With HMOs continually increasing their premiums every year, the number of people who are uninsured is also growing at a rapid rate. However, it is not only the uninsured that are affected; whether you are paying an insurance premium individually or getting it through the company you work for, there is still the expensive out-of-pocket costs, such as deductibles, copayments and coinsurance, that have to be paid. So, regardless of whether or not a person has health insurance, there is a big chance that they will still be left financially drained.
According to the latest statistics, the amount of people who do not have health insurance is now sitting at close to 50 million. From the survey that was taken in 2010, the majority of people that make up this alarming statistic are between the ages of 19 to 25, families that have an annual income that doesn’t exceed $25,000, and those that are not citizens. No matter how you look at the statistics, what is alarming is that those who are feeling the financial burden from expensive health insurance is the typical working class, which really is the driving force behind the American economy.
What Exactly Is an HMO?
In order to understand the process behind managed healthcare, it is important to have a good understanding of what an HMO is. According to authoritative sources, and HMO (health maintenance organization) is an entity that creates healthcare plans, which is achieved by working closely with other medical organizations, hospitals, and individuals such as doctors and other medical specialists. Once these plans are created, they are then purchased on a prepaid basis, and medical professionals who work under these plans have to agree to certain guidelines and restrictions that have been stipulated by the HMO. After the contract has been formed, these medical professionals are then able to receive a steady flow of customers from the HMO in question.
While this approach was initially designed with good intentions, after implemented, there have been endless issues. One of the main problems that patients face are the prepaid plans that they are forced to take. The problem with these plans is that not every patient is able to reap in the benefits, both in health and financial cost. For example, while two people might be the exact same age, gender and race, one can still suffer from far more serious health conditions than the other. Therefore, when trying to create a prepaid plan to suit everybody, where does one actually draw the line? If the plan is too expensive, then the person who doesn’t get sick very often suffers, and if the plan is too cheap, then the person that has many health conditions will suffer, because in most cases, that plan won’t allow for certain conditions to be treated.
This dilemma is one of many that have led to the continuous increase in health insurance prices over the years. According to the latest statistics that was carried out by Aon Hewitt, the amount of money that most major companies will pay on health insurance for their employees is around $11,000 per person. This is a huge jump when you compare it to what these companies paid back in 2005, which was around $6,400 per person.
Who Gets Affected the Most?
Another area in which these prepaid plans are facing many challenges is in the way health care spending has been distributed. Researchers have found that close to 50% of healthcare expenses comes from 5% of the population. In addition, close to 45% of healthcare expenses is distributed to people that suffer from health conditions that are considered to be the most expensive (15 of them). In fact, it is shown that an individual who suffers from multiple chronic conditions costs insurance companies seven times more than those who only suffer from one of these conditions.
So, what about the average citizen that is in generally good health? Unfortunately, because HMOs rely so much on their prepaid packages, they have to find a way to meet everyone’s needs, and even though a small percent of the population is costing health insurance the most money, those that are in good health have to make up for that financial burden.
Another part of the population that costs health care a lot of money are the elderly. According to a survey that was carried out in 2002, 36% of personal healthcare expenses in the United States were consumed by the elderly, which at that time was close to 13% of the population.
So What Is the Solution?
Unfortunately, this is an ongoing debate that never seems to have an ending. The reality is that HMOs are businesses, and so understandably, their end goal is to make a profit. At the same token, people also have their end goal, which is to ensure the well-being of themselves and their families, and this isn’t easy to do when trying to keep up with the rising costs of health insurance.
While the US government continues to find a solution in order to repair their managed healthcare model, there is a growing number of medical professionals who have decided to take a different approach; one that will provide an affordable solution for those who are uninsured or underinsured while still providing high-quality medical care. The way in which they are able to do this is by offering a pay for fee service. In fact, the same service that is now offered by these doctors was implemented long before managed healthcare was introduced to the public.
A Model That Is Focused on Helping Patients without Insurance
Many doctors are now forming clinics dedicated to patients who are unable to afford health insurance or who are underinsured, or simply want to utilize the cash only method of payment. These clinics are also focused on providing high-quality health care to their patients, and the reason why they are able to achieve this is because they rely on the preventative side of healthcare in order to ensure that certain conditions can be prevented if caught early.
When the patient knows that visiting the doctor isn’t going to cost them an arm and a leg, they will be more likely to book a consultation with a physician for minor conditions that they might be experiencing. This in turn will allow the physician to spot any potential problems that can occur when diagnosing the patient, which in turn can prevent serious health conditions in the future.
Some of the most common ailments that these fee for service clinics treat are
Unitary tract infections
Cold and flu
Hormone replacement therapy
Low-cost clinics can be between 40 to 90% cheaper than going to regular clinics. For example, a basic physical exam or a consultation appointment for patients who suffer from arthritis, anxiety, cold or flu, diabetes (both insulin and non-insulin-dependent) and high blood pressure will pay a consultation fee of $60. Other consultation fees can go as high as $100, but these fees are still substantially lower than if you were to go to a regular clinic. Prices also vary from one clinic to another, so it is still the patient’s responsibility to do their due diligence in research when it comes to choosing the best fee for service clinic in their area.
Light at the End of the Tunnel
Despite all the regulations and “fixes” that are being implemented into the managed healthcare model over the last few decades to make healthcare more affordable to the public, statistics are showing that the future ahead continues to look bleak. However, many physicians have also shown that it is still possible to see light at the end of the tunnel, and they have been able to achieve this by developing an affordable approach to healthcare by implementing a fee for service model in their medical clinics, which benefits people of all ages, regardless of what their financial status is.