Health care is the services and facilities provided by healthcare professionals to help people stay healthy and manage disease, illness, injury and disability. Healthcare providers diagnose and treat patients, but the health system also includes research and education.
The larger healthcare landscape includes physicians offices, hospitals, labs and imaging centers, physical therapy clinics, pharmaceutical companies and pharmacies. It also includes a myriad of interlocking relationships like group purchasing organizations, pharmacy benefit managers and insurers (in the form of health insurance, Medicare Advantage plans, PBMs or combinations thereof).
Many people see healthcare as a right that everyone deserves access to regardless of their ability to pay. Others feel that efficiency should be the driving force behind the allocation of healthcare resources. The latter view is usually rooted in the ethical theory of utilitarianism, which asserts that the “right” action is one that maximizes overall happiness.
Most healthcare systems include a general practitioner or primary care physician who can help you with your basic needs and refer you to specialists when needed. The primary care physician is a crucial part of your medical team because they play an important role in the prevention, detection and management of chronic diseases.
As a consumer, you need to understand the health insurance options available to you in order to make the best choice for your individual needs. To do so, start by comparing premiums, deductibles and coinsurance. You should also consider extra benefits, such as a 24/7 nurse line or discounts on wellness programs. Finally, look at how the different options compare in terms of their networks and coverage levels. For example, HMOs generally have lower monthly premiums but may restrict the list of doctors they will cover. PPOs, on the other hand, tend to cost more, but they offer more flexibility in choosing a doctor.
A health plan’s network determines which providers are included in its coverage and which ones you have to pay more out-of-pocket expenses for if you go outside of the network. It is essential to check whether your preferred doctors are in the network or not, as this will impact your coverage and out-of-pocket costs.
A key aspect of a good health insurance policy is its coverage of prescription drugs. Be sure to review the list of covered medications and how much each one will cost you, as well as your deductible and coinsurance. Also, keep in mind that not all medications are equal. Some may be generic while others are brand name. Generic medications are just as effective and typically cost less. Lastly, it is always worth checking if you qualify for any financial assistance or subsidies, as this can dramatically reduce your costs.