Caring for patients and paying for it are two different things.
Tied together, but vastly different, caring for the sick or injured constitutes health care, while health insurance pays for care. Doctors, nurses and other providers take care of patients, while private and government-sponsored insurance programs pay the bills.
Health Care Providers vs. Insurance Companies
Health care providers include hospitals, nursing homes, physical therapists and dentists. They can be for-profit or non-profit and most are privately owned, although there are examples of publicly funded entities, such as military hospitals, VA medical centers and local health districts.
Insurance coverage is obtained through companies like Aetna, Blue Cross Blue Shield and Kaiser Permanente, which provide most insurance coverage in the United States. Insurance programs funded by federal and/or state governments include Medicare, Medicaid, TRICARE, Medi-Cal, MassHealth and COBRA.
How People Get Care, Insurance
People see doctors in many settings, including the emergency room (ER), during surgery or annual physicals. Most visits require appointments, although the ER and community health clinics see patients as they arrive.
Insurance can be obtained through an employer, often to cover both the employee and family members. Insurance can also be provided by entities like unions or purchased directly from insurance companies.
Care With Insurance
Group coverage offered by employers or unions may pay all insurance costs or be a combination of employer benefits and pay deductions. The government and insurance companies reimburse providers for the cost of care.
For those without private insurance, state programs help the uninsured or under-insured pay for care.
Denials
Individuals with preexisting conditions or in need of experimental or expensive care may be denied coverage.
Challenges
It is expensive to provide care and fund advancements in technologies, treatments, and drugs. As of 2010, no consensus has been reached in the U.S. on what role, if any, government should play between providing care and paying for it.
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