Category: Healthcare

#9 The Uninsured Populations of the US

Despite the existence of many different insurance plans and models, there is still a significant uninsured population in the US. While there are many reasons for this, the result is a fragmented healthcare system. Insurance options in the US range from public options that you’ve already learned about, like Medicare for the elderly and CHIP […]

#8 Managed Care: Balancing the Payment System

Managed care is one of the most popular systems of health insurance. It is designed to ensure the efficiency of a wide variety of healthcare services. Managed care aims to secure an overall high level of quality, while also reducing prices and overall utilization. This is especially true for the usage of expensive or unsubstantiated […]

#7 Provider Reimbursement: The Two Extremes

Now that we have covered how enrollees pay insurers, let’s take a closer look at how insurers reimburse providers.  The two methods are at opposite ends of the spectrum: fee-for-service (FFS) and capitation. With fee-for-service, the provider gets paid a fixed, agreed amount for each individual service. In this plan, the insurance company is burdened […]

#6 Medicaid Explained: Facts and Benefits

Now that you’re an expert on Medicare it’s time to learn about the second tier of public insurance programs: Medicaid. While they are similar in name, these two insurance programs are significantly different.  For starters, Medicaid is run by the federal government and covers uninsured Americans with incomes up to 138% of the Federal Poverty […]

#3 The Role of State Governments in Healthcare and COVID-19

The concept of federalism, or the sharing of political power between federal and state governments, is important for the American governmental system. Healthcare is no exception to this, and federalism can be seen in how regulation is divided by federal programs, regulatory bodies and state governments.     The US federal government regulates overall health insurance policies, […]

#1 Introduction to the US Healthcare System

Due diligence

Compared to other similarly developed countries, the US has the greatest amount of healthcare expenditures and the worst healthcare outcomes. This is in part due to its convoluted insurance/payment systems and the degree of variation present in the country—not only is it geographically expansive, but it is also diverse in virtually every other aspect. More […]