Health Insurance

Surgeons raise alarm over waiting

2011-04-07T15:29:00.000-07:00

By Branwen Jeffreys Health correspondent, BBC News

Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment.

In several areas routine surgery was put on hold for months, while in many others new thresholds for hip and knee replacements have been introduced.

The moves are part of the NHS drive to find £20bn efficiency savings by 2015.

The government said performance should be measured by outcomes not numbers.

Surgeons have described the delays faced by patients as "devastating and cruel". Peter Kay, the president of the British Orthopaedic Association (BOA), says they've become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings.

We've started to get reports over the last nine months that access to these services are being restricted”

End Quote Peter Kay, president of BOA

"GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery."

He says that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate.

"The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early. "

Common Dietary Fat and Intestinal Microbes Linked to Heart Disease

2011-04-06T20:10:00.000-07:00

ScienceDaily (Apr. 6, 2011) — A new pathway has been discovered that links a common dietary lipid and intestinal microflora with an increased risk of heart disease, according to a Cleveland Clinic study published in the latest issue of Nature.

The study shows that people who eat a diet containing a common nutrient found in animal products (such as eggs, liver and other meats, cheese and other dairy products, fish, shellfish) are not predisposed to cardiovascular disease solely on their genetic make-up, but rather, how the micro-organisms that live in our digestive tracts metabolize a specific lipid -- phosphatidyl choline (also called lecithin). Lecithin and its metabolite, choline, are also found in many commercial baked goods, dietary supplements, and even children's vitamins.

The study examined clinical data from 1,875 patients who were referred for cardiac evaluation, as well as plasma samples from mice. When fed to mice, lecithin and choline were converted to a heart disease-forming product by the intestinal microbes, which promoted fatty plaque deposits to form within arteries (atherosclerosis); in humans, higher blood levels of choline and the heart disease forming microorganism products are strongly associated with increased cardiovascular disease risk.

"When two people both eat a similar diet but one gets heart disease and the other doesn't, we currently think the cardiac disease develops because of their genetic differences; but our studies show that is only a part of the equation," said Stanley Hazen, M.D., Ph.D., Staff in Lerner Research Institute's Department of Cell Biology and the Heart and Vascular Institute's Department of Cardiovascular Medicine and Section Head of Preventive Cardiology & Rehabilitation at Cleveland Clinic, and senior author of the study. "Actually, differences in gut flora metabolism of the diet from one person to another appear to have a big effect on whether one develops heart disease. Gut flora is a filter for our largest environmental exposure -- what we eat."

Dr. Hazen added, "Another remarkable finding is that choline -- a natural semi-essential vitamin -- when taken in excess, promoted atherosclerotic heart disease. Over the past few years we have seen a huge increase in the addition of choline into multi-vitamins -- even in those marketed to our children -- yet it is this same substance that our study shows the gut flora can convert into something that has a direct, negative impact on heart disease risk by forming an atherosclerosis-causing by-product."

In studies of more than 2,000 subjects altogether, blood levels of three metabolites of the dietary lipid lecithin were shown to strongly predict risk for cardiovascular disease: choline (a B-complex vitamin), trimethylamine N-oxide (TMAO, a product that requires gut flora to be produced and is derived from the choline group of the lipid) and betaine (a metabolite of choline).

"The studies identify TMAO as a blood test that can be used in subjects to see who is especially at risk for cardiac disease, and in need of more strict dietary intervention to lower their cardiac risk," Dr. Hazen said.

Healthy amounts of choline, betaine and TMAO are found in many fruits, vegetables and fish. These three metabolites are commonly marketed as direct-to-consumer supplements, supposedly offering increased brain health, weight loss and/or muscle growth.

These compounds also are commonly used as feed additives for cattle, poultry or fish because they may make muscle grow faster; whether muscle from such livestock have higher levels of these compounds remains unknown.

"Knowing that gut flora generates a pro-atherosclerotic metabolite from a common dietary lipid opens up new opportunities for improved diagnostics, prevention and treatment of heart disease," Dr. Hazen said. "These studies suggest we can intelligently design a heart healthy yogurt or other form of probiotic for preventing heart disease in the future. It also appears there is a need for considering the risk vs. benefits of some commonly used supplements."

Masturbation calms restless leg syndrome

2011-04-04T09:27:00.000-07:00

Too much of it will make you go blind – or so you might have been told. But for some, masturbation might have a real clinical benefit: it can ease restless leg syndrome (RLS). The insight could provide sweet relief for the 7 to 10 per cent of people in the US and Europe who suffer from the condition.
RLS is a distressing neurologic disorder characterised by an urge to move the legs. It is usually associated with unpleasant sensations in the lower limbs such as tingling, aching and itching.
The exact causes of RSL have yet to be pinpointed, but brain autopsies and imaging studies suggest one contributing factor is an imbalance of dopamine – a hormonal messenger that, among other things, activates the areas of the brain responsible for pleasure. It is suspected that dopamine imbalance is responsible for some of the symptoms of Parkinson's disease.
Drugs that increase dopamine have been shown to reduce symptoms of RLS when taken at bedtime and are considered the initial treatment of choice.
Although such drugs provided significant improvement of symptoms for a 41-year-old man with RLS, he found an even better treatment – complete relief after masturbation or sex.

Cannabis-like drugs could kill pain without the high

2011-04-04T09:21:00.000-07:00

An ingenious set of experiments has teased apart the mind-altering and pain-relieving effects of the main component of cannabis. This could open the way to cannabis-like drugs that provide pain relief without causing unwanted highs.

Cannabis is taken as a painkiller – to dull pain in cancer for example – but it can produce unpleasant side effects such as hallucinations and impaired mobility.

Now, a team led by Li Zhang of the US National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, has shown that tetrahydrocannabinol (THC) – the active component in cannabis that makes people high but that is also thought to dull pain – binds to different molecular targets on cells to produce these two effects.

It has long been known that THC gives people a high by binding to a molecular anchor on cells called the cannabinoid type-1 (CB1) receptor. Zhang and his team discovered that THC relieves pain by binding instead to receptors for the brain-signalling compound glycine and increasing their activity.

Through experiments on mice, they then confirmed that if the glycine receptor is absent or if its activity is blocked by another drug, the animals experienced pain in a standard "tail-flick" test even when given THC, confirming that the drug's pain-relief and psychotropic effects can be decoupled.

Tiny amounts of radiation from Japan reach Nev

2011-03-26T20:23:00.000-07:00

Minuscule amounts of radiation from Japan's damaged nuclear plant have reached Las Vegas, but scientists say it poses no health risk.

Extremely small amounts of the radioactive isotopes iodine-131 and xenon-133 reached a monitoring station by the city's Atomic Testing Museum this week, said Ted Hartwell, manager of the Desert Research Institute's Community Environmental Monitoring Program.

Hartwell said he's certain the isotopes came from Japan because they're not usually detected in Nevada. But he said the readings were far below levels that could pose any health risks.

"Unless you have an accident like this (in Japan) you wouldn't expect to see this. No doubt it's from Japan," Hartwell told The Associated Press.

Minuscule amounts of radiation from Japan have been reported elsewhere in the West, including California, Colorado, Hawaii and Washington. Officials have said those levels also were not harmful.

Nevada health officials have said they do not expect any risk to the state from Japanese radiation releases because of the distance the materials would have to travel.

"Any material released must travel 10,000 miles across the Pacific Ocean, during which time it will be dispersed and diluted in the atmosphere to levels that might eventually be detectable, but which will not present a health hazard nor require any protective actions," said Eric Matus, radiation physicist for the Nevada State Health Division.

Scientists say they weren't surprised that radioactive isotopes from Japan were detected in the Western states.

"They get caught up in the right wind pattern and they'll move across the ocean," said Jeff Daniels, an environmental scientist with Reno-based DRI.

Tiny amounts of the radioactive isotope cesium-137 were detected at a University of Nevada, Las Vegas laboratory between March 17 and 21, but haven't been reported since then, Hartwell said.

The Desert Research Institute operates 29 stations that monitor the air for radioactivity around the Nevada National Security Site, formerly the Nevada Test Site, about 65 miles northwest of Las Vegas. The institute plans to release the results of testing at the other stations and post them online at http://cemp.dri.edu/ by late in the week, Hartwell said.

The vast majority of the monitoring stations are in Nevada, with four in Utah and one in California.

10 Things You Didn't Know About You + What's the Maximum Weight A Human can Lift

2011-03-25T10:51:00.000-07:00

10: Your Stomach Secretes Corrosive Acid
There's one dangerous liquid no airport security can confiscate from you: It's in your gut. Your stomach cells secrete hydrochloric acid, a corrosive compound used to treat metals in the industrial world. It can pickle steel, but mucous lining the stomach wall keeps this poisonous liquid safely in the digestive system, breaking down lunch.

9: Body Position Affects Your Memory
Can't remember your anniversary, hubby? Try getting down on one knee. Memories are highly embodied in our senses. A scent or sound may evoke a distant episode from one's childhood. The connections can be obvious (a bicycle bell makes you remember your old paper route) or inscrutable. A recent study helps decipher some of this embodiment. An article in the January 2007 issue of Cognition reports that episodes from your past are remembered faster and better while in a body position similar to the pose struck during the event.

8: Bones Break (Down) to Balance Minerals
In addition to supporting the bag of organs and muscles that is our body, bones help regulate our calcium levels. Bones contain both phosphorus and calcium, the latter of which is needed by muscles and nerves. If the element is in short supply, certain hormones will cause bones to break downeupping calcium levels in the bodyeuntil the appropriate extracellular concentration is reached.

7: Much of a Meal is Food For Thought
Though it makes up only 2 percent of our total body weight, the brain demands 20 percent of the body's oxygen and calories. To keep our noggin well-stocked with resources, three major cerebral arteries are constantly pumping in oxygen. A blockage or break in one of them starves brain cells of the energy they require to function, impairing the functions controlled by that region. This is a stroke.

6: Thousands of Eggs Unused by Ovaries
When a woman reaches her late 40s or early 50s, the monthly menstrual cycle that controls her hormone levels and readies ova for insemination ceases. Her ovaries have been producing less and less estrogen, inciting physical and emotional changes across her body. Her underdeveloped egg follicles begin to fail to release ova as regularly as before. The average adolescent girl has 34,000 underdeveloped egg follicles, although only 350 or so mature during her life (at the rate of about one per month). The unused egg follicles then deteriorate. With no potential pregnancy on the horizon, the brain can stop managing the release of ova.
5: Puberty Reshapes Brain Structure, Makes for Missed Curfews
We know that hormone-fueled changes in the body are necessary to encourage growth and ready the body for reproduction. But why is adolescence so emotionally unpleasant? Hormones like testosterone actually influence the development of neurons in the brain, and the changes made to brain structure have many behavioral consequences. Expect emotional awkwardness, apathy and poor decision-making skills as regions in the frontal cortex mature.

4: Cell Hairs Move Mucus
Most cells in our bodies sport hair-like organelles called cilia that help out with a variety of functions, from digestion to hearing. In the nose, cilia help to drain mucus from the nasal cavity down to the throat. Cold weather slows down the draining process, causing a mucus backup that can leave you with snotty sleeves. Swollen nasal membranes or condensation can also cause a stuffed schnozzle.

3: Big Brains Cause Cramped Mouths
Evolution isn't perfect. If it were, we might have wings instead of wisdom teeth. Sometimes useless features stick around in a species simply because they're not doing much harm. But wisdom teeth weren't always a cash crop for oral surgeons. Long ago, they served as a useful third set of meat-mashing molars. But as our brains grew our jawbone structure changed, leaving us with expensively overcrowded mouths.

2: The World Laughs with You
Just as watching someone yawn can induce the behavior in yourself, recent evidence suggests that laughter is a social cue for mimicry. Hearing a laugh actually stimulates the brain region associated with facial movements. Mimicry plays an important role in social interaction. Cues like sneezing, laughing, crying and yawning may be ways of creating strong social bonds within a group.

1: Your Skin Has Four Colors
All skin, without coloring, would appear creamy white. Near-surface blood vessels add a blush of red. A yellow pigment also tints the canvas. Lastly, sepia-toned melanin, created in response to ultraviolet rays, appears black in large amounts. These four hues mix in different proportions to create the skin colors of all the peoples of Earth

10 Essential Health Tips (The Basics to Practice Every Day)

2011-03-25T10:41:00.000-07:00

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it's a stress buster. Think 'move' in small increments of time. It doesn't have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that's great when you're up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we've seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or 'tough guy' stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can't live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It's a good pollution and dirt from the street deterrent. Thought for the day: 'Smoke gets in your eyes'…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it's because people who floss tend to be more health conscious than people who don't? Thought for the day: Floss and be your body's boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There's a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can't be unhappy when you're smiling or singing.

10. Choose Your Parents Well
The link between genetics and health is a powerful one. But just because one or both of your parents died young in ill health doesn't mean you cannot counteract the genetic pool handed you. Thought for the day: Follow these basic tips for healthy living and you can better control your own destiny.

Health insurance (major medical insurance)

2011-02-19T19:45:00.000-08:00

Health insurance and Health insurance in the United States
• AARP
• Aetna
• American Family Insurance
• American National Insurance Company
• Amerigroup
• Anthem Blue Cross and Blue Shield
• Assurant
• Blue Cross and Blue Shield Association
• Celtic Insurance Company, subsidiary of Centene Corporation
• Centene Corporation
• Cigna
• Coventry Health Care
• EmblemHealth
• Fortis
• Golden Rule Insurance Company
• Group Health Cooperative
• GHI
• Health Net
• HealthMarkets
• HealthSpring
• Highmark
• Humana
• Independence Blue Cross
• Kaiser Permanente
• LifeWise Health Plan of Oregon
• Medical Mutual of Ohio
• Molina Healthcare
• Premera Blue Cross
• Principal Financial Group
• The Regence Group
• Shelter Insurance
• Thrivent Financial for Lutherans
• UnitedHealth Group
• Unitrin
• Universal American Corporation
• WellCare Health Plans
• WellPoint
Medicare
Medicare (United States)
• Aetna
• American Family Insurance
• Bankers Life and Casualty
• Conseco
• Mutual of Omaha
• Premera Blue Cross
• Thrivent Financial for Lutherans

2011-02-19T19:41:00.000-08:00

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Several are the companies who provide medical insurance. Insurance companies will provide different packages so people can choose which one fits their needs.

It can get pretty hard to get a hold of the appropriate insurance policy. It's vital to acquire the best insurance you can for an amount that you are comfortable paying. As a result, it's a great plan to compare health insurance quotes online to figure out who will give you the most coverage for the least amount of money.

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To get Health Insurance Quotes USA, you will need to fill out a basic questionnaire when using a health quote site. You will get a number of different insurance policies from different providers to review the prices and policy figures from all the different providers. Then you can sort out the insurance policies that meet your needs and that are financially sound.

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Read more: http://www.articlesbase.com/insurance-articles/health-insurance-quotes-usa-get-free-health-quotes-2030333.html#ixzz1EKow9UbW
Under Creative Commons License: Attribution

Other types of health insurance

2011-02-19T12:02:00.001-08:00

Other types of health insurance (non-medical)
While the term "health insurance" is most commonly used by the public to describe coverage for medical expenses, the insurance industry uses the term more broadly to include other related forms of coverage, such as disability income and long-term care insurance.

Disability income insurance
Main article: Disability insurance
Disability income (DI) insurance pays benefits to individuals who lose their ability to work due to injury or illness. DI insurance replaces income lost while the policyholder is unable to work during a period of disability (in contrast to medical expense insurance, which pays for the cost of medical care).For most working age adults, the risk of disability is greater than the risk of premature death, and the resulting reduction in lifetime earnings can be significant. Private disability insurance is sold on both a group and an individual basis. Policies may be designed to cover long-term disabilities (LTD coverage) or short-term disabilities (STD coverage).Business owners can also purchase disability overhead insurance to cover the overhead expenses of their business while they are unable to work.
A basic level of disability income protection is provided through the Social Security Disability Insurance (SSDI) program for qualified workers who are totally and permanently disabled (the worker is incapable of engaging in any "substantial gainful work" and the disability is expected to last at least 12 months or result in death).
Long-term care insurance
Main article: Long term care insurance
Long-term care (LTC) insurance reimburses the policyholder for the cost of long-term or custodial care services designed to minimize or compensate for the loss of functioning due to age, disability or chronic illness. LTC has many surface similarities to long-term disability insurance. There are at least two fundamental differences, however. LTC policies cover the cost of certain types of chronic care, while long-term-disability policies replace income lost while the policyholder is unable to work. For LTC, the event triggering benefits is the need for chronic care, while the triggering event for disability insurance is the inability to work.
Private LTC insurance is growing in popularity in the US. Premiums have remained relatively stable in recent years. However, the coverage is quite expensive, especially when consumers wait until retirement age to purchase it. The average age of new purchasers was 61 in 2005, and has been dropping.
Supplemental coverage
Private insurers offer a variety of supplemental coverages in both the group and individual markets. These are not designed to provide the primary source of medical or disability protection for an individual, but can assist with unexpected expenses and provide additional peace of mind for insureds. Supplemental coverages include Medicare supplement insurance, hospital indemnity insurance, dental insurance, vision insurance, accidental death and dismemberment insurance and specified disease insurance.
Supplemental coverages are intended to:
Supplement a primary medical expense plan by paying for expenses that are excluded or subject to the primary plan's cost-sharing requirements (e.g., co-payments, deductibles, etc.);
Cover related expenses such as dental or vision care;
Assist with additional expenses that may be associated with a serious illness or injury.
Medicare Supplement Coverage (Medigap)
Main article: Medigap
Medicare Supplement policies are designed to cover expenses not covered (or only partially covered) by the "original Medicare" (Parts A & B) fee-for-service benefits. They are only available to individuals enrolled in Medicare Parts A & B. Medigap plans may be purchased on a guaranteed issue basis (no health questions asked) during a six-month open enrollment period when an individual first becomes eligible for Medicare. The benefits offered by Medigap plans are standardized.
Hospital indemnity insurance
Hospital indemnity insurance provides a fixed daily, weekly or monthly benefit while the insured is confined in a hospital. The payment is not dependent on actual hospital charges, and is most commonly expressed as a flat dollar amount. Hospital indemnity benefits are paid in addition to any other benefits that may be available, and are typically used to pay out-of-pocket and non-covered expenses associated with the primary medical plan, and to help with additional expenses (e.g., child care) incurred while in the hospital.
Scheduled health insurance plans
Scheduled health insurance plans are an expanded form of Hospital Indemnity plans. In recent years, these plans have taken the name mini-med plans or association plans. These plans may provide benefits for hospitalization, surgical, and physician services. However, they are not meant to replace a traditional comprehensive health insurance plan. Scheduled health insurance plans are more of a basic policy providing access to day-to-day health care such as going to the doctor or getting a prescription drug, but these benefits will be limited and are not meant to be effective for catastrophic events. Payments are based upon the plan's "schedule of benefits" and are usually paid directly to the service provider. These plans cost much less than comprehensive health insurance. Annual benefit maximums for a typical scheduled health insurance plan may range from $1,000 to $25,000.
Dental insurance
Main article: Dental insurance
Dental insurance helps pay for the cost of necessary dental care. Few medical expense plans include coverage for dental expenses. About 97% of dental benefits in the United States is provided through separate policies from carriers—both stand-alone and medical affiliates—that specialize in this coverage. Discount dental programs are also available. These do not constitute insurance, but provide participants with access to discounted fees for dental work.
Vision care insurance
Main article: Vision insurance
Vision care insurance provides coverage for routine eye care and is typically written to complement other medical benefits. Vision benefits are designed to encourage routine eye examinations and ensure that appropriate treatment is provided.
Specified disease
Main article: Critical illness insurance
Specified disease provides benefits for one or more specifically identified conditions. Benefits can be used to fill gaps in a primary medical plan, such as co-payments and deductibles, or to assist with additional expenses such as transportation and child care costs.
Accidental Death and Dismemberment (AD&D) insurance
Main article: Accidental death and dismemberment insurance
AD&D insurance is offered by group insurers and provides benefits in the event of accidental death. It also provides benefits for certain specified types of bodily injuries (e.g., loss of a limb or loss of sight) when they are the direct result of an accident.

Managed care

2011-02-19T11:52:00.000-08:00

Main article: Managed care
The term managed care is used to describe a variety of techniques intended to reduce the cost of health benefits and improve the quality of care. It is also used to describe organizations that use these techniques ("managed care organization"). Many of these techniques were pioneered by HMOs, but they are now used in a wide variety of private health insurance programs. Through the 1990s, managed care grew from about 25% US employees with employer-sponsored coverage to the vast majority.
Rise of managed care in the US
Year Conventional plans HMOs

PPOs
POS plans
HDHP/SOs
1998 14% 27% 35% 24% ~
1999 10% 28% 39% 24% ~
2000 8% 29% 42% 21% ~
2001 7% 24% 46% 23% ~
2002 4% 27% 52% 18% ~
2003 5% 24% 54% 17% ~
2004 5% 25% 55% 15% ~
2005 3% 21% 61% 15% ~
2006 3% 20% 60% 13% 4%
2007 3% 21% 57% 15% 5%
2008 2% 20% 58% 12% 8%
Network-based managed care
Many managed care programs are based on a panel or network of contracted health care providers. Such programs typically include:
• A set of selected providers that furnish a comprehensive array of health care services to enrollees;
• Explicit standards for selecting providers;
• Formal utilization review and quality improvement programs;
• An emphasis on preventive care; and
• Financial incentives to encourage enrollees to use care efficiently.
Provider networks can be used to reduce costs by negotiating favorable fees from providers, selecting cost effective providers, and creating financial incentives for providers to practice more efficiently. A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees.

Network-based plans may be either closed or open. With a closed network, enrollees' expenses are generally only covered when they go to network providers. Only limited services are covered outside the network—typically only emergency and out-of-area care. Most traditional HMOs were closed network plans. Open network plans provide some coverage when an enrollee uses non-network provider, generally at a lower benefit level to encourage the use of network providers. Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans.
The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan. In a "closed panel" HMO, the network providers are either HMO employees (staff model) or members of large group practices with which the HMO has a contract. In an "open panel" plan the HMO or PPO contracts with independent practitioners, opening participation in the network to any provider in the community that meets the plan's credential requirements and is willing to accept the terms of the plan's contract.

Health Insurance of USA Today

2011-02-19T11:42:00.000-08:00

American Health Insurance

In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, but excludes social welfare programs such as Medicaid. In addition to medical expense insurance, it also includes insurance covering disability or long-term nursing or custodial care needs.

The US health care system relies heavily on private and not-for-profit health insurance, which is the primary source of coverage for most Americans. According to the United States Census Bureau, approximately 85% of Americans have health insurance; nearly 60% obtain it through an employer, while about 9% purchase it directly. Various government agencies provide coverage to about 28% of Americans (there is some overlap in these figures).

In 2007, there were nearly 46 million people in the US (over 15% of the population) who were without health insurance for at least part of that year. Over 1 million workers lost their health care coverage in January, February and March 2009. Approximately, 268,400 more workers lost health care coverage in March 2009 than in March 2008. Proving that today, that number is markedly higher as many workers who have lost their jobs have also lost their employer-provided health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000. There is considerable debate in the US on the causes of and possible remedies for this level of uninsurance as well as the impact it has on the overall US health care system.