Source: Intro Music by Mark Hannan; Public Domain
Hello. Welcome to sociological studies. Thanks for tuning in. In this lesson, we're going to discuss paying for health care in the United States. This is a very complex system. I'm going to just give you the terms that are important in the context of this course, and those are direct fee systems, health maintenance organizations, and we're going to discuss the 2010 Health Care Reform.
For starters, direct fee systems are systems in which patients pay directly for medical services. So we have that here in this country. Obviously, when you're paying directly for medical care that you receive, this can be helped by insurance.
Insurance providers help pay some of the cost of health care under direct fee systems by paying portions. So you have then co-pays that help the insurance company then pay for your care. Of course, you can go in and get health care under a direct fee system without insurance, but you have to pay for the value of the services directly, and this is prohibitively expensive for some people. Health care then is exorbitantly expensive, which is why we had the 2010 Health Care Reform. It was health care reform aimed at trying to bring the cost of health care down and make it more affordable in this country.
Health care costs are getting so expensive and many people then are getting priced out of the health care market because they can't afford the treatment they need. So the 2010 Health Care Reform was an effort to bring these costs down. We have some of the best medical services in the world, but they're very, very expensive and not available to everyone. So we wanted to make them available to everyone. We wanted to make it so insurance companies couldn't exclude you if you had a preexisting condition.
So if I had diabetes, or something, I'm a very expensive patient for an insurance company so they might not want to take me on. Well, how ethical is that? So as a society then, do we want people who are sick to be able to be excluded based upon pre-existing conditions? Well, the 2010 Health Care Reform said, no. So the idea was more access to health care at a lower cost for everyone was the utopian goal of this reform. Of course, there's been much political contestation over the reform so has not been fully implemented for everyone as of 2012.
Finally, I'd like to shift gears and discuss HMOs, or health maintenance organizations. Health maintenance organizations are systems in which patients pay a monthly fee for comprehensive care that follows a specific treatment regime. So just like direct fee systems, you're paying for care, but yet there's a pre-established plan for treatment already laid out. So doctors and clinics then working with the HMO administrators agree to treat patients in a processed fashion in an effort to bring costs down.
So for example, if you come into the clinic with say a problem with your leg, you're having trouble walking and you might need like a steroid injection, or something. OK, you have that problem then the doctors have a step by step process that they have to treat you. Like, we can't give you that scan right away, because we've got to make sure it's not this first. We've got to make sure it's not this first, before we give you the scan and before we give you that steroid injection. So by doing this, before we get to that really expensive thing that you might need, we got to make sure it's not all this other stuff first. So by doing that then the idea is that it would bring the cost down.
Of course, there are criticisms of this model of health care because, well, what if they really that right away and they've got to go through all this other stuff anyway and it does cost money to do all these other tests. So does it really bring costs down? Are patients really happier? This is the debate. So as you can see, paying for health care in the United States is a very complex process, subject to political debates. But I've given you the basic terms necessary for understanding paying for health care within the context of this sociology course. Direct fee systems, 2010 Health Care Reform, and health maintenance organizations. Have a great rest of your day.
A health care reform in the US attempting to make health care affordable by reforming the system.
A system which has patients pay for medical services directly.
A prepaid health care plan in which a fee is paid in advance for all necessary health care.