Talk:Health insurance

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Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): Ala008, Stc0148, Alanchan49, Isunwoo, Margaret.yang.2021. Peer reviewers: Nathan.koreie, Joe.Li2019.

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Request for more input

This article needs some more input from economists. It sounds like it's written by an arts student :)—The preceding unsigned comment was added by Psychobabble (talk • contribs) 10:09, 1 October 2004 (UTC).

why the hell this page has stuff about health insurance in the US , well othere countries have it you know and you shouldn't talk about the health inusrance in the US and not mention other countries , and it shouldn't have given that much space

Recent added material

Hi, some of the added material by 67.150.9.250 had some merit, but other parts of it were so patently bad that I reverted. Please discuss some of that material here before re-adding it and try to have a factual basis and some references to back up the material you add. - Taxman 03:43, Nov 5, 2004 (UTC)

While this is a very difficult subject, the acticle does seem to be in need of a rewrite. I have begun this rewrite. After you (that is, anyone) reads it, a would welcome comments. Johnwhunt 19:15, 7 Mar 2005 (UTC)

Okay, so I chickened out and made no changes. I still think the entire thing needs a rewrite. In fact, I suggest redcing the material under the subject heading "health insurance" and moving the bulk of this material to "health care costs". That latter topic could then include the pros and cons of private v. public and related issues. Johnwhunt 21:45, 7 Mar 2005 (UTC)

Well I agree it does need a lot of changes. It just hasn't made it high on my priority list. I only know a lot about health care in the US, so it would be difficult for me to properly fix the article. Its obviously one that attracts a strong POV. Private v public is a key part of the health insurnce issue, so it shouldn't be moved entirely out. In any case, feel free to make what changes will obviously help, try to discuss contentious ones here, and do as much research as you can and cite good sources. - Taxman 13:13, Mar 8, 2005 (UTC)

Hi. It seems to me that much of this health insurance article is pro public health insurance bias. Look how much there is written in Common complaints of private insurance (alot) versus Common complaints of publicly funded medicine (a little).—The preceding unsigned comment was added by 67.150.43.158 (talk • contribs) 08:29, 11 April 2005 (UTC).

Hi, I would like to make some changes to the first part of the health insurance article. I corrected some syntax, mispellings and created a more balanced viewpoint with additional material. The rewritten article is below. Please comment. Jmcmeans—The preceding unsigned comment was added by 69.55.161.153 (talk • contribs) 19:32, 26 April 2005 (UTC).

I don't know about anybody else, but I can't easily parse the changes just from what is below. Why not just make the changes and let the software show us the diffs. Then we can discuss and change or keep what is agreed on. Also, why not create and account so it is easier to respond to you and track your edits. Then you can sign your comments by typing ~~~~ to add your username and the time of the edit. - Taxman 02:33, Apr 28, 2005 (UTC)

Private health insurance

Health insurance is one of the most controversial forms of insurance because of the conflict between the need for the insurance company to remain solvent versus the need of its customers to remain healthy, which many view as a basic human right. This conflict of interest is why state and federal regulation of health insurance companies is so important. Some say this conflict exists in a liberal healthcare system because of the unpredictability of how patients respond to medical treatment. But too many health insurance companies put the need for high profits before the lives of their customers.

Here is a hypothetical example of a situation that might confront an insurance company:

Suppose a large number of customers of a particular insurance company contracted a rare disease and the hospital charged 10 million dollars a patient. The insurance company would be faced with the choice of either charging all its future customers astronomical contributions (thus losing customers and going out of business), paying all claims without complaint (thus going out of business) or fighting the customers in an attempt to deny the costly treatment (thus outraging patients and their families and forcing them into bankruptcy, and becoming a target for lawsuits and legislation).

Of course, the insurance company has voluntarily signed a valid, legal and binding contract, the insurance policy, and thus should pay all valid customer claims without question.

Because health insurance companies are in the money business, not the health care business, they tend to be paranoid that their customers are out to take advantage of them. The companies fear that the customers will unfairly get some benefits they are not entitled to or engage in risky behavior that an otherwise sane person without health insurance would not engage in. For example, health insurance companies say there are faced with several unique economic problems with private health insurance. Asymmetry of information about a persons health and behaviour is likely to lead to adverse selection and moral hazard. Health insurance companies say that, in essence, those seeking health insurance are likely to be those with existing medical problems or high likelihood of future medical problems and those who take out insurance may engage in risky behaviour, such as smoking and excessive alcohol consumption, which they otherwise would not. If true, these problems may lead to 'good' insurance risks being priced out of the market or even insurance being uneconomical to provide.

However, most individuals who buy health insurance do so in order to ensure that their family will be able to afford medical care if they need it, knowing that without insurance, they probably will not be able to pay for expensive hospital care or life saving prescription drugs, which could threaten their financial or physical health.

Insurance companies say that with publicly funded health insurance the good and the bad risks are all included in the coverage and the same moral hazard applies.

Health insurance companies in the United States have steered their business model away from the concept of "risk sharing," (offering policies to as many people as possible) to the concept of "risk avoidance." (refusing to offer policies to the sick, the elderly and those who might get sick) These companies emphasize that every risk must subsidize the unhealthy, and those that take care of their health have no opportunity to avoid this subsidization. But disease is no respecter of persons. Even a healthy individual who exercises and eats a perfect diet can fall victim to a life threatening microbe, an environmentally induced cancer, or suffer serious injury in an accident. That's why everyone, including healthy people, needs health insurance, and why individuals need a comprehensive health insurance plan that covers all contingencies.

Insurance companies say that, in general, if many sick people buy health insurance from a private health insurance company, but few healthy people buy it, the price of the insurance rises. However, in reality, few sick people are able to buy health insurance. Insurance companies also say, that, if many healthy people buy health insurance, but few sick people buy it, the price drops. In other words, the price drops if more money is going into the insurance, and less is being paid out. In reality, only healthy people are allowed to buy health insurance, but the price of insurance still rises by ten percent or more each year.

Some people argue that most healthy people don't buy health insurance because they don't need it, so the price tends to stay high. But, 80-90% of Americans do buy or obtain health insurance, either through their employer or as individuals, because they realize that they cannot afford the high cost of hospital care, which can amount to as much as $10,000 a day. Because of advanced medicine, people are living longer and longer, creating a larger group of senior citizens who require more pay outs than the young (a similar effect is seen in Social Security). This also increases the price of health insurance. Some factors that raise health insurance premium prices are: people who don't exercise, eating junk food, shortage of doctors in proportion to population size, excessive alcohol use, smoking, street drugs, obesity, the modern sedentary lifestyle, and the large number of semi-fraudulent health insurance companies exploiting small businesses and the self employed. The opposites of these (exercise, eating healthy food, less addictions, non-profit community based health insurance providers, etc.) lowers health insurance prices, because healthier lifestyles protect the body from disease, and with fewer diseases, fewer doctor bills must be paid by the health insurance companies. The savings are passed on to the customer, paid out in generous salaries to company executives, or retained as profits by the health insurance company.

A person who buys health insurance must fill out a form that asks about the person's medical history, whether that person is a smoker, how much the person weighs, etc. The applicant can get discounts if he lives a healthy lifestyle. This incentive may encourage some people to live a healthier lifestyle. Unfortunately, this medical history is also used as a tool to deny coverage to many individuals with pre-existing conditions.—The preceding unsigned comment was added by 69.55.161.153 (talk • contribs) 19:32, 26 April 2005 (UTC).

Changes

Hi,I have made the changes to the article. What I ended up with is slightly different than what I submitted below. I welcome your input. I tried to maintain the core and format of the orginal article. I thought that the original article only gave the insurance industry point of view, so I retained that and added the health insurance reformers or consumers point of view. I didn't want to get too technical or statistically, is that a word?, since this is a general interest encyclopedia. I learned about the wik from an article in the Atlanta Journal Constitution. April 17. I have created an account. Since I'm new, I'm not sure about procedures, so feel free to tell me if I mess up.

Jim—The preceding unsigned comment was added by 69.55.161.151 (talk • contribs) 02:54, 29 April 2005 (UTC).

Removed from article, etc.

In addition to other changes, I removed the following paragraph from the article:

Consumer advocates say that health insurance companies have adopted a business model of "risk avoidance" (refusing to offer policies to the sick, the elderly and those who might get sick) rather than the traditional insurance concept of "risk sharing" (offering policies to as many people as possible to mitigate individual risk, i.e., a Universal Pool). Insurance companies say that in Universal Pools, healthy policyholders must subsidize the unhealthy, and that those who take care of their health can pay lower premiums if they are given the opportunity to avoid this subsidization. Consumer advocates say that risk sharing or cross subsidies between classes of people like the sick and healthy and the young and elderly are what constitutes the very definition of health insurance. Consumer advocates say the young and healthy need to remember that one day they could well be older and sicker.

Just who says that "risk sharing" as opposed to "risk avoidance" is the traditional insurance concept? "Risk sharing" doesn't seem like something that people with different levels of risk would do voluntarily.

Generally, this article has way too much of a "point-counterpoint" style of writing. It also relies much too heavily on the term "consumer advocates". "Consumer advocate" is a title that could reasonably be claimed by almost anyone who is not actually in the industry, or their dependents and loved ones; something more precise would be good. Other changes, in addition to what's in my edit summaries:

• I took out "But consumer advocates say that only healthy people are allowed to buy health insurance, but the price of insurance still rises by ten percent or more almost every year." This is actually a different argument that doesn't follow from the preceding paragraph. Industry people and people familiar with economics argue that such-and-such makes the price higher or lower than it otherwise would be.
• I added a couple specifications where we are talking about developed countries specifically; some parts had something of a geographic bias.
• I took out a couple instances "unfortunately" or the like, for NPOV purposes.

- Nat Krause 10:48, 25 Jun 2005 (UTC)

Consumer advocates

As noted by Nat Krause, the term "consumer advocates" is vague to whom it actually refers. I may also make some similar changes to those sentences in which it appears. AED 9 July 2005 05:40 (UTC)

Liberal healthcare system

The third sentence in the Private health insurance section states: Some say that this conflict exists in a liberal healthcare system because of the unpredictability of how patients respond to medical treatment. Liberal healthcare system redirects to healthcare system leaving me wondering what the "liberal" adjective is supposed to mean in this context. Can anyone rephrase that sentence to make it make sense? AED 9 July 2005 05:40 (UTC)

Private healthcare insurance

I'm a bit confused as to what the Private healthcare insurance section is to discuss. A great deal of the information in the section is duplicated in the Common complaints of private insurance section. Should the criticisms in the former be moved to the latter? AED 9 July 2005 06:06 (UTC)

Statistics

Is there a place in this article to mention that as of 1998, 44.3 million Americans do not have health insurance?—The preceding unsigned comment was added by Adc718 (talk • contribs) 05:21, 17 December 2005 (UTC).

According to the article, 85% of Americans have health insurance. So it's already there; 15% of 300 million is 45 million. Kafziel 15:32, 23 January 2006 (UTC)

It is important to break down the 47+ million uninsured by the reason for lack of coverage to give perspective on this figure. According to the US Census 20 million of the uninsured are college age childen and those making $75k+/year who choose not to take insurance. 11 million are eligible for Medicaid or SCHIP but have failed to enroll. 10 million are not US citizens. That leaves 10-15 million long term truly uninsured Americans.Aecooper (talk) 18:57, 29 June 2009 (UTC)

"Socialism"??

Because publicly funded medicine is a form of socialism.

Give me a break. Just because something is publicly funded doesn't make it socialist. Socialism means the state *OWNS* the means of production, as well as *FUNDS* the production itself. By this reasoning, almost everything in the United States is a form of socialism because it's supported by taxpayer dollars. 198.59.188.232 15:07, 6 April 2006 (UTC)

The claim that many parts of our economy has socialist elements, i.e. employer provided benefits get tax benefits (pensions and health care premiums) is not necessarily a dirty word. In addition Judge Janice Rogers Brown has called our New Deal consensus as socialistic. It is to some degree. Other parts of the society are more laissez faire.John wesley 15:34, 6 April 2006 (UTC)

I added a capitalism section to the private health care part. 169.232.94.217

Employer Based Insurance

This whole article treats health isurance as if it is a choice between individually purchased health insurance and government-funded insurance. However, the vast majority of health insurance in this country is employer-funded. This is critical to the debate for several reasons:

1. The bigger the employer, the less underwriting goes into identifying bad risks among the employees.

2. Small business insurers (2-50 employees) are currently highly regulated by all 50 states. These laws restrict how much insurers can charge due to unhealthy members. All policies are guaranteed to be renewable, and the increases are restricted.

3. The ex-post moral hazard costs are higher, since the employee generally only pays 20% of the premiums, while the employer pays 80% of the premium.

4. The statement above is no longer true; employers choose how much they are willing to pay for an employee and their dependents. In most cases, 50% is the minimum for employees and 0% for dependents.

5. Employees and Employers can write off their portion of premium (tax deductible) with the use of Section 125 of the IRS tax laws. —Preceding unsigned comment added by 76.86.94.77 (talk) 07:12, 19 September 2007 (UTC)

Toonces 20:01, 17 April 2006 (UTC)

–Not to mention that it incorrectly states that employees pay taxes on health insurance premiums. Sonria 00:55, 17 September 2006 (UTC)

History and evolution section

I removed a reference to the industrial revolution. I don't think anyone say that the industrial revolution 'matured' during the late 20th century. I hope no one objects. Also, this sentance: 'This payment model continued until the start of the 21st century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.' is a little obscure. Are we trying to say that the "disability" payment model still existed in california, or that the law still referenced disability rather than health insurance. I would assume it's the latter, but as I don't live in Cali I don't know. 69.207.22.219 19:11, 15 June 2006 (UTC)

History and Evolution Question

The linked Pinky Show at the bottom of the article mentions that the real historical reason for the divergence of the American system away from other industrialized countries was the incentive scheme devised by employers during the second world war as a way to attract scarce workers. It's hard to really identify a cohort nation for comparison -- the best example seems to be Canada, since it didn't suffer invasion during the war. Britain might be a close second. Both of these nations' economies must have experienced the same difficulties of a constrained labour force during wartime, but neither evolved a significant private health insurance system. Perhaps this is more of a political question, but I would be interested in references to material that discusses this history, sociology, and political science in more detail. —The preceding unsigned comment was added by 69.119.92.25 (talk) 23:10, 7 January 2007 (UTC).

Health insurance in the world or health insurance in the USA

Hey, When i looked up this article i was looking up information about health insurance in the united states. Almost all the information there was indeed about united states. Only then, lower in the article i noticed that there is a "main" article for Health care in the United States. As such that means that the article is about USA, USA, and two lines about other countries.

I think in this article should be general information about health insurance, it's origins, and maybe a short comparison of differences between the countries (in Netherlands, where i am from, the basic (mandatory) health insurance covers all the costs of hospitals, GP, and all prescription medication, while in USA that's not the case). Right now the article is not very balanced.

It would be nice if someone could do it.. Otherwise i'll begin moving stuff around :)

Robert 19:24, 24 February 2007 (UTC)

Resources

I am employed by a United States health insurance company, so I will not be editing the article, but if anyone has any questions I might be able to answer, I would be happy to contribute. Just ask. I do watch this page, so posting here should catch me. Slavlin 19:35, 28 March 2007 (UTC)

There is no reason you should not edit this article provided you give citations and avoid POV and OR ... this article needs a lot of work ... it is very US centric. :) Abtract 23:08, 1 May 2007 (UTC)

Proposed merger of Health plan

(start proposal for merge into Health care) I suggest Health plan be merged with this article. If you read both articles, you can see that "Health plan" is but just another name for "Health care," and both entries hold virtually the same information. --I Are Scientists 21:26, 12 April 2007 (UTC)

• Against - these are two quite distinct things: health care concerns the provision of various services designed to improve the health of a population, whereas health plan is an insurance based method of paying for individual treatment. As you will see, if you look at Health insurance, there is quite a lot to say about this subject which is not suitable for the article Health care. If you wanted to propose that Health plan be merged with Health insurance, I would agree instantly. Abtract 09:51, 17 April 2007 (UTC)

• Against and I've changed the merger proposal on Health plan to point to Health insurance. I'll copy the discussion so far into Talk:Health insurance. Canuckle 19:06, 20 July 2007 (UTC)

(end proposal for merge into Health care, relist in Talk:Health insurance) Canuckle 19:06, 20 July 2007 (UTC)

• Agree - makes complete sense, a health plan is another name for health insurance. Abtract 19:45, 20 July 2007 (UTC)

• Against - In the U.S. there is a big difference between health plan and insurance. A health plan can be sold without regulation, and we've had record numbers of 'health plans' sold to many people and the last few years, who consider it to be the equivalent of insurance, as documented by the U.S. General Accounting Office. There is strict state and federal regulation of insurance, but not plans. With that said, many health insurers refer to their products as health plans. But other unscrupulous entities tend to confuse the issue, selling sham insurance and other "plan" products that are little more than Ponzi schemes. See NAIC.org (National Association of Insurance Commissioners) a U.S. based organization for more details of scams. I think that merging Health Insurance and Health Plan would help the scams to perpetuate. Perhaps a cleanup of Health Plan, Health Insurance, and appropriate splitting of topics would be beneficial? Personalfinancewriter 15:34, 15 August 2007 (UTC)

• Against - In the U.S. there's also a historic difference between commercial health insurance, Blue Cross Blue Shield organizations, and Health Maintenance Organizations. While some of the differences are definitely blurring, they haven't completely disappeared - especially in the terminology used. "Health Plan" is a term that's historically associated with HMOs (and more recently with other forms of network based health coverage, such as PPOs). "Health Insurance" and "Health Coverage" are becoming the more general terms these days. Historically, health insurance was some form of fee-for-service coverage provided by a commercial insurance company; Blue-Cross & Blue-Shield plans were described as pre-paid service benefit plans; it was the HMO world where Health Plan became the more common term.

• The point's also well taken about hte various non-insurance, non-HMO programs out there, such as self-funded MEWAs and discount-only plans.

• • • • Agree** When referring to health insurance the organization typically refers to themselves as the "health plan" I understand various organizations attempt to muddy the waters by referring to themselves are health plans, but giving a clear explanation of what health insurance is and what isn't considered insurance (not by use of jargon) provides the clarifying aspect to allow the reader to determine if they are coming in contact with a non-insurance offering. — Preceding unsigned comment added by 50.140.114.75 (talk) 03:44, 28 July 2013 (UTC)

Something to check out - State medical coverage is not portable across state boundaries.

In the U.S., for most policies if you are covered in California (as an example, it's apparently like this for every state), you're not necessarily covered in Nevada, Oregon or Arizona. You're usually not covered at all if you go to Mexico. Definitely not covered at all anywhere else by an HMO.

Wouldn't that be a wonderful discovery to make? Go to Las Vegas and get sick or hurt, and you'll wish you'd been killed when you get the medical bill and discover that insurance you've been paying for all your life won't pay a penny of it.

You can't seem to get a comprehensive policy with nation-wide coverage for the U.S. At least I can't find one, and I'm pretty good at web searches. It only goes state by state, with at best exclusions and reductions of coverage when you go out of your home state, and usually no coverage at all outside of the country. There are 'global' insurance policies with international coverage, but so far I've only found policies that specialize for short term international travel.

Something to think about before you visit family out of state.

Evildave 17:50, 7 September 2007 (UTC)

Actually, HMO's routinely extend emergency coverage for out of area treatment, including over sea's treatment. Also, if coordinated with your primary care physician, most of the major companies will authorize providers outside of your normal area if needed while traveling. I actually work for an international insurance company based in the US and those provisions are written in all of our plans. A client paying the claims with their own money, or a "self funded" plan, would have to specifically request that something like this be excluded. Also, there are federal limits on what can be excluded for ER services. Slavlin 01:53, 8 September 2007 (UTC)

The problem is defining what is an 'emergency'. What's debilitating and painful now that prevents you from traveling all the way home for treatment might not be covered at all. You may have gone into an ER for treatment, but the insurance company can decide AT THEIR DISCRETION that whatever sent you scurrying to the ER wasn't a 'real emergency' after the fact, and neither was any surgery, diagnostics or hospital stay to fix or observe the problem that got you there in absolute agony and wondering if you were going to die. At BEST, you're "covered", in that they reduce what they pay to a fraction of your normal coverage and massively increase or eliminate any out of pocket maximums, so even if you're "covered", you're 'only' thousands in the hole for having the poor sense to ever leave your home 'in network' area. Now either lawyers have to get involved and you spend the next ten years of your life in court racking up legal fees that you might also have to pay if you lose, or you pay up, or you join the teeming ranks of the people who declare bankruptcy because of medical expenses. Evildave 18:25, 10 September 2007 (UTC)

Again, you are wrong here. With an HMO product, the definition of an emergency is based on a legal definition, not defined by the insurance company. Check in with the Department of Insurance, except for California, it is the department of Corporations there. They can confirm this. Slavlin 18:50, 11 September 2007 (UTC)

Actually, in CA, HMOs are now regulated by the Department of Managed Health Care (DMHC). Fully-insured PPOs are regulated by the Department of Insurance. But you're right about the history, it did used to be the DOC. Kelsied 07:15, 11 October 2007 (UTC)

This is an important topic, and it raises some distinctions between the various types of health coverage that should be discussed somewhere. Plans that are based on provider networks are restricted to providing most services within the area of their network. HMOs tend to be the most tightly tied to a local network. PPO networks are often - but not always - broader. The reason is that most PPO network physicians aren't capitated - they're just based on discounted fees. That means that enrollees don't have to be tied to a particular provider. It's not uncommon for a health plan to "rent" networks to expand their service area. Some large health insurers have essentially national PPO networks, and others, such as the Blue Cross and Blue Shield plans, may have reciprocity agreements with other PPO networks. But bottom line, when a network-based plan pays for services from a non-network provider, they're paying retail rather than discounted fees - so they only do it in cases of emergency or when the necessary care isn't available within the network.

Plans that aren't based on a network - and there are a few of them left - can provide coverage anywhere. They will still be licensed for sale within particular states, since insurance is regulated at the state level. But if you get a fee-for-service indemnity plan (perhaps a high-deductible catastrophic plan) it can provide coverage anywhere. But, you won't get any of the benefits of a provider network.

My sense is that the different types of health coverage aren't described well. This article might be a good place to define each of them, with links to subarticles that describe them in more detail. That's going to take a lot of work, though - and may not be easy, because the lines between them blur as plans come up with all sorts of hybrid approaches in an attempt to gain a competitive advantage. —Preceding unsigned comment added by 146.145.79.247 (talk) 15:09, 8 October 2007 (UTC)

I think you're right, that this page would benefit from an approach that defines health insurance generally, and then branches off into linked pages that provide more detailed explanations of each type of plan. As for how long it will take... well, expect to hear a lot from me for a while! One or two changes per day will stack up over time.  :) Kelsied 04:24, 13 October 2007 (UTC)

Government Insurance

In paragraph 1, I am confused by the statement "Governmental agencies may offer health plans, but generally are not insuring anything..."

As far as I'm aware, the insurance model is based on the following foundational concepts:

• Any individual may experience significant costs if they get very sick or badly injured.

• In a large population, the number of people who will get very sick or badly injured during a given time period is relatively limited, compared with the number of people who will be healthy during that same time period.

• We can predict fairly reliably how many people in a large group will be (for example) struck by lightning. We cannot reliably predict which individual in that group will be the one who is struck by lightning in three months.

• By pooling together money to help cover the costs for people who get sick or injured, the group as a whole can pay for expensive health care treatments, while each individual within the group pays relatively little. This helps to protect each individual from having to pay sudden, largely unpredictable, and potentially very expensive health care bills.

• Because anybody can become sick or injured at any time, everybody benefits, because they know that if they get sick or injured, the group as a whole will pay for them, just the same as anybody else.

So, based on that understanding, even government-sponsored healthcare coverage is still insurance, albeit of an extremely specialized type. It is still funded by people pooling their money together (in the form of taxes) in order to spread the cost of unexpected health expenses across the entire population, so that people can afford to get the health care treatment that they need.

Is there a more limited definition of insurance that people are using here? -- Kelsied 01:12, 12 October 2007 (UTC)

Right. I've had a shot at clarifying this a bit. See if y'all think it's generally on point. I need to take a break & handle some stuff around the house, but I'll provide my references in a little while, never fear!  :) Kelsied 23:16, 13 October 2007 (UTC)

Moral Hazard in Government-sponsored Healthcare

So the article presently seems to indicate that moral hazard is a problem specific to privately-offered healthcare. I'm a bit new to the particular arguments around moral hazard, being more on the employer-purchasing side as far as experience goes. But looking at the argument logically, it seems like this is a problem that (rooted in human psychology as it is) would affect any insurance program, regardless of whether it is private or government-sponsored. Can anyone help clarify this for me? Kelsied 21:36, 13 October 2007 (UTC)

Government Insurance vs. Mandatory Participation

I also note that I think we are confusing "government-sponsored" with "mandatory participation" in some cases. I'm still thinking about how to clarify that -- it's made more confusing by recent trends in the US, where they're starting to require people to have SOME health insurance, but not health insurance through a specific program. So health coverage is mandatory, but health coverage in a specific plan (such as a European-model centralized government-sponsored plan) is not mandatory. Kelsied 21:36, 13 October 2007 (UTC)

Medicare

How have we written an entire section on US healthcare and neglected to include any mention of Medicare or Medicaid?  :) What an oversight! Kelsied 21:36, 13 October 2007 (UTC)

History of Disability & Health Insurance

"In the late 19th century, "accident insurance" began to be available, which operated much like modern disability insurance.[1]. This payment model continued until the start of the 20th century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance.[2] "

The citation for disability insurance continuing until the start of the 20th century looks like individual research. Moreover, this seems to imply that disability is no longer available, which is false. The whole history section is a bit light & could use some revisiting... Kelsied 22:39, 13 October 2007 (UTC)

Frequency of Health Insurance Types: private vs. government-sponsored

I'm concerned about the assertion that private insurance is more common than government-sponsored insurance. That is true only in the United States, which is one of the last remaining industrialized nations that doesn't offer government-sponsored health coverage. As this is a general topic, we should be careful to reflect international trends, instead of being limited by what is common in the US. Kelsied 00:17, 14 October 2007 (UTC)

Afterthought: Even in the US, Government-sponsored health coverage is exceedingly common, particularly via the Medicare and Medicaid programs. So I think the assertion that private insurance is "most" common is really very questionable. —Preceding unsigned comment added by Kelsied (talk • contribs) 00:19, 14 October 2007 (UTC)

I think your concern is related to the need to globalize the perspective of the entire article. If so, then the lead needs a few additional sentences, after "Market-based health care systems such as that in the United States rely heavily on private and not-for-profit health insurance." We should attempt to summarize how the term applies in other countries, but this is very hard to generalize. For example, it's my understanding that in some countries, the term "insurance" is frequently used only to refer to private supplements to the public health care system, but the public system itself is not called insurance. If the usage of the term "insurance" is not universal, and I think it's not, then there should be a summary of the points of controversy in the lead. Some use the term "social insurance" versus "actuarial insurance" -- see this article by Malcolm Gladwell. --Sfmammamia 23:53, 14 October 2007 (UTC)

Thanks, that's useful to know; I hadn't previously heard that distinction explicitly made. (I'll take a look at the article... sounds useful.) Is that something you feel up to addressing? You sound like you've got a pretty good handle on the issue. And yes, I agree the entire article could do with some work as far as globalizing it. Unfortunately, I'd personally have to do some fairly serious from-scratch research, as I'm not as familiar with the international field as with trends in the US. Comprehensive edits of that nature are consequently taking a bit of a back seat for me, while I work on the stuff I know more about... Eh, simply to say, feel free to keep me honest!  :) Kelsied 04:43, 15 October 2007 (UTC)

For what it's worth, the actuarial profession in the U.S. tends to distinguish between "Social Insurance" and "Private" or "Commercial" insurance ("Social Insurance" is a universally recognized term - it's the use choice between the terms "private" and "commercial" that varies - though I have seen "Public" versus "non-Public," but that's usually been among policy wonks). The U.S. Actuarial Standards Board has a separate standard of practice for Social Insurance [1]. It has a four-pronged definition of social insurance programs, defining them as programs that are: a) defined by statue; b) provides for explicit accountability of benefits and funding; c) funded by contributions (taxes or premiums) by or on behalf of participants; and d) are compulsory for a defined population, or is heavily enough subsidized that most eligible individuals choose to participate. —Preceding unsigned comment added by 146.145.79.247 (talk) 16:03, 21 November 2007 (UTC)

Canadian "medicare"

There's nothing in Canada known formally as "medicare". That's a term borrowed from our American friends, and increasingly out of favour. We usually just say either "health insurance" or use the formal name, which is different in each province (Nova Scotia has "MSI", Quebec has "RAMQ", Ontario has "OHIP", etc.) —Preceding unsigned comment added by 70.55.52.130 (talk) 21:06, 6 November 2007 (UTC)

The official page on the Health Canada website appears to disagree with you. --Sfmammamia 00:12, 7 November 2007 (UTC)

Again, there is nothing officially called "medicare", even in that link. That people sometimes or even often call it "medicare" doesn't make it so. —Preceding unsigned comment added by 70.55.59.64 (talk) 21:36, 8 November 2007 (UTC)

I made a slight wording change in this article, indicating that the name is informal. This is in keeping with other articles on Wikipedia that reference Canada's health care system. --Sfmammamia 22:19, 8 November 2007 (UTC)

Canadian care

The references to Canadian care being totally "government run" are inaccurate.

Canada has a largely government funded health care system that is mostly delivered in a private manner. Doctors are not government employees, and thus they bill individual provincial public insurance programs for individual services. If the doctor treats non-residents, he bills the private insurance or individual directly if necessary.

The section on Canadian health care needs to be edited so that it does not have such inaccurate statements. —Preceding unsigned comment added by 71.59.219.3 (talk) 05:33, 27 December 2007 (UTC)

I see nothing in this particular article that implies that Canadian health care is totally government run. The paragraph deals specifically with insurance, and to my knowledge it's quite neutral and accurate. If you see something specific in this article that you think is inaccurate, please feel free to point it out here or make a bold edit. --Sfmammamia (talk) 18:57, 27 December 2007 (UTC)

Should This Be Split?

This article is getting quite long, and much of the discussion is focused on the U.S. Would it make sense to move most of the U.S. material into an article called "Health Insurance in the United State" or (perhaps better yet, since things like Medicaid aren't technically insurance) "Health Benefits in the United States." We could then leave a summary paragraph here that would be about the same length as the ones on Canada and Australia. It might look something like:

Health benefits in the United States are provided through a mix of public and private programs. Public programs provide the primary source of coverage for most seniors and for low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, which is a social insurance program for seniors and certain disabled individuals, Medicaid, which serves certain very low income children and their families, and SCHIP which serves certain children and families that do not qualify for Medicaid but who cannot afford private coverage. Private insurance is the primary source of coverage for non-elderly, non-poor Americans. While individually purchased health insurance are available, most Americans with private coverage obtain it through an employer-sponsored program.

According to the United States Census Bureau, approximately 84% of Americans have health insurance. Some 60% obtain health insurance through an employer, about 9% purchase it directly, and various government agencies provide coverage to about 27% of Americans (there is some overlap in these figures). In 2006, there were 47 million people in the U.S. (16 percent of the population) who were without health insurance for at least part of that year. About 37% of the uninsured live in households with an income over $50,000. Health insurers have a significant economic impact as employers - in 2004 they directly employed almost 470,000 people at an average salary of $61,409.

That's just intended to give an idea what a summary might look like - it would need a LOT more work. I do think something along these lines would make this article feel more balanced, and the new article on health coverage or health insurance in the U.S. would feel a bit less cluttered. We'd need to adjust a lot of links, though - many of the current links to "health insurance" would need to be changed to link to the new article. —Preceding unsigned comment added by 146.145.79.247 (talk) 17:33, 7 January 2008 (UTC)

I'm going to add a splitsection template suggesting that the U.S. section be split into its own article. This article is now getting too long -- it's about 47K in readable prose, and the U.S. section is just too big for this article. Some of the subsections that have been added in the U.S. public section seem to me unnecessary and repetitive -- why do we need a single-sentence section on the Indian Health Service when it has already been mentioned and linked? That said, I think the split article's title should be Health insurance in the United States, and if public programs don't quite fit that defnition, any detail there should be moved to the main article, Health care in the United States. I've recently refactored the overview portion of the U.S. section in this article -- I think what's there now would be adequate for this article if the rest of the detail goes to a split. --Sfmammamia (talk) 20:13, 18 January 2008 (UTC)

Thanks for adding the splitsection template - I really do think that's the right direction to go. I'd like to suggest that we really do think hard about whether we need a "Health Insurance in the United States" article, or a "Health Coverage in the United States" article. There is an important technical distinction between insurance (including social insurance such as Medicare) and welfare benefit programs like Medicaid - but when people talk about "health insurance" in everyday conversation (or in a stump speech in a presidential campaign), they're usually really talking about any kind of health benefit program (including things like Medicaid and S-CHIP). A good example would be the Census Bureau statistics everyone throws around on the number of "uninsured" Americans - people with Medicaid aren't considered "uninsured." If I were "bold" I _think_ I'd split this stuff out and make a "Health Insurance in the United States" article, then in the summary talk about the usage and explain that it's commonly used in a broad sense to include any form of primary health benefit plan or health care coverage, including welfare benefit plans and self-funded employer plans. One reason is that I'm convinced that there should be one place that gives an overview of all the different sources of health care coverage and provides links to the detailed articles on each. The "Health Care in the United States" article doesn't look like the right place to me, because it sweeps in much broader health topics dealing with health care providers, such as EMTALA. That would seem to me an appropriate place to talk about such things as the structure of the health care market, availability of services, health of the population, outcomes relative to other countries, how much we spend on health care, etc. Bottom line, I think for most readers the distinction that puts Medicare in an article on health insurance, but excludes Medicaid, is going to be artificial and confusing, because it's not consistent with how they hear politicians use the term (and how they think about it). I'd rather mention both programs, explain the technical distinction, and help people understand how they relate to each other. Does that make sense? Would it be appropriate for me to take a stab at what the new article might look like (without taking anything out of the existing article until we get some more discussion, and people have a chance to look at the new one)? —Preceding unsigned comment added by 146.145.79.247 (talk) 21:42, 18 January 2008 (UTC)

Sfmammamia, I didn't mean to blow off your comment on the Indian Health Service. The current article is so big that I've been trying to put in appropriate subheads to help people navigate. In that case it may well have been overkill. I think if we can split this out to just the U.S. piece, it's going to get easier to organize. My real issue isn't how much we say about each of these programs, but just that we get an appropriate summary in place that helps people get there minds around all the different sources of coverage in the US. —Preceding unsigned comment added by 146.145.79.247 (talk) 21:54, 18 January 2008 (UTC)

146.145.79.247, please remember to sign your comments by using four tildes or the signature button in the toolbar. I agree with your reasoning that while there's a technical difference between programs like Medicare and Medicaid, that technical difference is not relevant to the average reader, and that grouping all public and private sources of health care coverage in one article is the way to go. That is also my reasoning for ignoring the technical distinctions and calling the split article "Health insurance in the United States" and not "Health benefits...", because that's how I believe most people would go looking for the topic. To me, "Health benefits..." suggests only employer-provided coverage -- I don't think of insurance that is self-purchased as "Health benefits" and I don't think of Medicaid as "Health benefits". To me "health insurance" is the broader, catchall term.

Barring other objections over the next few days, I think it's fine to be bold and make the split happen, rather than leaving a lot of duplicate content up. There's always a way back if needed. --Sfmammamia (talk) 22:01, 18 January 2008 (UTC)

Fow what it's worth, I too would support a split.--Tom (talk) 22:28, 18 January 2008 (UTC)

Thanks. I'll let it sit over the weekend, and then take a stab at it if I can carve out the time early next week. As an aside, how does the term "Health Coverage" sound to you? I agree that "Health Benefits" sounds too much like an employee benefit plan. (Of course, even the Census Bureau blows off the technical distinction and uses "health insurance" for everything - but I think we can be a bit more precise than that [2])146.145.79.247 (talk) 22:30, 18 January 2008 (UTC)

If the Census Bureau uses the term "insurance", I think we should too. Per WP:NAME: "Generally, article naming should prefer what the greatest number of English speakers would most easily recognize, with a reasonable minimum of ambiguity, while at the same time making linking to those articles easy and second nature...This is justified by the following principle: The names of Wikipedia articles should be optimized for readers over editors, and for a general audience over specialists." --Sfmammamia (talk) 22:35, 18 January 2008 (UTC)

Keep in mind we can always add a redirect for other terms under which people may search for the topic. --Sfmammamia (talk) 22:37, 18 January 2008 (UTC)

Fair enough. Let's plan on calling it "Health Insurance in the United States" and then covering the technical and colloquial definitions. I do suspect that a "Health Coverage in the United States" redirect may end up useful, but I'm probably getting ahead of myself there. Have a good weekend! 146.145.79.247 (talk) 22:43, 18 January 2008 (UTC)

I've created the new article - you can find it at Health insurance in the United States. I tried to modify the original article to reflect the move, but ClueBot reverted it. I've reported this as a false positive, but as it stand now the original article is unchanged.EastTN (talk) 14:49, 21 January 2008 (UTC)

Good work! The bot reverts seem to have been overcome. --Sfmammamia (talk) 20:11, 21 January 2008 (UTC)

Thank you! And thanks for fixing the second bot revert. EastTN (talk) 20:25, 21 January 2008 (UTC)

References

Removing Citation Tags

Every sentence in the "How it Works" section is labeled with a cite needed tag. I'm removing them, as all of the statements are pretty patently obvious to anyone who works with health care insurance at the provider level. I'm also making a couple of minor changes to the sentences. 216.201.119.71 (talk) 17:57, 25 April 2008 (UTC)

Insurance does not equal Expenditure

Why does "Health Expenditure" redirect here? I was looking for an article on expenditure by country and bizarrely got redirect here. 83.70.228.187 (talk) 17:27, 19 December 2008 (UTC)

Adverse selection, Medical underwriting, and spreading risks over time

As the article is currently written it implies that medical underwriting (in other words differential pricing and coverage) is a necessity when insurance is not compulsory because some people will tend to defer taking insurance until they are sick. But even if insurance was compulsory, insurance companies would still engage in the practice of trying to weed out the sick in order to maintain their profitablity. Unless of course insurers have to take all comers at the same price. There are countries that enforce this by law (and I think also some states in the U.S. do this also).

I think these two concepts are separate and to some extent (though not fully) independent. One could equally argue that BECAUSE some insurance companies are ALLOWED to engage in differential pricing and coverage and screen applicants for previous medical history, it becomes necessary for other insurers in the same market to do likewise. Banning medical screening and allowing full portability of employer based insurance with the insured being able to continue to pay insurance at the same rate as the emplyer paid would prevent a lot sick people from having to seek insurance in the individual market. It would not get rid of pool exclusion by choice but there are other ways around this (see for example the Australian solution).

The article also mentions the uneven distribution of health expenditures across the population but one of the obvious problems is also that health expenditures are also unevenly distributed across time. Older people tend to become sicker than younger ones, and indeed a very high percentage of health care expenditures come in the last few years of life. I can't remember exactly the statistic but I think that the average person's health care costs are skewed to something like 70-80% of total lifetime expenses coming in those last few years.

One of the principles of National Health Insurance is that there is just one national pool, everyone is in, and you contribute to the pool differently at different times according to your earnings capacity. Thus you pay in more when you are working and less when you are studying or are retired. Private health insurance pools do not seem to be able to do this. They balance their risks year on year and older people tend to have to pay MORE as they get older and not LESS. I guess that in the U.S. the introduction of Medicare was a way to limit this, but of course it did mean that the private insurance companies cleverly managed to push their biggest risks onto the government.

I therefore think that the article should reflect these issues. What do other editors think?--Hauskalainen (talk) 08:21, 13 June 2009 (UTC)

The article, as it is currently written, cites sources that say adverse selection is an issue in voluntary insurance markets and that medical underwriting is one method that insurers use to try and address that problem.

Every proposal I have seen for guaranteed issue and mandatory coverage would also prohibit the use of health status in setting premium rates.

Have you seen any serious proposal advanced that would make coverage compulsory without also including both guaranteed issue of coverage and a prohibition on using health status as a factor in setting individual premiums? Perhaps that's why we don't have any sources addressing that particular potential problem.

Average annual per capita health care costs do change dramatically with age. They start out relatively high at birth (you get a significant number of high cost neonates), drop steadily to a minimum at some point around age 11 or so, then rise gradually with age thereafter. They also vary by gender. Females have higher average costs than males until roughly the mid-50s, at which point the relationship flips and males have higher average costs than females (I've seen some evidence that it may flip again at extremely high ages - 90s and up - but it seems less conclusive). That's a moot point in the U.S., though, because the Medicare program for seniors is primarily funded through payroll taxes (the HI portion of the program) and general revenues (the SMI portion of the program) so something on the order of half the medical costs for seniors are in fact spread over the working lifetime. You can suggest that those costs be loaded onto the premiums for younger people instead, but given that one of the primary problems that people are trying to solve is high premiums, that doesn't strike me as a particularly useful avenue to explore (and again, I'm unaware of anyone who's advocating for it - or any sources discussing it).

You seem to me to be boxing at shadows here. If you want to get worked up about something in the U.S. system, I'd suggest you look at the categorical approach to eligibility for Medicaid - while Medicaid covers a lot of people, the categorical eligibility rules mean that a third of those living below the federal poverty level (FPL) are still uninsured. 37% of the uninsured live in families with incomes below 100% of the FPL; another 29% are in families with incomes between 100-199% of the FPL. By simply expanding Medicaid to cover everyone who is poor or near-poor, the government could solve roughly two-thirds of the uninsured problem without ever touching the existing private insurance markets. EastTN (talk) 19:11, 25 June 2009 (UTC)

Hi and thanks for taking the trouble to reply. I think you are looking at this issue as though I was talking about health insurance in the United States. I am not. I am talking about health insurance generally and the two kinds of model, private and public. I happened to mention Medicare as it is an aspect in the U.S. which most closely mirrors the alternative National Health Insurance model because it is in part funded from accumulated earnings. Britain has a private insurance system parallel to the NHS which engages in the same predatory pricing practice as the U.S. private insurers engage in. Both US and UK have elements of both models. Private insures, given no restraint or other incentives, will seek only to insure the healthy and to avoid insuring for long term care - i.e. avoid adverse selection by medical underwring. I was not trying to make a point about U.S. reform. Merely that the principles (designed and not-designed) underlying the two approaches to insurance each of which presents a completely different balance of risk for the insured person.

But as you raised the proposed U.S. reforms, I was intrigued to discover that, tucked away in the provisions of HR3200 is one that sets up a system for risk equalization which protects insurers from adverse selection. That is what the Dutch do and some other countries too. It is a very important element that has received hardly any publicity! --Hauskalainen (talk) 23:08, 16 September 2009 (UTC)

"Approximately 84% of Americans have health insurance"

I know this is a hot-button issue, so I will tread carefully: The article says: "approximately 84% of Americans have health insurance." The given citation (http://www.sensiblefinance.org/?page_id=46) doesn't actually say anything about health insurance coverage. Perhaps this citation was actually intended: "Income, Poverty, and Health Insurance Coverage in the United States: 2006." -- but that is a 78 page document and refers to "people" not Americans. If I am not mistaken, "people" in the census include non-Americans.

Where specifically is the reference for this fundamental statistic? Forgive me if I have just not read the citations correctly. HyperCapitalist (talk) 00:38, 21 August 2009 (UTC)

Execs get free health care

Could anything be said about NO "Liberty & justice for all" in America because: "Corporation executives often [always?} enjoy FREE medical services, for themselves & their families, from fulltime company medical departments. This amounts to so much tax-free medicine, which is charged to the consumers in price & to general taxpayers. High public officials often come in for such free medical services at various of the up-to-date governmental military hospitals... If he has no organization he can charge for the medical services, the rich man does have up to $20,000 of medical attention each year as a tax-free deduction...Most persons in the country never enjoy the services of a doctor until they are in extremus or a doctor must be called in to pronounce him [or his child] dead. This is because they cannot afford a doctor. The pleasant sounding medical deduction [for taxes] then, is of no service to the many persons without money to spare for doctors & medicine." It shows insurance is the problem, not solution (idolatry--false way). Stars4change (talk) 18:34, 16 September 2009 (UTC)

NPOV

The section on the US health care appears to be supporting a point of view: "The insurance industry represents a significant lobbying group in the United States" -- while that's true, it's not sourced and doesn't really belong in this part of the article (in my opinion of course). Others?? Couldn't this be re-written to be more neutral?--Paul McDonald (talk) 19:49, 16 July 2010 (UTC)

Himmelfarb study

The study assumed that anyone who declared bankruptcy and had medical bills over $1000 dollars had a "medical bankruptcy", and that's how they got 62%. I deleted the sentence claiming that 62% of US bankruptcies were "medical" because the definition is so broad as to be meaningless. Applying the same standard to bankruptcies in any country might well have yielded the same rate of "medical bankruptcies". Two of the study's authors are founders of Physicians for a National Health Plan, and have published similarly inflated claims of "medical" bankruptcy before; for example, classifying bankruptcies due to gambling, drug addiction and alcoholism as "medical bankruptcies".

http://www.factcheck.org/askfactcheck/what_is_the_percentage_of_total_personal.html http://www.theatlantic.com/business/archive/2010/02/a-little-more-about-medical-bankruptcy/35919/ http://old.nationalreview.com/comment/heriot200502110735.asp —Preceding unsigned comment added by 134.121.40.178 (talk) 21:57, 27 September 2010 (UTC)

Inappropriate Content?

The "Other factors affecting insurance prices" section refers to "broader-penis plans." I assume this is an inappropriate disruption of the article, but I wasn't sure, nor could I find an easy way to report the article. Either the original text needs to be returned or the term needs to be explained.

98.218.230.109 (talk) 03:39, 1 October 2010 (UTC)

ERISA

Is neither explained nor linked. It might be known only to a small percentage of readers. — Preceding unsigned comment added by 92.40.254.122 (talk) 21:40, 9 February 2013 (UTC)

cost of health insurance premium as a percentage of income in the US v.s. other countries

The cost of health care per capita is presented, but it would also be interesting to see what health insurance premiums are as a percentage of income. Also, is it possible to compared these numbers to the Australian health care income tax rate? — Preceding unsigned comment added by Kjgwiki (talk • contribs) 05:47, 30 September 2013 (UTC)

Healthcare schemes in the UK

These have been a feature in the UK for years, since before the NHS actually. I am wondering if we should add a paragraph underneath the section mentioning bupa, axa etc RoyalBlueStuey (talk) 17:07, 22 January 2014 (UTC)

Rwanda

Could we perhaps expand on the Rwanda section? The fact that we mention it is one of the few countries that has implemented a certain health care system, but don't explain how that system works, even briefly, is a bit confusing. We should add that in. Thoughts? Adamh4 (talk) 20:48, 24 April 2014 (UTC)

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health insurance fund

When i search for health insurance fund , there are many different wikidata items about that, available on all kind of languages. But all that is in my opinion not necessary, because a health insurance fund , private or national or for children or adults or whatever, it is everywhere a fund, for providing healthcare. — Preceding unsigned comment added by Just2correct (talk • contribs) 09:47, 6 June 2019 (UTC)

CP 133 2019 Group 32 proposed edits

1. Out-of-Network Provider: A health care provider that that has not contracted with the plan. If using an out-of-network provider, you may have to pay full cost of the benefits and services you get from that provider. Even for emergency services, providers not in your network may bill you for some additional costs associated. Alanchan49 (talk) 21:22, 16 October 2019 (UTC)

2. Suggested edits for paragraph 3 of the United States section:"Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and most prescription drugs (but this is not always the case)." I would change the phrasing of this last sentence because it's vague and doesn't offer any information on why drugs may or may not be covered. My suggestion would be as follows:"Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures. They also cover or partially cover the cost of certain prescription and over-the-counter drugs. Insurance companies determine what drugs are covered based on price, availability, and therapeutic equivalents. The list of drugs that an insurance program agrees to cover is called a formulary. Additionally, some prescriptions drugs may require a prior authorization before an insurance program agrees to cover its cost." Stc0148 (talk) 22:51, 16 October 2019 (UTC)

3. Link "Health Savings Account" Wikipedia page to the section under which this term is mentioned, the section for "History and evolution" under "United States." Edit explanation: As of 2015, a trend has emerged for employers to offer high-deductible plans, called consumer-driven healthcare plans which place more costs on employees, while employees benefit by paying lower monthly premiums. Additionally, having a high-deductible plan allows employees to open a health savings account, which allows them to contribute pre-tax savings towards future medical needs. Some employers will offer multiple plans to their employees. Ala008 (talk) 00:58, 17 October 2019 (UTC)

4. For the term "Premium" that is defined in the "Background" section of the article, I propose expanding on how premiums are calculated for further clarification. Proposed Edit: Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage. (US specific) According to the healthcare law, a premium is calculated using 5 specific factors regarding the insured person. These factors are age, location, tobacco use, individual vs. family enrollment, and which plan category the insured chooses. Margaret.yang.2021 (talk) 03:52, 17 October 2019 (UTC)

5.Under Explanation of Benefits, I propose adding information about how emergency room billing works as related to AB 1511. I want to talk about the notification process of hospitals contacting insurers and patients of the medical expenses and the estimate time before a patient is notified. I also want to talk about at what point in their ED stay they are given information about the medical bills. Hospitals are usually required to notify their patients within 30 days of service. Payment requests rarely come in one letter and there are usually multiple statements. Isunwoo (talk) 15:40, 17 October 2019 (UTC)

References

CP 133 2019 Group 31 Feedback

1. Group 32 improved the article by expanding on how emergency room billing works, how premiums are calculated based on specific factors and improving the phrasing for certain sentences. These edits would meet the Wikipedia's guidelines better if they cited what other things insurance companies can do and what formularies are as proposed in edit 2. Besides that missing citation, all the points proposed are included with verifiable cited secondary sources that are freely available. Joe.Li2019 (talk) 18:21, 6 November 2019 (UTC)

2. Group 32 improved the article by adding details about what a formulary is and what a prior authorization is to the "History and evolution" in the United States section. I think they could also add "Formulary" to the definition section of the article where it describes what a Deductible, Co-payment, Coinsurance, (ect) is. Prior authorization is already included in this section, so that seems fine. I do not see any evidence of plagiarism or copyright violations. I agree with Joe that they need to add some additional citations. Madelinekelly04 (talk) 18:08, 6 November 2019 (UTC)

3. Group 32 improved the article by including more information about how premiums are calculated, what a formulary is and how prior authorizations work. I agree with Madi that it would be a good addition to add these terms to the definition portion of the article. I believe that group 32's draft submission is taking a neutral point of view. Nathan.koreie (talk) 18:50, 6 November 2019 (UTC)

4. Group 32 improved the article because they clarified definitions (out-of-network provider, explanation of benefits, and premium). However, the definition for out-of-network provider needs a citation. Overall, this group did achieve its goal for improvement because These definitions help to provide a better upstanding of commonly used terms used to describe health insurance. The addition of how a premium is calculated was really informative. All of the edits are consistent with Wikipedia’s manual of style except for the definition of “out-of-network provider” because it uses second person pronouns which is inconsistent with the tone of the rest of the article. I suggest changing to third-person pronouns or nouns. Overall, Group 32 did a great job editing this article. MarylynnTrinh (talk) 20:44, 6 November 2019 (UTC)

Group 32's Response to Group 31's Feedback:

Thank you for the feedback! We linked definitions for "prior authorization" and "formulary." We also added citations for the definition of these items.Stc0148 (talk) 23:08, 6 November 2019 (UTC)

Thank you for the feedback! We added "Formulary" to the list of definitions, and edited "Out-of-Network Provider" to be in third-person to be consistent with Wikipedia's manual of style. Ala008 (talk) 23:08, 7 November 2019 (UTC) Alanchan49 (talk) 21:15, 20 November 2019 (UTC)

Thank you group 31 for the feedback! We have reassessed the paragraph that explains self-funded employer-sponsored benefit plan under ERISA regulation to be an example of a private-insurance coverage. We clarified mis-information through our assessment of what falls under insurance company roles and regulations. Isunwoo (talk) 05:37, 21 November 2019 (UTC)

History 2019 perspective

This is not the best history piece but it has some perspectives on the intent of insurance.

• https://stanmed.stanford.edu/2017spring/how-health-insurance-changed-from-protecting-patients-to-seeking-profit.html

Currently this wiki article has no history section, which is an omission. Blue Rasberry (talk) 12:03, 9 December 2019 (UTC)

A Commons file used on this page or its Wikidata item has been nominated for deletion

The following Wikimedia Commons file used on this page or its Wikidata item has been nominated for deletion:

• Universal Healthcare by Country.svg

Participate in the deletion discussion at the nomination page. —Community Tech bot (talk) 06:07, 14 September 2022 (UTC)