CLINICAL LAB SCIENEC

160
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
the consumer. In some cases, the limit is $1 million per lifetime; some companies
have recently raised this amount to $2 million. This sounds as though it would
be sufficient, but some major surgeries with the attendant expenses may cost in
excess of $500,000 for one hospital stay! Some states have laws regarding catastrophic
coverage and will subsidize treatment for some chronic illnesses. For
those using Medicare and Medicaid, there is also a requirement to pay at least
some fees out of the patients’ pockets.
Acceptance of Assignment
Some insurance companies have made contractual arrangements with certain
providers, including physicians, hospitals, and clinics. These arrangements provide
for a certain level of care at no additional cost to the consumer. Hospitals
and some physicians will accept assignment for patients covered by Medicare.
Those who have both Medicare and Medicaid are not usually liable for any of
the charges for medical services. In the case of a system called preferred provider
option (PPO), the health care provider often accepts assignment when the institution
provides medical care to all employees of a certain company at a contractual
cost. This plan shows that competition could work to the advantage of the
consumer, but this system must be carefully monitored to ensure that all patients
receive appropriate care.
Attempts to Aid the Consumer
Better-informed and educated consumers would lead to better health and better
provision of medical care throughout the world. Through use of the Internet, and
given the availability of information regarding laboratory testing and medical
procedures, many patients are able to determine the course they wish to follow
as to diagnosis and treatment. However, this can cause problems where patients
question physicians regarding a medical condition if the patient is only partially
aware of the impact of a disease and the reasons for embarking on a particular
course of treatment. A new company, Carol.com, is one of the beginning efforts
to aid the patient in gauging the cost of treatment in an online medical marketplace.
It is probable that this is just the beginning of efforts to inform consumers
and to answer their questions about their health. Such availability of information
is timely in that it is said that the health care system is “broken” in this country
and that the nation’s health care crisis shows both acute and chronic problems
that must be addressed personally and politically.
Will putting more choices in the consumers’ hands drive down spiraling
health care costs? A valid fear is that the vast array of choices may be too complex
for the average person to make informed selections. In some companies, the
previously expected health care insurance as part of the employee benefits package
is rapidly disappearing. It has been replaced by health care savings accounts,
sanctioned by the government, that include a tax benefit. In addition to health
care changes, pensions have been replaced by 401(k) investment plans in place
of a retirement plan managed by the company. As an advantage, employees
are now able to change jobs and take their retirement accounts and their health
care accounts with them if allowed.
Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.