Who will pay for your care may determine what kind of care you receive and where you receive it. Often payers control the amount and types of healthcare services people receive. Traditional insurance companies offer plans that pay for health care of plan members. Most people covered by traditional insurance are part of a plan at their place of work. The costs are paid for by the employer, the employee, or shared by both.
Traditional insurance plans usually provide excellent care for their members. However, the costs have risen greatly and many employers and employees tan no longer afford to pay for traditional insurance plans.
As a reaction to the increased costs of traditional insurance plans, many employers and employees belong to health maintenance organizations (HMOs). If you belong to an HMO, you must use a particular doctor or group of doctors except in case of emergency. The doctors working for HMOs are paid to provide care while keeping costs down. Thus they may see more patients, order fewer tests, or cut costs in other ways.
Preferred provider organizations (PPOs) are another healthcare option used to reduce costs. A PPO is a network of providers that contract to provide health services to a group of people. Employees are given incentives to use network providers. Employers are given reduced, fee-for service rates for getting employees to participate in the network. A person in a PPO may still get health care outside the network of providers, but must pay a higher portion of the cost.
If you become seriously ill, you may be admitted to a hospital. This decision is made by a doctor, and may have to be approved by your insurance company. The costs of hospital care have risen greatly. To make up for it, healthcare payers are controlling who can be admitted to a hospital and for how long.
After release from the hospital, many people need continuing care. This is particularly true as people are released after shorter hospital stays. Continuing care may be provided in a skilled nursing facility, a long-term care facility, a rehabilitation hospital, or by a home health agency. The type of care depends on the medical condition and needs of the patient or client.
Our healthcare system is constantly changing. As we develop new and better ways of caring for people, care becomes more expensive. Better health care helps people live longer, which leads to a larger elderly population that may need additional health care. New discoveries and expensive equipment have also driven healthcare costs higher.
HMOs and PPOs continue to replace traditional insurance plans. This affects the amount and quality of health care provided. These cost control strategies are often called managed care. In the past the goal of health care was to make sick people well. Today it is to get sick people well in the most efficient (least expensive) way possible. Home health care is in part a cost-controlling strategy because it is less expensive to care for someone in the home than in a facility. Shorter hospital stays, another cost-controlling strategy, have also increased the need for home health care.