The Ins and Outs of Different Healthcare Systems

a doctor looking at a patient

There are many models of healthcare systems throughout the world. From single-payer/provider like the Veterans Affairs Department in the United States to universal care in most of Europe, or even multi-payer/provider like the Affordable Care Act and Open Marketplace in the U.S., the ways patients and doctors go about navigating these systems can be different in every case. Sadly, it all adds up to a complicated healthcare system and can impact the level and quality of health care a person can receive. While many would argue that it’s nice to have healthcare providers and insurance options, the key to making the most of your coverage and care is understanding your policy, as it’s likely very different than your neighbor’s.

If you’re not sure how to move within your U.S. healthcare system it works with healthcare services in general, you’re far from alone. Read on for some common issues people find hard to navigate.

Pharmaceutical Services


In the United States, people use a combination of private and federally owned pharmacies to get their prescriptions and medications. These drugs are paid for in many ways. In the Open Marketplace, for example, it could be an insurance company, a combination of insurance companies, or even a patient with a high deductible paying for important medications. Whether they are fortunate enough to use USA Rx for discount coupons or not, the amount of coverage a patient has is often dependent on their health insurance plans. Many Americans do, in fact, opt to use discount coupons such as the ones offered by USA Rx in order tomato their trip to the pharmacy a bit more financially manageable.

If a veteran wants their medications, they can get them for free through federally run pharmacies in local VA hospitals and facilities. While this may sound easy, it can also be inconvenient. The same veteran is required to see a VA doctor for this benefit. Sometimes, this means drives of up to two hours each way just for the renewal of a prescription.

Emergency Services


Emergency services in the United States aren’t any less complicated. For a multi-provider and multi-pay system, a person looking for emergency treatment or a ride in the ambulance may very well have a billing nightmare ahead of them. This is because some insurance companies will demand pre-authorization for emergency treatment while others won’t. For a person with primary and supplemental insurance coverage, this can turn into a logistical battle of who picks up the bill, when all the patient needs is first aid or CPR.

While EMTs, paramedics, and others in emergency services are brushing up on first aid training and CPR skills at places like American Health Care Academy, a potential patient with Medicare could be ready to make that emergency call. In this healthcare system, the patient has single-payer but multiple provider services. While many might assume a single-pay, multi-provider system would be easy because of one bill, they’d be wrong. Because people with Medicare have options for advantage and supplemental plans, it again becomes a matter of how much their specific insurance company is willing to pick up the costs. Where one retired person might have great coverage and an insurance company waiting to foot most of the bill, another person may not. Obviously, CPR is not a service you can hem and haw about if you need it, so it’s important to have an understanding of your health insurance coverage for informational purposes, long before emergency strikes.

Mental Health Services


Mental health services are no different than emergency and pharmaceutical and it all boils down to the same thing: which healthcare system your policy and plans fall under and which country you live in. While mental health services are covered for everyone in England, for example, it’s very different in the United States.

Many people in the U.S. have commercial health insurance. This type of coverage, tied to employment, is multi-payer/private insurance. Different than insurance from the Open Marketplace, these coverage types often move strictly within networks and limit the doctors or types of services a person can have. Tied to employment, commercial health insurance also becomes an issue after job loss.

Maybe you have a serious mental health diagnosis and in spite of treatment, it causes you to lose your job. Without your job, it will likely be a matter of time before you lose your insurance and either have to move to the Open Marketplace or pick up federally funded Medicaid. This will certainly cause a disruption to your treatment. On top of it, if you are now in a single-pay situation with Medicaid, your options could be again limited on if your doctor would even see you as this system pays out at a reduced rate.

In the end, there are major complications with multiple healthcare systems in the same country. While some claim this is why universal care is needed in the United States like many other countries, others argue that such a thing would limit choices and quality of care. They claim it could also hurt healthcare providers in that they’d be forced to stick to federally mandated rates. The best way to navigate the ins and outs of this complicated web of systems is to know where you stand and to ask questions about your plan. Don’t be shy‚Äîask as many questions as it takes to ensure accuracy of information.

Related Articles