Coming to Grips With the US Health Care System

To an outsider the health care system in the US can appear bewildering. Unlike other countries, there is no policy of social medicine or a National Health Service open to all.  In order to get treatment, a patient needs to have some form of health insurance in place or be able to meet the costs of their care out of their own pockets.

Aspects of Care

Emergency Room: The majority of hospitals have an emergency room where the critically ill are taken for immediate care, for example following a car accident. The telephone number for emergency services is 911 and an ambulance will deposit the patient at the nearest emergency room. The ambulance ride does not come free; this too is billed to your health insurance provider.

Acute Care: Acute care clinics deal with emergencies that are not quite severe enough to warrant a trip to the hospital emergency room. Payment for the treatment you receive here should be settled before you leave, unless your insurance policy covers this kind of treatment.

Clinics: Health care clinics are often community based and offer a lower cost method of care and treatment, and are utilized mostly by families without health insurance that cannot afford to pay for private care.

Health Insurance

Health insurance is provided as a benefit by some employers. However, smaller companies cannot afford to meet the cost that comes with providing such a benefit. According to Federal Law, any company which employs more than twenty-five people must offer them the option of enrolling into a work based health insurance plan. On such a plan, the employer will pay part of the cost of the policy and the employee will pay the rest as a deduction from his or her pay check.

Understanding Your Policy

Whether you have private medical insurance or group insurance through your employer, you should pay attention to what your policy covers and what it excludes. Some policies offer a very limited amount of cover. For example, a basic plan may only provide cover for basic medical procedures, whereas a comprehensive policy would pay for investigative treatments as well as remedial care. Check your policy for what are called copay items, as some policies will not cover medical tests or inpatient stays. Mental health treatments too may not be covered in the way that you would expect them to be.

You should also be clear about the amount of cover that your policy is good for. If you find that you need extensive treatment or several rounds of testing, you may reach the limit of your policy before your treatment has concluded, leaving you with the difference in the cost of care to pay. Never take the fact that you have a health insurance policy for granted. Make sure you know exactly what the policy requirements and restrictions are so that you can have the peace of mind knowing that all your health care needs can be met at the time that you need them the most. Furthering your knowledge with an online specialization in health policy course is always a good idea to fully understand the health care system. 

About the author
Melanie Chalmers understands how confusing it can be looking in on the health care system from the outside.