Sunday, May 25, 2014
Perception of Health Consumers
Consumer perception drives most of the success or failure of an industry. When consumers perceive a need for a product or service, an industry has a limitless ability to expand, innovate and thrive. In the health care industry, the product consumers crave (and need) is health and wellness. Health and wellness is an essential quality of life factor that many consumers are willing to pay a high price to achieve.
Consumer perception of health has expanded drastically in the last 30 years. A long time ago, it was adequate to just “feel” well. Today, health is also defined as adequate preventative care, supporting healthy lifestyle choices for long-term health and adequate access to health care. All three of these factors are heavily influenced by consumer health care insurance availability and affordability. Subsequently, health care insurance availability and affordability is influenced by market threats and health care market equilibrium.
The largest group of health care consumers in America today is the Baby Boomer generation (approximately 76 million Americans). This generation is faced with rising costs as the health care industry faces its most turbulent time in history due to staffing shortages, decreasing insurance reimbursements and staggering malpractice costs within the industry. Compounding decreasing private insurance reimbursements, this generation is also facing a Medicare crisis as they reach age 65.
To complicate matters, as this generation ages they are faced with new health care problems and chronic conditions that demand treatment for wellness. As the consumer perception of health and wellness becomes more complicated, so does the demand for healthcare. When compared to figures from 1984, a significant amount of Americans show higher levels of preference in terms of which hospital and which provider they use for long-term care. Surprisingly enough, regardless of age, a higher percentage of Americans also show an increased use of specialists (2010 PRC National Consumer Perception Study).
Health care is unlike most other goods as consumers actively seek out methods and resources to safeguard their intangible sense of wellness. Consumer motivation to safeguard health is directly proportional to the long-term benefits of well 1being and marginal “health stock”. Consumers recognize that better health leads to less sick days, increased productivity and higher pay. Americans especially are perceptive to health care specialists and care due to the high internal locus of control associated with Western culture. Western ideals espouse self-determination that’s driven by a strong sense of internal control. Health-seeking behavior is a prime marker of this cognitive view of one’s external environment. As a result, American culture encourages and rewards this behavior.
Today’s long-term well being is driven by the three factors discussed earlier: preventative care, support for healthy lifestyle and access to care. As these three items are met (with increasing costs), a consumer’s sense of “health stock” rises. Health stock is the perception of consumer control over one’s health and consumer satisfaction with health care in relation to resources spent. Resources can be defined as time, money or even travel to healthcare access.
Today, the cost of consumer happiness in relation to health stock and perceived wellness is higher than ever. In 1990, the total cost of the health care industry was approximately $714 billion. In 2008, this cost tripled to $2.3 trillion. Compared to the rest of the world, the American health care industry has expanded exponentially in terms of cost while accessibility has risen only marginally. This increased demand has led to an increased cost as market threats keep the industry turbulent.
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Health Insurance for All #insurance
The prospect of universal health coverage for all Americans is weighing heavily on lawmakers right now. But, if the current proposals pass Congress, Americans may be looking at an even “weightier” problem. New economic research suggests that having health insurance actually makes people fat, and that, in turn, increases health care spending.
A working paper recently published by the National Bureau of Economic Research (NBER) discovered that Americans who have any type of health insurance coverage, either public or private, are more likely to gain weight and be obese. According to the research, Americans with private insurance had increases in body mass index (BMI) of 1.3 points, and those with public insurance had BMI increases of 2.1 points. (Both of these findings were statistically significant.)
The healthcare costs associated with obesity are overwhelming, and account for nearly $150 billion annually in the United States, roughly half of which is already funded by Medicare and Medicaid. This translates to an additional $1400 per year in medical costs for an obese person compared to a normal-weight individual. Remarkably, the cost of treating obesity-related conditions and diseases has risen faster than the incidence of obesity itself. The cost has nearly doubled in the last decade, while the incidence of obesity has only increase by 37%. Today, obesity-related costs account for 9.1% of total medical spending.
Economists have long shown that workers with employer-sponsored health coverage, as well as all tax-paying Americans, pay the costs associated with obesity through increased taxes, decreased wages, or increased insurance premiums. Now, the authors of the NBER paper actually call health insurance an “economic subsidy for obesity.” The authors assert that people with health insurance are less health-conscious and less attentive to weight gain since they believe health insurance will cover the costs of their weight-related maladies. The authors offer weak evidence that better insurance coverage begets greater weight gain, and risk-adjusted health insurance deters weight gain. Other economists have come to different conclusions using different economics models and estimations, but most agree that obesity needs to be addressed before medical costs can ever be contained.
Rather than making healthier lifestyles available to all Americans, will universal health coverage create a moral hazard in matters of body weight? The authors of the NBER paper think so. Instead, they contend that providing incentives for healthy behaviors and lifestyle choices will improve social welfare more than providing blanket coverage for everyone. If the latter becomes reality, the United States may need a mighty big blanket.
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Why do I need Health Insurance?
One common thing that people in their twenties have told me is that they made the decision to go without health insurance. When you are healthy and rarely see a doctor, it may seem like a good idea to cut out health insurance completely and to just go without it. You can pay for things as you go instead of worrying about the insurance premiums and co-payments on the way. However this is faulty reasoning. It is essential for everyone to always have some form of health insurance.
The reason is that medical emergencies are expensive. If you have a medical emergency without insurance, it is easy to find yourself with a crippling amount of medical debt, and seemingly no way out of the mess. One accident on the ski slope could cost you thousands of dollars in medical bills, and it can quickly climb higher if you need surgery or anytime in rehabilitation. Generally, that is a time when you will not be working either, and that means that you will lose money that way as well. Emergency surgeries such as an appendectomy can be very expensive as well. Even with insurance you may find it difficult to pay for health care costs in these instances. It is very hard to pay for medical costs without health insurance, especially if you are checked into a hospital even just overnight.
Minor things can turn into bigger things as well. When you do not have insurance you avoid going in and getting treated for the little things, which can escalate into bigger things quickly. Preventive medicine and quick treatment is one of the best ways to avoid long hospital stays. If you have insurance, then you will not worry about this as much. Additionally if you are diagnosed with a serious medical condition, you may have a difficult time finding health insurance after you have not had any.
At the very least you should have a high deductible insurance plan, and set up a health savings account with it. These plans are much lower in cost then other insurance plans. You will be responsible for the cost of your medical until you hit the deductible, but then the insurance plan will pick up the rest of the bills. It is much easier to find a way to pay $5,000.00 in medical bills as opposed to $50,000.00. You can often work out a payment plan for the $5,000. This means that you will not face bankruptcy due to medical bills.
Health insurance is not a luxury; it is a necessity. Many people in their twenties feel that they are safe and relatively healthy and choose to go without it. Do not make this mistake begin looking for a good low cost insurance now. There are several things you should do without before you choose to go without insurance. This includes eating out at restaurants, and cable television. You should even go without a gym membership before you give up your health insurance. Take the time to find the extra money in your budget to cover your healthcare costs.
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The Importance of Health Insurance
Protect Your Future
You protect yourself and your family from financial losses when you purchase home or car insurance. The same goes for health insurance. And, what you may not realize is that a trip to the hospital can be much more costly than you might expect. Here are some facts:
The average cost of a trip to the emergency room for an adult is about $700, not including any tests or hospitalization, which may increase the bill to well over $1,000.1
A broken leg can cost up to $7,500.2
Average expenses for childbirth are up to $8,800, and well over $10,000 for c-section delivery.1,3
The total cost of a hip replacement can run a whopping $32,000.2
These examples sound scary, but the good news is that, with the right plan, you can protect yourself from most of these and other types of medical bills.
Get the Care You Need
The sad fact is that many people who do not have health insurance simply don't get the medical care they need. That's because they may be worried about the cost. It may also be because they don't have access to the best resources. One of the key benefits of health insurance is access to a large network of doctors and hospitals, as well as other handy resources to help you stay healthy. Other benefits of health insurance include:
Being able to quickly and easily find the help you need close to home
Peace of mind and less stress during a tough time because you know you're covered
Access to affordable care and health information to keep you happy and healthy
Why health insurance? The bottom line is health is the most valuable asset of all. With a good health insurance plan, you help protect the health and financial future of you and your family for a lifetime. With the new opportunities to get insurance that you can afford, it doesn’t make sense to take a risk and go without insurance.
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Saturday, May 24, 2014
HIPAA (Health Insurance Portability and Accountability Act)
Family coverage is defined as the contract holder and his or her dependents. Dependents include a spouse and unmarried dependent children including legally adopted children, step-children and children of a domestic partner if the child depends on the contract holder for his or her support. Some states also include unmarried domestic partners under the definition of family.
HIPAA established national standards for the portability of insurance and set security standards for electronic health care information. HIPAA regulates the availability and breadth of group and individual health insurance plans, amending both the Employee Retirement Income Security Act and the Public Health Service Act. HIPAA prohibits any group health plan from creating eligibility rules or assessing premiums for individuals in the plan based on health status, medical history, genetic information or disability. It does not apply to private individual insurance. It also limits restrictions that a group health plan can place on benefits for preexisting conditions. HIPAA also includes rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information. The final rule adopting HIPAA standards for security was published in the Federal Register on February 20, 2003. This rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information.
Primary Care Physician
Under managed care plans such as HMOs or POS plans, the first contact for health care is the primary care physician—often a family doctor, internist or pediatrician. A primary care physician monitors your health and treats most basic health problems. In many plans, the insured must have a referral from the primary care doctor in order to receive covered care from a specialist.
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Co-payments or Co-insurance
Co-insurance or a co-pay is a percentage of each claim above the deductible paid by the insured. For a 20 percent health insurance co-insurance clause, for example, you would pay the deductible plus 20 percent of the covered losses. After the insurer pays 80 percent of the losses up to a specified ceiling, the insurer will start paying 100 percent of the losses.
If you are disabled or unable to work as a result of an accident or illness, disability income insurance, which complements health insurance, can replace lost income. There are basically three ways to replace income:
1. Employer-paid disability insurance
2. Social Security disability benefits
3. Individual disability i/ncome insurance policies
Deductible
A deductible is the amount of loss paid by you before the insurance kicks in. Either a specified dollar amount, a percentage of the claim amount, or a specific amount of time must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.
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If I change jobs or become unemployed, can I take my health insurance coverage with me?
If you switch employers, you have the right to carry your group health
insurance coverage with you to a new job for up to 18 months under the
Consolidated Omnibus Budget Reconciliation Act (COBRA).
You must pay the full premium, but at group rates that are far cheaper
than the individual rates you would pay for similar coverage. Health
insurance under COBRA is available if you are in the following
situations:
You leave a company and become unemployed or self-employed for up to 18 months.
You are a widow or widower or child of an employee who dies while working for the same company for three years or more.
You are the divorced spouse or child of an employee who has left the company he or she was employed at for at least three years.
You are the child of an employee who left a job and have not yet reached age 23.
trouble settling my claim?
If you are unsatisfied with how your insurance company is handling your claim, you have several options:
Talk to the agent or company representative who sold you the policy Let the agent know that you are dissatisfied and explain the specifics of your problem.
Contact the claims manager of the company Provide a written explanation of your problem with copies of supporting documentation. Remember to send only a copy and not any original documentation. If you are insured with a smaller company, consider writing directly to the president. Going to the top can sometimes speed the process.
Contact your state insurance department Insurance is a regulated industry and your state department of insurance should be able to help you resolve your problem.
Consult an attorney If you have tried all four of the above tips and still cannot resolve the claim, you have the option of talking to an attorney. You may have to pay a consultation fee for your initial visit, so make sure you know how much this will cost. Meet with an attorney who has solid references or get the name of someone from your local bar association. Prepare for the visit by bringing a copy of your insurance policy and other relevant documents. Get the fee structure in writing before you decide to pursue the case.
NOTE: If you need COBRA benefits, you must fill out the appropriate forms from your employer’s benefits department within 60 days of leaving your job. If you do not act within that time, you may be denied coverage.
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Health Insurance Plans
Whether your employer gives you a choice of plans or you need to
purchase your own coverage, it is crucial that you understand your
health insurance choices and pick the insurance that is best for you and
your family.
Here are some questions you should ask yourself when choosing a health insurance plan:
How affordable is the cost of care?
What is the monthly premium I will have to pay?
Should I try to insure most of my medical expenses or just the large ones?
What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?
After I have met my deductible, what percentage of my medical expenses are reimbursed?
How much less am I reimbursed if I use doctors outside the insurance company’s network?
Does the insurance plan cover the services I am likely to use?
Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company’s network?
If I want to use a doctor outside the network, will the plan permit it?
How easily can I change primary-care physicians if I want to?
Do I need to get permission before I see a medical specialist?
What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?
If I have a preexisting medical condition, will the plan cover it?
If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?
Are the prescription medicines that I use covered by the plan?
Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?
Does the plan cover the costs of delivering a baby?
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Wednesday, May 14, 2014
Health Insurance
What are my health insurance choices?
There are essentially two types of health insurance plans: indemnity plans (fee-for services) or managed care plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one “best” plan for everyone. Some plans are better than others for your or your family’s health care needs, but no one plan will pay for all the costs associated with your medical care.Here is a brief description of the types of available health insurance plans: Indemnity Plans; Managed Care Options; and Government-sponsored Health Insurance
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i Health Insurance Policies
COBRA (Consolidated Omnibus Budget Reconciliation Act)
Critical Illness Policies
Life Insurance Benefits
Medical Expense Policies for College Students
Medigap
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