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Doctors and the US.

PostPosted: June 13th, 2003, 1:11 pm
by DanielDK
Hi everyone,

I just have a few questions I' ve been wondering about.

Out of pure interest, I'd like to know how the medical system works in the States. I mean, is EVERYTHING based on user-payment?

How do medical-insurances work? Do you have to pay every kind of doctor every time you consult them? ANd do people with less money only get to see `worse` doctors than the people who can afford more?

Coming from a region where all medical expenses and bills are picked up by the government, and therefore `free` for everyone (Of course - have a 60 % tax figure, and that´s where the money are taken from), it's a rather different idea to adjust to, that you actually have to pay for seeing a doctor. What if a poor person gets mortally ill, needs operation, and he doesn't have a cent? Doesn't he get operated? Or does he just have to pay the bill afterwards?

Don't get me wrong - I' m asking out of curiosity and nothing else :D

See ya,


PostPosted: June 14th, 2003, 6:16 am
by jcavan4125
There are several systems of healthcare in the United States.

The poor are covered by a government plan called Medicaid; the elderly (over age 65) are covered by a government plan called Medicare; they are able to see any doctor that accepts Medicaid or Medicare. This is paid for by tax dollars.

The military and some politicians are covered by a separate healthcare system (with its own doctors and hospitals) and the same holds true for veterans of the military (a completely separate system that is separate even from the military system).

Then there is the private healthcare system which is the majority of the population. This is health insurance that is sold by insurance companies to either individuals or to employers. Employers are the largest provider of healthcare to individuals after the government. They provide health insurance coverage to their employees as a benefit of employment. Not all employers do this, but the majority do. The insurance premiums (payments) are subsidized by the employer anywhere from a portion of the cost, all the way up to 100% of the cost.

Health insurance comes in two main varieties, fee-for-service and managed care.
Fee-for-service plans (which are becoming rare) will pay a portion of the bill for doctors, tests or hospitals; usually 80% with the remaining 20% paid by the patient.
Managed care plans generally pay for more of a bill, but the patient must obtain pre-approval from the insurance company before they can see a specialist, have a procedure or be hospitalized (except in an emergency).
Either type of plan may or may not have a drug benefit as part of the plan. This will pay for a portion of the cost of a prescrption medication.

Lastly, there are those that don't qualify for Medicaid but have difficulty paying for their own health insurance. They are what are often refered to as the "working poor". Usually those individuals that are at entry level jobs making minimum wage whose employer does not offer health insurance as a benefit. They must either pay for their healthcare themselves (what is called "out of pocket") or they have the option of using the emergency room at the hospital which must see everyone whether they can pay or not.
There are also free clinics in many cities (though not all) that people that have no insurance or can't afford to pay can be treated by doctors that volunteer their services.
If one of these patients needs treatment for something that requires hosptialization, often times they are admitted to a teaching hospital where a medical school is affliated with the hospital and students and residents are involved in patient care. These are actually some of the best hospitals in the world (Duke, Johns Hopkins, Mayo Clinic to name a few).
If there is no teaching hospital nearby, doctors that admit to the local hospital take turns on a list ( ER call list) to accept patients that have no insurance but need to be hospitalized.
The bottom line is that there are healtcare options for everyone and nobody has to go without treatment.

I hope I explained this well enough for it to make sense. I realize this must sound like a very complicated and strange system to someone from a country with socialized medicine; and I agree there is alot of room for improvement. Billions of dollars could be saved if the system were to be consolidated, but that is not likely to happen. Still it beats a federal tax rate of 60%.

PostPosted: June 14th, 2003, 7:35 am
by DanielDK
Hi Joe!

Very well explained indeed! So THAT'S how things work in the US......

Well yes, the bottom line that "There are healtcare options for everyone and nobody has to go without treatment" surely is nice to hear. I just heard all these horror stories of people saving up money to be able to pay for their daughters cancer-operation, or people picking up traffic-accident-victims in the street, winding up actually PAYING for that victims medical care, since he/she didn't have any medical cover him/herself. Well, the federal tax rate of 60 % is among one of the highest in the world, and naturally it's functionality is arguable. But let's not forget....had it not been for our 60+ % - rate, we would never have been able to spend 15 % of the TOTAL annual danish BNP, on building a bridge across the sound to our dear neighbors in Sweden :lol: - Ooops, I think there's a swede in here, so I' ll just finish by saying that it actually IS a very nice experience to go from Denmark to Sweden across the bridge in 15 mins.!

Thanx for the reply!