companies. It takes time before you become a doctor, nurse, hospital employee, physician assistant, dentist or whatever. It also takes a lot of education and training before one is qualified enough to become an administrator, supervisor, buyer, quality assurance officer and so on.
One very unique feature of the new model of how healthcare is provided to Americans is the concept of employer-based health care. In this system, the patients who need medical attention get help from other professionals in the healthcare system like physicians, nurses and therapists. They coordinate with the doctors and the specialists in their field of expertise. If you want to be part of this team of healthcare providers and you have completed your schooling, you can apply to be a therapist or a nurse practitioner. Both these jobs require more schooling and certification than the jobs that general practitioners and surgeons do.
The healthcare providers are fully insured by their insurance company, either private or government-run. They are legally allowed to offer their services in the healthcare system of their locality. There are a few exceptions to this rule like for instance when the doctor and the hospital share a common site or when they both participate in the same insurance company’s network. However, if they work independently and do not work under an agency, they are not considered as part of the health care system.
Insurance companies are the ones who set up the system that will cover the service fees for the doctors and the nurses. In return, they get paid a fee for providing health care services to Americans. So if the patients are in need of health care services but they do not have the money to pay for it, the insurance company will pick up the tab. But what makes them attractive to many Americans is the fact that they have the option to use the health care services of other private health insurance plans, Medicare and Medicaid offered by the government.
These insurance plans are meant to help people in need of health care but do not have the money to avail of it. So what they do is they enroll in one of these insurance plans and pay a small co-pay for doctor visits, tests, surgeries and other health care services. They are also covered with prescription drugs and health care services that are not usually available to regular customers. But there is one thing good about these insurance plans; once the consumer gets a few months or years under his belt, he can renew his membership and continue to be covered under these insurance plans. However, it will all depend on how these insurance plans work.
How does this work? If you are insured through your employer-based health insurance system, you will most likely be covered with medical benefits that are provided through that particular employer. This means that you can avail of a doctor’s checkup, preventive care visits, hospital stays and much more. There are even cases wherein the benefits extend to dental care too. But since there is no cap on how much a person can spend on his or her healthcare, the consumer must be careful not to fall into debts. Otherwise, the government would take action and will fine employers who do not provide their workers with a proper healthcare system.
This is why the new model of how healthcare works has been introduced. The consumer can now get a chance to choose what type of healthcare he wants from an already established health insurance system. It is also a chance to save money from getting a monthly premium or deductible. He can also opt for the traditional pay as you go system or he can select a high deductible health plan. In addition to that, if he already has a health insurance policy, he can combine it with his spouse’s policy or other group policies. So if ever you get tired of being in the same shoes as your co-workers who are getting sick or injured, this is your chance to stand up and be counted.