A Comparative Analysis of Public and Private Health Insurance

1. Definition/description/ advantages and disadvantages of Public Health Insurance

Define: Public Health Insurance is a program run by the local, state and federal governments within which the people have some or all their healthcare related costs paid by the government (Awoke et al. 2017)

Description: The public healthcare plan can be divided into two parts. Part A is for the hospital related care and Part B is for healthcare services. The care plan is eligible for individuals or their spouses who have paid for their social security for a decade. In mentioned medical services age and disability is viewed as a major criteria coupled with the level of income (Bíró and Hellowell, 2016). The characteristics of the mentioned programs are composed of two components as follows:

Part A (Hospital Insurance):

The event of enrollment is automatic at the age of 65 years with the use of no premium charges. However, Booysen and Hongoro (2018) argued the fact that premium charges were levied on individuals who did not pay medicare taxes during their tenure of employment; such individuals can avail part A by paying premium. Part A provides successful coverage for several healthcare related facilities within several hospitals handling even the critical cases, with skilled nurses. The enrollment is not periodic in nature

Part B (Medical Insurance):

The beneficiaries in Part A may sign up and enroll anytime during the course of 7 months beginning three months they enter 65 years of age. Enrollees pay a bare minimum premium of $54 for a month. Part B manages the outpatient services inclusive of occupational and physical therapies and healthcare services at home (Schneider, 2018)

Pros and cons of Public Health Insurance

Pros

The government is not a profit making organization. The goal of the government is to cover the healthcare costs through the scope of service and not to earn profits (Curto et al. 2019). Secondly, administrative costs would be lower, controlling the unnecessary expenditure in healthcare services. Thirdly, a large entity is seen to hold greater bargaining power. As influenced by Nandi, Schneider and Dixit (2017), better level of bargaining power is likely to bring down the existing price

Cons

The disadvantage of public health insurance is that it relates to the healthcare professionals involved in the chosen professional domain. However, what affects the healthcare service providers eventually impact the patients. Providers are additionally concerned and believe high levels of negotiation powers can lower down the costs that are further borne by the service providers. As stated by Nandi, Schneider and Dixit (2017), doctors are often seen to exhibit a fear that they may be reimbursed at low costs. Thus, it can be conclusively stated conservative health care reform observant let us know that lower level of reimbursements means that doctors may reject the patients who are making use of healthcare related plans funded by the government

2. Definition/description/ advantages and disadvantages of Private health insurance

Define: Private health insurance refers to the health insurance coverage that is not offered by the government. As influenced by Sharma (2018), private health insurance is offered by private entities such as broker or an insurance company

Description: Private health insurance plan is laced with benefits that need to meet the minimum requirements for important coverage for affordable care. There exists a series of private health insurance plans for short terms offering different healthcare services but may not qualify under the definition of affordable care (Orzechowski, 2018)

Pros and cons of Private Health Insurance

Advantages: Offers flexibility of choosing the healthcare professional. Secondly, in case of surgery or other healthcare facilities that are urgent can be obtained on a timely basis, without delay for days. Unfortunately, the public healthcare facilities are funded by the government and thus lack the needed resources. The public healthcare facilities are often seen to lack the minimum comfort and amenities. While on the other hand private healthcare facilities are properly maintained (Mossialos et al. 2017)

3. Compare and contrast public and private types of health insurance

In order to supplement the gap in healthcare coverage plan of public insurance policies with the private ones, consumers may be subjected to innumerable insurance solutions in the market. As it may be difficult for a normal person to understand the obscure terms and conditions of healthcare insurance policies, a professional help can be termed useful

4. Give examples and descriptions of health insurance practiced in at least 2 countries of your choice.

Healthcare in the UK

In the case of the UK, healthcare and related services can be accessed through both the private and public sector. The comprehensive healthcare service is a system funded by the public, often termed as National Health Service (NHS) provides preliminary healthcare services for all, irrespective of their residential status (Fourquet et al. 2019). It is not possible to explain the UK healthcare system without drawing attention to the NHS’s history. Established in the year 1948, the system is well known for providing healthcare services run by general taxation providing free care. Moreover, it recognises the importance of availing healthcare related services as a right. The standards of medical facilities may be good; however, the waiting list is extremely long and the choices are highly limited.

Even though the prescriptions are paid they often have a fixed price irrespective of the medication quantity and the frequency of the treatment. In ordinary terms, it becomes important to underline the statement that the residents in the UK are entitled to being treated in hospitals (Wong et al. 2018). However, if the situation is not an emergency then a qualified healthcare professional refers the patient. In contrast with the NHS, patients report getting a better quality of care, which is likely because of a basic condition: quiet numbers are lower and spending plans are bigger. As should be obvious, the UK human services framework has favorable circumstances and disadvantages you ought to consider on the off chance that you are for all time moving. Right now, will be qualified for all the administrations gave by the NHS, lessening medicinal services expenses to a base. Should you choose to get private clinical protection in any case, you will unquestionably have quicker access to masters, better offices and decreased holding up times (Selden, 2020).

Healthcare in the Italy

Openly financed medicinal services: The National Health Service (NHS) covers all residents and lawful remote inhabitants. Inclusion is programmed and widespread. Since 1998, undocumented migrants approach critical and fundamental administrations. Brief guests get wellbeing administrations by taking care of the treatment related to healthcare expense Open financing represented 75.8 percent of all out wellbeing spending in 2014, with the expected level of consumption at 9.1 percent of GDP (Beogo et al. 2016). The open framework is financed basically through a corporate duty pooled broadly and assigned back to areas, ordinarily in relation to their commitments (there are enormous interregional holes in the corporate assessment base, prompting financing disparities), and a fixed extent of national worth included expense income gathered by the government and redistributed to locales whose assets are inadequate to give fundamental degrees of care (Linden and Ray, 2017). The locales are permitted to create their own extra income, prompting further interregional financing contrasts. Consistently, the discussion about the finding to be made within the domain of healthcare, for ensuring better health related outcomes.

Neighborhood wellbeing units are supported essentially through capitates spending plans.

Since the National Health Service doesn't permit individuals to quit the framework and look for just private consideration, substitutive protection doesn't exist, yet reciprocal and beneficial private medical coverage is accessible (Gabler et al. 2019). Secretly financed human services: Private medical coverage assumes a constrained job in the wellbeing framework, representing about 1 percent of all out spending in 2014. Around 6 million individuals are secured by some type of willful medical coverage (VHI), which by and large covers administrations rejected under the LEA, offering a better quality of solace and protection in emergency clinic offices and more extensive decision among open and private suppliers. Some private medical coverage approaches additionally spread copayments for secretly offered types of assistance or an everyday pace of remuneration during hospitalization (Fabbri and Monfardini, 2016). Tax benefits favor reciprocal over beneficial deliberate protection.

There are two kinds of private medical coverage: corporate, for which organizations spread workers and in some cases their families, and non-corporate, with people purchasing protection for themselves or their families (Ward et al. 2017). Arrangements, either group or individual, are provided by for-benefit and charitable associations. The market is described by three sorts of charitable associations: willful shared protection associations and corporate and aggregate supports composed by managers or expert relationships for their representatives or individuals. There is no data on the quantity of approaches sold by each sort of VHI supplier, yet philanthropic guarantors spread to most of the insured. In 2010, around 5.5 percent of the populace had individual VHI inclusion (1.33 million families), while around 2.5 million individuals had bunch coverage. (Cheikh et al. 2019)

5. Describe the type of health insurance in Saudi Arabia and compare/contrast this with one of the countries you cited above

The Health Ministry of Saudi Arabia is the important supplier of healthcare insurance benefits in Saudi Arabia. It gives the citizens a scope to obtain the valued healthcare related services at all levels. In excess of 240 medical clinics and 2,000 important social insurance holders speak to 60% of the administrators profits are dedicated to the well being of the people (Jin, Hou and Zhang, 2016). The nature of the open human services expanded throughout the years. The mentioned intervention works on creating a level of competition within the industry increased significantly. The private healthcare sectors need to change their scope of services or at least lower their prices for meeting the prices set by the public healthcare services

Roughly around 2,000 essential medicinal services habitats the nation over, more than 200 have received a referral framework (Cheikh et al. 2019). The mentioned structural intervention can work for providing the much needed healthcare services. Since numerous private medical clinics and facilities utilize British and American specialists and nursing staff, human services in Saudi Arabia operates with a medical care framework similar to the one operating in Europe or the United States. Despite, knowing the fact that medicinal drugs are easily available over the counter, it is always advised to get drugs with prescription in order to avoid the chances of medical emergencies (Gabler et al. 2019).

Clinical treatment in Saudi Arabia is given at a large number of the quality clinical offices in the nation. Infrequently do worldwide understudies want to travel abroad for treatment; however that choice might be essential relying upon the medical coverage given. Clinical innovation is continually being redesigned in Saudi Arabia and specialists, attendants and other clinical experts are being prepared in offices structured explicitly for that reason (Beogo et al. 2016). Clinical treatment in Saudi Arabia can run from basic consideration and thoughtfulness regarding progressively particular types of treatment, for example, open-heart medical procedure, kidney transplants, malignant growth treatment and that's just the beginning. The King Khaled Eye Specialist Hospital is one of the world's biggest eye emergency clinics; since Saudi Arabia is the biggest nation in the Middle East, it accommodates roughly 50 percent of the clinical treatment for its area. Saudi Arabia was likewise positioned 26 on the planet for clinical treatment by the World Health Organization's worldwide assessment (Selden, 2020).

The human services framework in Saudi Arabia keeps on developing in quality, exertion and productivity. With clinical treatment in Saudi Arabia going from wide to particular structures and the human services in Saudi Arabia being accessible to everybody, once in a while do global understudies find that they need to leave the nation to get appropriate treatment (Dale et al. 2017). Universal understudies who choose to concentrate in Saudi Arabia can confide in the human services framework in Saudi Arabia to keep them well during their stay.

Reference list

Awoke, M.A., Negin, J., Moller, J., Farell, P., Yawson, A.E., Biritwum, R.B. and Kowal, P., 2017. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana. Global health action, 10(1), p.1301723.

Beogo, I., Huang, N., Gagnon, M.P. and Amendah, D.D., 2016. Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso. BMC research notes, 9(1), p.34.

Bíró, A. and Hellowell, M., 2016. Public–private sector interactions and the demand for supplementary health insurance in the United Kingdom. Health Policy, 120(7), pp.840-847.

Booysen, F. and Hongoro, C., 2018. Perceptions of and support for national health insurance in South Africa’s public and private healthcare sectors. Pan African Medical Journal, 30(1).

Cheikh, A., Bouatia, M., Ajaja, M.R., El Malhouf, N., Cherrah, Y., Abouqal, R. and El Hassani, A., 2019. Impact of Disparities in Reimbursement Rules Between Public and Private Sectors on Accessibility to Care in Moroccan Mandatory Health Insurance: A Cross-Sectional Study. Value in health regional issues, 19, pp.132-137.

Curto, V., Einav, L., Finkelstein, A., Levin, J. and Bhattacharya, J., 2019. Health care spending and utilization in public and private Medicare. American Economic Journal: Applied Economics, 11(2), pp.302-32.

Dale, K.D., Tay, E.L., Trauer, J.M., Trevan, P.G. and Denholm, J.T., 2017. Comparing tuberculosis management under public and private healthcare providers: Victoria, Australia, 2002–2015. BMC infectious diseases, 17(1), p.324.

Fabbri, D. and Monfardini, C., 2016. Opt out or top up? Voluntary Health Care Insurance and the Public vs. Private Substitution. Oxford Bulletin of Economics and Statistics, 78(1), pp.75-93.

Fourquet, J., Zavala, D.E., Missmer, S., Bracero, N., Romaguera, J. and Flores, I., 2019. Disparities in healthcare services in women with endometriosis with public vs private health insurance. American journal of obstetrics and gynecology, 221(6), pp.623-e1.

Gabler, C., Carvajal, C., Osorio, C., Camus, M., Sánchez, C., Silva, M. and Merino, T., 2019. EP-1321 Waiting times for breast cancer treatment in Chile according to public or private health insurance. Radiotherapy and Oncology, 133, p.S724.

Jin, Y., Hou, Z. and Zhang, D., 2016. Determinants of health insurance coverage among people aged 45 and over in China: who buys public, private and multiple insurance. PLoS One, 11(8).

Linden, M. and Ray, D., 2017. Life expectancy effects of public and private health expenditures in OECD countries 1970–2012: Panel time series approach. Economic Analysis and Policy, 56, pp.101-113.

Mossialos, E., Wenzl, M., Osborn, R. and Sarnak, D., 2016. 2015 international profiles of health care systems. Canadian Agency for Drugs and Technologies in Health.

Nandi, S., Schneider, H. and Dixit, P., 2017. Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage. PloS one, 12(11).

Orzechowski, P.E., 2018. The Case for a Private Healthcare Insurance Monopoly. Applied health economics and health policy, 16(4), pp.433-443.

Schneider, T., 2018. Thriving in a changing world–opportunities and challenges for private health insurance companies. Wiadomości Ubezpieczeniowe, (1), pp.97-102.

Selden, T.M., 2020. Differences Between Public And Private Hospital Payment Rates Narrowed, 2012–16: A data analysis comparing payment rate differences between private insurance and Medicare for inpatient hospital stays, emergency department visits, and outpatient hospital care. Health Affairs, 39(1), pp.94-99.

Sharma, V., 2018, July. Out-of-pocket and Catastrophic Health Expenditure on Hospitalization in India: Role of Health Insurance. In 13th IEA SEA Meeting and ICPH-SDev.

Ward, P.R., Rokkas, P., Cenko, C., Pulvirenti, M., Dean, N., Carney, A.S. and Meyer, S., 2017. ‘Waiting for’and ‘waiting in’public and private hospitals: a qualitative study of patient trust in South Australia. BMC health services research, 17(1), p.333.

Wong, C.A., Kulhari, S., McGeoch, E.J., Jones, A.T., Weiner, J., Polsky, D. and Baker, T., 2018. Shopping on the public and private health insurance marketplaces: consumer decision aids and plan presentation. Journal of general internal medicine, 33(8), pp.1400-1410.

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