Health insurance plans

In many cases, health insurance plans will cover the costs of genetic testing when it is recommended by a person s doctor. Health insurance providers have different policies about which tests are covered, however. A person interested in submitting the costs of testing may wish to contact his or her insurance company beforehand to ask about coverage. 

The third axis in Fig. 1 is that of the perspective of an economic analysis of medical care. Costs and benefits can be calculated with respect to society s, the patient s, the payer s, and the provider s points of view. A study s perspective determines how costs and benefits are measured, and the economist s strict definition of costs (the consumption of a resource that could otherwise be used for another purpose) may no longer be appropriate when perspectives different from that of society as a whole are used. For example, a hospital s cost of providing a service may be less than its charge. From the hospital s perspective, then, the charge could be an overstatement of the resources consumed for some services. However, if the patient has to pay the full charge, it is an accurate reflection of the cost of the service to the patient. Alternatively, if the hospital decreases its costs by discharging patients early, the hospital s costs may decrease, but patients costs may increase because of the need for increased outpatient expenses that are not covered by their health insurance plan. 

To be credentialed, health care professionals usually are required to submit specific information to the insurance carrier, such as license numbers, malpractice insurance information, board certifications, and copies of diplomas. Health insurance plans may have specific requirements, such as requiring physicians and other health care professionals to have specific credentials, carry a specified amount of malpractice insurance, or be board certified. The health care professional typically submits this information along with an application (Snella, 1999). 

Insured The party covered by the insurance contract or persons entitled to benefits under the terms of the policy (e.g., family members may be covered under the employee s employer-sponsored health insurance plan). 

According to the President s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, there are five trends that summarize the characteristics of health insurance plans of the late 1990s ... 

Further evidence has been presented that a strong association exists between smoking and atherosclerosis. Increased mortality is seen in smokers j although the correlation between smoking and serum lipid patterns is not clear. A study by the Health Insurance Plan of Greater New York has shown that physical activity plays a role. The least active smoker has an incidence of rapidly fatal myocardial Infarction which is nine times that found among the most active smokers. A rapid rise in free fatty acid is seen and an enhanced utilization of fatty acids occurs in smokers apparently due to nicotine ingestion. The relationship of this fatty acid rise to myocardial infarction is uncertain. 

USD 1,250. The Health Coverage Tax Credit is 65% of the premium for qualified health insurance plans. Dislocated workers older than 50 years of age may be eligible for Alternate Trade Adjustment Assistance (ATAA) benefits - a wage supplement of up to USD 10,000 for 2 years, if they get re-employed within 26 weeks in a job that pays less favourably than the previous one. 

When a patient s health insurance plan covers prescription drugs, the balance between perceived quality and price tips in favor of quality. While it protects consumers from uncontrollable and catastrophic expenses, health insurance also reduces the effective price of health care services and products. By reducing patients out-of-pocket cost, health insurance makes them less sensitive to price than they would otherwise be (516). 

The importance of price versus perceived quality depends on many factors, including the severity of the disease or condition for which the drug is intended, the availability of close substitutes, and the effectiveness of advertising and promotion in convincing doctors (and sometimes patients) that the drug is the right choice for the patient (86), Most important in tipping the balance between perceived quality and price, however, is health insurance. When a medical service or product is covered under a patient s health insurance plan, the patient pays less and is less sensitive to price (5 16). 

Most Americans-86 percent-have public or private health insurance, continuing a steady trend over the last decade (292). Virtually all health insurance plans cover hospital care, including drugs dispensed to hospitalized patients. 

Formularies—A formulary restricts the doctor s choice of drugs to drugs on a list (or to those not on a list of excluded drugs) when more than one therapeutically similar compound is available to treat a condition, Except for HMOs, formularies do not exist in private health insurance plans. Recent surveys of HMOs indicate that between 28 and 55 percent of all plans have some type of formulary, but the nature and effectiveness of these restrictions have not been documented (515). 

With the rising cost of healthcare mentioned in Chapter 1, employer-sponsored health insurance is a very valuable benefit these days in the US. Anyone who s had to pay entirely for his own coverage before will understand this. Companies no longer routinely pay the full amount of the health insurance, so some employee contribution for himself and/or his family may need to come out of the paycheck. Most companies will offer the candidate a choice of plans. Don t assume that because you work in a health-related field your own health insurance will somehow be better or more comprehensive than anyone else s. It just isn t so. Even physicians can end up with less-than-desirable health insurance plans these days. 

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