Hi, and welcome to what will probably be many articles about careers in the healthcare industry. This article is designed to give you an overview of the basics of the somewhat embattled US healthcare system. This is not an exhaustive review of the entire industry, but it should give someone who is considering for jobs in nursing a leg up.
In the US, a diverse selection of individuals and legal entities pay for health care- patients are offered both inpatient and outpatient services by charitable, commercial, or governmental entities. The healthcare system is funded by a mix of public and private funding, with the government picking up about 45% of the total annual cost.
There is also a huge market in the US for medical devices, medicines and medical research and development. Most spending on medical R and D is privately funded; however, non-profit organizations and the government provide some funding as well. Most medical research and development for direct medical application is conducted in commercial labs, and most general research is funded by the government (for example, the National Institute of Mental Health) or by universities.,
The law uses a “fee for service” business model when it comes to healthcare similar to other service industries, meaning that the patient must pay out-of-pocket, in full, for all medical treatment rendered. If a patient has insurance, they will pay a set monthly premium that will help pay most of the cost of medical treatment, however, a deductible (a minimum part of the total cost) is usually paid up front. Alternatively, the patient may have to pay a “co-payment”- a small part of the cost of every procedure.,
Most health care coverage provided through a person’s work is provided through managed care organizations which pay much lower prices for medical services than an individual would if they paid out of pocket. The thing that makes managed care different from traditional insurance is that the health plan organization has contracts with specific health care providers, as the managed care organization is able to bring their numbers to bear to negotiate price reductions.
There are many individuals that are not covered by private insurance, but are covered by government programs such as Medicaid (which provides care to the poor), Medicare (which provides care for the elderly and disabled), or the Veterans Administration (which provides care to veterans, their families and survivors). In 2006, Medicaid provided coverage for 38 million Americans while Medicare did the same for about 40 million. Another 11 million people are eligible for coverage but are not enrolled in any kind of government program.
The number of physicians accepting Medicaid has decreased over the past decade due to high administrative costs and low levels of reimbursement. Another program, the State Children’s Health Insurance Program was created in 1997 to provide coverage for children in families that earn too much to qualify for Medicaid yet can’t afford to buy health insurance- however, this program is already losing funding in may states.
As you move forward in your career, only you can decide if the health care industry is right for you. Be vigilant, don’t get discouraged- and you will find the perfect jobs in nursing job you’re looking for in no time at all!
