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Posted by Mama Max - - 0 comments

Gee whizz... time flies when you're having fun! It's been an absolute age since I blogged on here and I apologise for my tardiness but, frankly, I've been having too much fun elsewhere!!! However, this evening I have been 'abandoned' by Him Indoors who has headed to the pub so I thought I would sit down and spend some time writing.

But what to write about? To be honest, craft projects have been a little thin on the ground of late (see above excuse) and my spare time has been taken up with planning our super duper summer vacation to California. However, a joking comment made by a friend a little while ago has been hanging around in my head. For those of you who haven't followed my blog, I self published a book in January 2013 entitled "The British Expat's Guide to Grocery Shopping in America"... a labour of love based on my 3 years experience of navigating the US grocery stores through the eyes of a Limey expat! Within a week or two of publication I was told by a friend over a glass of wine... "So, you've written about the food shopping, what you should do now is tackle the medical insurance system!" This comment was scoffed at by all in attendance... as no one, I repeat no one, truly understands it all. Even the Americans.

But... it did start the beginnings of an idea deep in my head. There is absolutely no way I am going to try to write a book explaining the US medical insurance system. It is too big, too complicated and I just wouldn't know where to start. The problem is that there are so many different policies out there that are all slightly different that you'd never be able to comprehensively detail all of it. However, that doesn't mean that there isn't the need for a higher level overview... especially one aimed at expats who struggle to understand the terminology let alone the policy intricacies.

So, this is where I come in. Firstly, a caveat. I am a Brit and so have been brought up with the NHS (national health service)... an institution that entitles every British man, woman and child with free healthcare from cradle to grave (if you want it). Obviously, there is the option for private health insurance in the UK in addition to the care available from the NHS but having utilised both, I can honestly say that the care is pretty much the same and usually provided by the same doctors that also work in the NHS (you just get a coffee brought to you by the concierge in the waiting area of a private practise and more convenient appointment times). Obviously, my thoughts on state funded healthcare provision are going to be a little influenced by this background, but I am going to try to refrain from weighing in on the healthcare reform debate ('Obamacare') as I truly don't understand it well enough.





Therefore, this is an overview of the current system and an explanation of terminology (in laymans terms) and usual procedures. Read on to find out more...

OVERVIEW

Healthcare is one of the leading industries in the United States and US hospitals are at the forefront of many medical advancements and cutting edge therapies. I've lost count of the times I've heard local people say here in Houston, "Well, if you're going to get sick, this is the place to do it!" In fact, here in Houston the medical industry rivals the oil & gas industry for dominance. So why is the US falling behind other developed countries in important health indicators such as infant mortality, life expectancy, cardio-vascular diseases, teen pregnancies, disabilities and STDs? The answer is because there is unequal access to healthcare provision. A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population." Consequently, it is estimated there are 48,000 unnecessary and preventable deaths in the US every year.

This is because nearly all healthcare provision in the US is through private sector businesses. Their objective is to make money. Healthcare is therefore expensive to purchase, and being a big country with a big population, the US government cannot afford to pay for equal access to healthcare for everyone (at least, not with taxation at current levels). Consequently, most individuals in the US opt to have medical insurance to safeguard them against potentially high healthcare costs in the event that they become sick.

BUT... and here's the kicker... private medical insurance is ALSO expensive. The vast majority of people under the age of 65 have to purchase private medical insurance, often sponsored and subsidised by employers as a taxable benefit. The government does what it can and provides state funded or subsidised insurance (Medicaid, CHIPS, Medicare, Medigap etc...) for those in poverty, but for those just above the means tested threshold, often being uninsured and keeping your fingers crossed you don't get sick is the only option. Approximately 16% of the US population is in this position.

One question I often pondered when I first arrived in the US is that surely (having taken the Hippocratic Oath) doctors would/could not turn away a sick or injured person from hospital? And for the uninsured this IS luckily the case thanks to the Emergency Medical Treatment and Active Labor Act enacted by congress in 1986. This act states that hospitals are obliged to treat emergency conditions of ALL patients that present themselves regardless of their citizenship, legal status or ability to pay, until they are stabilised and able to “self-care” following discharge. Note, this does not mean cured. In reality, this means that many uninsured families resort to using the hospital emergency rooms for treating things like ear infections that under 'normal' circumstances would be treated by a GP or primary care physician (who would charge lots of money requiring insurance). Something like 55% of all ER visits now go unpaid, which unfortunately means healthcare providers shift the costs onto those who can pay. A vicious circle indeed.

For those who do purchase medical insurance the levels of coverage vary widely and there are numerous types of policies, the most common types being traditional indemmity (a.k.a. Private Fee For Service, PFFS), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point of Service (POS) plans. These will be explained in greater detail in Part 2.

The system is huge and very complicated, but for the benefit of a newbie expat trying to understand everything I have summarised the overview above into a flow diagram.





As you would imagine with a topic as BIG as this, there will be a series of posts. Coming soon...

PART 2: An Expats Guide to Understanding the US Medical System ... Types of Insurance
PART 3: An Expats Guide to Understanding the US Medical System ... Where to go for healthcare
PART 4: An Expats Guide to Understanding the US Medical System ... Paying the bill








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