However, third-party payer systems became more popular with the increased bureaucratization of healthcare, particularly with the spread of HMOs and their complex paperwork for referrals. The use of third-party payers means “the processing of payments for insurance and other duties are handled” by another agency that is responsible for collecting premium payments and issuing reimbursements (Easey 2009).
It has been alleged that the use of such third parties means that individuals not well-versed in medical needs are making decisions about when reimbursements are valid regarding treatment and care, and are often looking for reasons not to pay for care, rather than to provide customers with the medical services they require as patients. It also creates another level of red tape between the patient and his or her doctor and insurance provider. An example of such an abuse might be an individual denied coverage because of forgetting to disclose a relatively benign pre-existing condition such as acne.
Q3: Discuss the role of government in health care funding.
Despite current fears about a government take-over of healthcare via a single-payer system, today the government already has a relatively aggressive role in health care funding. “Government programs to cover health care costs began to expand during the 1950s and 1960s. Disability benefits were included in Social Security coverage for the first time in 1954. When the government created Medicare and Medicaid programs in 1965, private sources still paid 75% of all of the health care costs. By 1995, individuals and companies only paid for about half of the health care with the government responsible for the other half” (History, 2010, Neurosurgery).
According to the Brookings Institute, the federal government spent over $600 billion on health care in fiscal 2008, with Medicare will claiming roughly $390 billion of that total, Medicaid and the State Childrens Health Insurance Program (SCHIP) about $210 billion, and veterans medical care about $34 billion.
SCHIP is a state-administered program for needy children of the working poor who do not qualify for poverty-level assistance. “In addition to these direct outlays, various tax provisions for health create tax expenditures that total roughly $175 billion; about 85% of that figure comes from the exclusion from taxable income of employers payments for their workers health insurance premiums.”
Easey, Cameron. (2009, April 2). Define third-party health insurance. Retrieved May 9, 2010 at http://www.ehow.com/about_5301200_define-thirdparty-health-insurance.html
Healthcare: How much does the federal government spend? (2009). The Brookings Institution.
Retrieved May 9, 2010 at http://www.taxpolicycenter.org/briefing-book/key-elements/health-insurance/spending.cfm
The Health Insurance Portability Act of 1996. Full text retrieved May 9, 2010 at http://www.dhhs.gov/ocr/privacy/hipaa/administrative/statute/hipaastatutepdf.pdf
The history of health insurance in the U.S. (2010). Northern California Neurosurgery Medical
Group. Retrieved May 9, 2010 at http://www.neurosurgical.com/medical_history_and_ethics/history/history_of_health_insurance.htm
Omnibus Budget Reconciliation Act of 1981. P.L. 97-35, 95 Stat. 357-933
Aug. 13, 1981. Retrieved May 9, 2010 at http://www.fns.usda.gov/SNAP/rules/Legislation/history/PL_97-35.htm
Rubel, Eugene. (1975). Implementing the National Health Planning and Resources Development
Act of 1974. Public Health Report. Retrieved May 9, 2010 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1432083/pdf/pubhealthrep00156-0005.pdf
Phillips, Robert (et al. 2004). The Balanced Budget Act of 1997 and the financial health of teaching hospitals. Annals of Family Medicine 2:71-78. Retrieved May 9, 2010 at http://www.annfammed.org/cgi/content/full/2/1/71.