What is the medical system in America?

Many foreign students living in the United States find it difficult to understand the American medical system, because the American medical system itself is very chaotic and complicated. Not surprisingly, even many American citizens can't fully understand the American medical system. Today, I will take you back to the source and learn about the American medical system.

First, an overview of the American medical system

What is the main part of the American medical system?

(1) public medical insurance system

Free medical system for veterans, active servicemen, Indians, etc. The federal and state medical insurance plans in the United States provide medical insurance for about 30% of Americans, including the elderly, the disabled, children, the poor and veterans. These publicly funded medical insurance plans are mainly aimed at vulnerable groups to ensure social equity.

(2) Social medical insurance (medical insurance and Medicaid)

Medicaid insurance for the poor in America;

Medicaid insurance for the poor is the insurance that the federal government and the state government cooperate to provide medical services for low-income people. American citizens and legal immigrants who meet the standards can apply, but they must obtain a US green card for more than five years before they can apply. If you have a good income in the United States, you may not be able to apply for Medicaid when you are old, but only for medical insurance.

Medical insurance (federal medical insurance):

Medicare is the government medical insurance provided by the federal government of the United States for the elderly aged 65 or above, the long-term disabled under 65 or the patients with permanent renal failure. The applicant must be an American citizen or permanent resident, and the applicant or his spouse has paid the medical insurance tax to the country for more than 10 years (40 quarters). The health care insurance plan is managed by the federal government, and the States implement a unified policy.

(3) Commercial health insurance (individual health insurance)

In the United States, medical insurance for working people is provided by commercial insurance institutions. The medical insurance in America is mainly commercial insurance, which has its historical reasons in America.

American politics has three remarkable characteristics: federalism (decentralization), limited government and liberal ideology. Therefore, it is more in line with the common political and economic concept of Americans to provide basic medical insurance for employees by some employers.

Second, medical insurance common sense

Disadvantages of American medical system:

We have learned about the American medical system, and we will know that the public programs of medical insurance and Medicaid are specially designed for the elderly, the disabled, low-income families and individuals.

Everyone else needs to buy private insurance, either through their employers or by themselves. If you are not insured, you will have to pay your medical expenses, and the bill may be astronomical.

Private medical insurance is provided by either the employer or the school, or it must be purchased by itself. You can learn from f =(ACA) of the Patient Protection and Affordable Care Act.

"> health insurance market (health insurance market):

Choose the scheme that suits you best. The Affordable Care Act, also known as Obamacare, provides subsidies to those who cannot afford high insurance premiums. The amount of subsidy depends on personal income. California, Colorado, New York and Massachusetts all have their own medical insurance markets.

Medical insurance plans for non-US citizens are usually as follows:

(1) If you are employed by an American company, you may be covered by an insurance plan provided by your employer. Some employers will pay the full cost of the insurance plan, while others may pay part of the cost and ask you to pay the rest.

(2) If you have a work visa (H 1B visa) but plan to start your own business, you need to buy medical insurance yourself. During the registration period, you can find an insurance plan in the medical insurance market of the Patient Protection and Affordable Care Act. If you arrive in the United States outside the registration time, you are still eligible to apply for an insurance plan due to your special circumstances.

(3) Students or exchange scholars (visas F- 1 and J- 1): Most schools require proof of medical insurance before admission. Usually at the beginning of the semester, the school will automatically include students in the student medical insurance plan.

The United States requires all exchange scholars and their accompanying spouses and children to have medical insurance. You can get an insurance plan through your university.

Third, the organizational model of commercial medical insurance

The American medical insurance system consists of two parts. One is government-led medical insurance, Medicaid, children's health insurance and veterans' health insurance system (VA). After the implementation of Obamacare reform, 38% of the American population was covered in 20 14 years. The other is commercial insurance, which covers 53% of the American population.

Next, HuHu focuses on commercial insurance, which accounts for 53% of the total population. What organizations are there?

One is the Health Maintenance Organization (HMO). After the promulgation of the Health Maintenance Organization Law from 65438 to 0973, this organization developed rapidly. The premium of this insurance plan is relatively cheap, and the self-payment ratio of the insured is also low. The goal is to improve the overall health level of the insured and reduce medical expenses through health management. Compared with other insurance plans, health maintenance organizations provide more preventive services. The insured must choose a primary care doctor as a "gatekeeper" to be responsible for the diagnosis and treatment of common diseases and the necessary referral services. Insurance companies pay primary care doctors per head, which encourages doctors to improve the health level of contractors and reduce medical expenses, thus benefiting from the balance. Health maintenance organizations usually have their own network of doctors and hospitals. In non-emergency situations, the insured can only seek medical treatment online. If they go offline, the insurance company can refuse to pay the medical expenses.

Second, preferred supplier organization (PPO) is preferred. Preferably, the provider does not require the patient to sign up for the first-time doctor, and the insured person can directly seek medical treatment from a specialist. Although the preferred medical service provider also has its own network of doctors and hospitals, the insured can see a doctor outside the network, but must pay a high out-of-pocket fee (40%). Compared with health maintenance institutions, it provides institutions with more flexible management and control, as well as higher guarantee fees and out-of-pocket proportions. Generally speaking, the monthly premium of the preferred provider organization is twice that of HMO. The preferred provider organization also has loose control over doctors, and the payment rate is usually twice that of medical insurance.

The third is the point of service (POS). This is a form of insurance that combines the characteristics of health maintenance organizations and preferred providers. It has more medical options than health maintenance organizations, but its cost is also lower than the preferred provider. Designated service institutions also have their own medical service network, which requires the insured to choose the first doctor.

Let's use a picture to illustrate the difference between these insurance plans:

Health care organization (USA)

card reader

erythropoietin (EPO)

Polyphenylene Oxide (short for polyphenylene oxide)

Ask for an appointment with a family doctor

be

be

no

no

Suggest seeing a specialist.

be

be

no

no

Require prior approval

Generally, it is not necessary.

Usually not.

be

be

Reimbursement of out-of-network medical expenses

no

Yes (recommended by family doctor)

no

be

Insurance premium and cash expenditure

low

Low inside the network and high outside the network.

low

High, especially higher outside the net.

trait

The overall cost is low, and there are medical benefits such as exemption from annual physical examination.

With HMO's low premium advantage, it can also give members more independent choices.

Medical institutions in the network can enjoy the membership price.

Medical institutions in the network can enjoy the membership price.

I hope you can learn something about the American medical system through this article. It is strongly recommended that international students who have studied in the United States for more than a few months can learn more about the American medical system, the insurance institutions for international students, and the American medical insurance plan.