CLINICAL LAB SCIENEC

CHAPTER 7: MEDICAL ECONOMICS AND LABORATORY EQUIPMENT 159
no more successful in doing so than were Medicare and Medicaid insurance.
Certain services have diminished over the years, such as the old familiar house
calls, which will most likely never return.
In summary, health care insurance and plans designed to provide optimum
medical care for the majority of the population have fallen short of providing
this care on a more economical basis.
Direct and Indirect Pay
When the consumer pays for his or her own care, it is called direct pay, and
includes the required co-pay at the time of service. When the insurance company
pays for the medical care by collecting insurance premiums, it is called indirect
pay. In the opinion of many citizens, there should be a balancing between insurance
and direct responsibility by shifting the cost burden to the consumer of
medical care. Consumers of health care may have a choice in the type of insurance
they choose. Lower premiums are available if the consumer chooses to pay
a high-deductible amount of the first few thousand dollars for care. This forces
the consumer into a direct pay mode, until a certain level is reached, at which
time the insurance plan begins to pay for at least a portion of the services. Others
may choose health care insurance that covers the majority of the costs, from
the beginning, with a low or no deductible provision. This type of insurance
often requires the paying of higher premiums for the luxury of having coverage
immediately. The plan where direct pay is required for the first few thousand
dollars of care tends to encourage the consumer to avoid medical visits except
when absolutely necessary.
Another option lies in the funding of a universal type of health care that
is paid at least in part by the taxpayers. Some political activists seek to require
taxes to pay for the care of everyone. There is a possibility that medical care
would then be rationed and limited to all except those who can afford to pay
their entire medical costs.
A system along a business model in which everyone contributes and which
allocates costs, risks, and contributions in an equitable manner would be the
optimum solution. Lifestyle choices usually are often responsible for either health
or lack of health, and in the minds of some, those who practice risky behavior
and lifestyles should be required to pay more for their care.
Insurance and Reimbursement
No current insurance plan for health care reimburses the consumer or pays for
the entire cost of medical procedures, and laboratory services are no exception.
Most often, the consumer is asked to pay a co-pay of a set amount for any
service provided, including charges for prescription drugs. There is also a hefty
deductible in most insurance plans that must be met before any payments are
made by the insurance provider. Some HMO plans allow a certain number of
visits per year, and a certain level of services without a co-pay, to discourage
overuse of the services. There are also lifetime limits imposed by most insurance
plans, and when these funds are exhausted, the insurance will no longer cover
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