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Health care insurance

Basic principles of health insurance in the USA

In the US, there is a kind of relationship system: a client-insurance company-doctor. Health care insurance companies pay special attention to the list of medicines and treatment schemes. In a country with effective legislation, every step of the doctor is under control.

Health care insurance includes such main items:

  • relationships of the client and an insurance company;
  • relationships of the client and doctor;
  • relationships of the insurance company and doctor.

All health care insurance items “work” in a good manner. It is especially important both for the health care insurance company and for the client how the relationship of the insurance company and doctor has been established. In each insurance case, the doctor operates according to the scheme approved by the health care insurance company. Diagnostic and treatment protocols include the appointments that in each insurance case are the most necessary, efficient, and effective. Properly established diagnosis and appropriate treatment are the results to which an insurance company is striving for offering health care insurance.

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What medicines will the doctor prescribe?

American doctors do not prescribe drugs that are not included in the officially adopted list of medicines accepted at the level of the Ministry of Health or health care insurance company. If there is a certificate for a professional error, all its prescriptions are checked. If the “illegal” drug appears on the prescribing sheet, the consequences of such an inspection may be disastrous for the doctor. 

The list of drugs in the arsenal of the American doctor is very specific. It does not have, for example, immunomodulators. These drugs for such an indicator, as efficacy, have not reached the level of antibiotics and non-steroidal anti-inflammatory drugs. Therefore, there is always the probability of the lack of effect on their application.

The ineffectiveness of the drug is almost always an extraordinary event in the work of the health care insurance company and the doctor, which can lead to a trial. To avoid such consequences, highly efficient drugs are prescribed, which allow you to achieve a positive result.

What is peculiar in American health care insurance?

In America, insurance medicine with its voluntary medical insurance is guarding the health of its customers, guaranteeing not only the registration of the provided medical service but also a qualitative treatment with traditional medicines. No insurance company will pay for the cost of treatment with the application:

  • hypnosis;
  • acupuncture;
  • рomeopathic or phyto- preparations.

In terms of insurance medicine, such therapy is unconventional and the effect of its application is controversial.

Medical insurance in the United States has another feature. There is certain credibility of drugs appointed by the doctor. But, if the result from their use is insufficient and the disease slowly but steadily progresses, the next and right stage of treatment for customers of the insurance company is not the purpose of drugs, but surgical treatment. The United States takes first place in the number of operations of the aortocoronary artery shunting.

One of the basic principles of health insurance is the high efficiency of medical care. Americans are distinguished by a serious attitude towards their health. On the one hand, insurance companies protect their customers from non-professional medical care. On the other hand, Americans trust their doctors and do not buy medicines without the recommendation of a specialist.

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