PUBLIC HEALTH ISSUE

Public Health Issue

Public Health Issue

Health insurance often seems confusing and can be difficult to navigate for even the most knowledgeable consumer. It is one of the most talked about topics in political elections and has received considerable media attention because of the rules and restrictions placed on people who have insurance and the plight of the growing numbers of uninsured Americans.

The primary feature of health insurance is to pay for the cost of medical events that a person cannot afford. Insurance intends to pool for groups of people the financial risk of expensive, unforeseen medical events. Lately, however, the trend has been to use health insurance to pay for routine and ordinary health care as well as those catastrophic events. As a result, the cost of health insurance is rising for everyone.

Insurance as a concept is easy to understand. It is simply a mechanism for pooling financial risk within a community so that no single person has to bear the burden of a substantial expense. When members of a community or a company insure against health risk, everyone puts money into a collection, and the cost of their health care is paid for, in part, from that pool. No individual person is responsible for overwhelming medical costs because they all share the burden of each other's costs.

Insurance in practice is more difficult to navigate. To participate in insurance plans, a consumer must enroll in a plan either through his or her employer, through programs run by the federal or state governments, or individually with an insurance company. The enrollee pays a monthly payment called a premium, which goes to fund the risk pool. When insurance is accessed through work, the employer frequently pays all or part of this premium, and any remainder is paid by the employee using pretax wages. When insurance is accessed through public programs, little or no money is required of the consumer for the premium; however, funds are deposited by the government to fund a risk pool just the same.

Insurance companies offer different health insurance plans, each of which maximizes benefit or minimizes cost to the enrollee. Often, this means that plans that are the most financially appealing to the consumer because they cost less in premiums will have greater restrictions when the insurance is used and health care is sought. Health maintenance organizations (HMOs), preferred provider organizations (PPO), and point-of-service plans (POS) are plans that cost less in premium dollars than traditional, more expensive health insurance plans, but they also have more restrictions and guidelines that the consumer must follow in order for their care to be paid for by the insurance plan. The rules and guidelines of these types of insurance plans are often the basis of many complaints about health insurance today. It seems that in theory, health care is easily accessed and less costly with these types of health insurance plans; however, in practice, people find the rules and restrictions difficult to manage and to ...