Insurance is a system/service that essentially protects the insured against risks. The general principles of risk are as follows [1] risk is unpredictable for an individual, [2] risk can be predicted for a group or population with some degree of accuracy, [3] by gathering resources, insurance can shift the risk from an individual to the group, and [4] equitable losses are shared by all members.
The types of private health insurance options are group insurance, self-insurance, individual private insurance, and MCOs.
Group insurance: an insurance that covers a defined group of people
Self-insurance: insurance of one's interests by maintaining a fund to cover possible losses rather than by purchasing an insurance policy.
Individual private insurance: determines premium price and eligibility based on risk calculated by an individual's health status and demographic
Managed Care Plans: consists of HMOs and PPO
We are the only country that does not guarantee universal health care coverage to all of its citizens.
Bismarck model-
Countries that use it:
German, Japan, Belgium, Switzerland, and Latin American countries
What is it:
It's a private multi payer system. health insurance plans purchased from privately owned insurance firms which is usually purchased through employment payroll deduction.
What part of the US operate like this :
we mostly use this in
America.
difference:
insurance companies are basically non-profits by law. companies can't exclude based on preexisting conditions. more incentives and requirements for employers to provide insurance
results:
universal coverage
The Beveridge Model-
countries that use it:
Great Britain, Italy, Spain, Scandinavian countries
What is it:
medical services are treated as a right and a public good - public single-player system. which are funded by taxes [no medical
bills], doctors are public [government run care facilities] and private. services are all bought and paid for by the government tax revenue. low cost per person [government also controls medical services costs].
what part of the US operate like this:
military and veterans [VA], native Americans [IHA]
results:
universal coverage
The National Health insurance model [NHI]
countries that use it:
Canada, Australia, Taiwan, South Korea
what is it:
medical services
still treated as a right and public good - single payer system but privately provided care. Founded by taxes into a specific and isolate government fund [no medical bills, no chance of funds being redistributed]. doctors and care facilities are private institutions. services are privately dispensed, but all bought and paid by government tax revenue, not private insurance. Low cost per person- government also controls medical service costs. every citizen pays into the system.
what part of the
US is like this:
Medicare coverage
results:
universal coverage
the out of pocket model-
Countries:
most developing countries
what is it:
medical care is paid for by the patient as needed- no insurance plan or government issued payment or distribution system. this works for the "god-forbid" parts of life. this does not work well with chronic conditions requiring repeated treatments.
what part of the US is like this:
the uninsured. technically since we
don't have national play we could be considered this because of stratified, unequal, and spotty coverage is what we got!
results: stratified, unequal, and spotty coverage
US healthcare "system"
We combined all the top above[Military veterans, over 65 out of pocket]
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