In the world of healthcare there are many choices for individuals to consider when making sure needs are meet in order to get, the quality of healthcare necessary to stay healthy in the community. Depending on financial obstacles it can be at times very difficult to afford the proper care needed to provide quality healthcare for you and your family. With President Obama signing the Affordable Care Act, it is now a lot easier to obtain affordable healthcare options.
Also, under this act hospital facilities get rewarded for quality not quantity therefore, people do not have to be afraid that since they cannot afford expensive coverage, there will not be a lack of quality and they can feel confident that their needs will be met. Also, the act helps families that already have insurance coverage through their employer or private insurance companies such as Kaiser by providing tax credits of up to 2000 per family per year (ProCon. org).
The Affordable Healthcare Act also imposes heavy tax credits depending on household income which will really help more families stay healthy which in turn, is healthier for the community as a whole. This paper will strive to compare and contrast the personal healthcare choices of the writer with the choices of others in the community and determine the relative contribution to the demand for health care. Moreover, the degree of information asymmetry will be address as it relates to, personal asymmetry and how that asymmetry impacts the health care choices of the writer.
And finally, HMO, PPO, AND MCO will be explained as it relates to, how these types of coverage’s will benefit by having a person like the writer as a member. As stated earlier there are many health care choices out there to choose from however, having the ability to afford could pose a problem for some. In the writer’s individual case full coverage insurance is obtained through spouse’s job so there is not a problem with needed medical attention of any kind.
In looking at some of the health care options available there are several choices which include primary medical services such as a general practitioner, Gynecology, Psychiatry, Psychological Testing, Neurology, Gastroenterology, Physical Therapy, Podiatry, Pulmonolgy and Cardiology just to name a few. Other things to think about would for example, if you have a patient that is not of American decent. Within their health care choices are options for multilingual doctors, nurses, therapist and dentist to listen to your needs, concerns and preferences in order to, deliver the best possible care to you (ICL, 2011).
In the writer’s personal case she is very young in her thirties and in fairly good health therefore, the only healthcare choices that are used include the services of a primary care physician and Gynecologist. The primary care physician is seen about 1-2 times per year unless needed more often due to children being sick. The writer’s Gynecologist is not seen very often anymore only once a year for check-up however, in the past the use of a Gynecologist is more frequent when seen for pregnancy of three children.
The demand is fairly high for women in the writer’s situation who are married with children because there is a need to make sure families are healthy from birth and that in turn makes the demand for healthcare increase. For a neighbor of mine who has a daughter with special needs, her choices will be more involved than mine because her daughter would have to see a specialist regularly as well as a pediatrician and neurologist if necessary. Another example would be my mother who is in her 50’s and has to deal with more issues as women such as menopause.
Another issue in the writer’s family is tumors therefore, my mom has had to have a hysterectomy. Also about a year ago she was in a near fatal accident and since she has medical and the accident was not her fault she has the person who caused the accidents insurance as well. The health care choices for her are Physical Therapy, Plastic Surgery, Gastroenterology as well as, Gynecology and primary care physician. With all the health care choices available it becomes difficult in the moment to know what individual options they are out there for patients.
Informational asymmetry is another hurdle for patients when faced with emergency situations on who to trust and what answers are needed to get the best possible care in the moment. Asymmetry of information in referencing health care is a problem with the information available as well as the relationship between physician and patient. Most medical information is technically complex and so not easily understood by a layman and this is made worse by the fact that many illnesses do not repeat themselves, so that the cost of gaining the information is very high (The
Office of Health Economics, 2002). Most individuals are forced with the realization that with the information being of technical nature that the room for error could be very costly and lead to a bigger problem. The costs of a mistaken choice are much greater and less reversible than in other cases: in the worst situation if you make the wrong decision you will be dead. It is also often difficult to postpone treatment and so virtually impossible to shop around, and anyway how do you judge between different doctors’ opinions (The Office of Health Economic, 2002)?
The relationship aspect of asymmetry is also a relevant situation for patients to be concerned with. The asymmetry of information makes the relationship between patients and doctors rather different from the usual relationship between buyers and sellers. We rely upon our doctor to act in our best interests, to act as our agent. This means we are expecting our doctor to divide herself in half – on the one hand to act in our interests as the buyer of health care for us but on the other to act in her own interests as the seller of health care (The Office of Health Economics, 2002).
Asymmetry of information in health care is also a concern for health insurance because most decisions on health care are left up to the employee whose background has nothing to do with health care in majority cases. Employees have to be well informed about their coverage options in order to, make competent decisions about their families health care. There is a gap between the consumer (patient) and the professionals (physician and nurses) that needs to be closed so that everyone involved feels safe in their decisions.
Because of this gap, understanding and interpreting performance metrics of physicians, hospitals, and health plans can be difficult (Retchin, 2007). Healthcare metrics for making choices about price and volume are especially complicated by imprecise risk adjustment, the relative infrequency of meaningful outcomes, and the broad range of performance domains. Even when these challenges can be addressed, appropriate data often are unavailable (Retchin, 2007). For example, there is evidence that the poor, the elderly, and those with multiple co morbidities all have lower health literacy rates.
Further, health literacy deficits have been associated with worse healthcare outcomes, such as in diabetes mellitus. Thus, it is not surprising that adult literacy has been shown to be a major factor in explaining health disparities among low-income, under-represented minorities (Retchin, 2007). In looking at personal obstacles for asymmetry there are not a lot of problems when an individual is of a younger age. The important concept to adjust to is asking questions and making sure the physician is explaining everything in a why that is clearly understood.
If the understanding is not there simply ask the physician to explain again as long as it takes for the information and process to be clear. HMO’s commonly known as health maintenance organizations, require the patient to use only network providers. HMO’s require that you appoint a primary care physician who will coordinate appointed primary physicians. These physicians will is responsible for managing and coordinating your whole health care (About. com, 2011). The primary care will serve as your personal doctor to provide all of your basic healthcare services.
PCPs include internal medicine physicians, family physicians, and in some HMOs, gynecologists who provide basic healthcare for women. For your children, you can select a pediatrician or a family physician to be their PCP (About. com, 2011). If you need care from a physician specialist in the network or a diagnostic service such as a lab test or x-ray, your primary care physician (PCP) will have to provide you with a referral. If you do not have a referral or you choose to go to a doctor outside of your HMO’s network, you will most likely have to pay all or most of the cost for that care (About. com, 2011).
PPO’s commonly known as preferred provider organizations, is a health plan that has contracts with a network of “preferred” providers from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network (About. com, 2011). If you receive your care from a doctor in the preferred network you will only be responsible for your annual deductable (a feature of some PPOs) and a copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going “out-of-network”) you will pay a higher amount.
And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed (About. com, 2011). An MCO, commonly known as managed care organization is a health care provider or group of medical service providers who contracts with insurers or self-insured employers to provide a wide variety of managed health care services to enrolled workers through participating panel providers (Oregan. gov, 2011).
In my case the health care industry would most benefit by having me in their network as a PPO. The easoning would be because I have such a larger family and collectively we go about 5-10 times a year to pediatricians and primary care physicians and on occasion the emergency room. Our co pays are normally twenty dollars per visit and emergency room visits are one hundred dollars. So if you take this information into consideration we are spending about two hundred dollars in co pay that is not to mention that each time we go depending on the service provided can range from one hundred to two hundred dollars in doctor’s fees per visit.
In conclusion, there is an array of health care choices out there for individuals to take advantage. Cost becomes a driving factor in many individual decisions on how much to contribute to their individual health care needs. It is impossible to compare and contrast all members of the society but an idea can be given as to the complexity of the issue. Individual health plans can be HMO, PPO or MCO and it is up to the individual and their family to decide what is the best plan as a whole.
Moreover, when discussing health care choices and health plans asymmetry of information becomes an issue for individuals because of the gap between the patient and the physicians. The patient has to have the competences to make informed decisions moreover, the physician has to be able to explain the technical information in a non-technical way so all parties feel comfortable with the decisions that are made.