As you might expect, the biggest disadvantage of private health insurance may be the cost. This is especially true if you have health problems and don't have access to any type of group coverage. Many individual policies can cost several hundred dollars a month, and family coverage can be even greater. One of the major disadvantages of having health insurance is the cost.
The health insurance policy can be very expensive even for those who have a health insurance plan through their employers. Insurance participation makes primary care more expensive. It is estimated that up to 40 percent of the revenues paid to primary care doctors who participate in major health insurance are used to pay for administrative expenses, claims processing, profits from insurance companies, and compensation from insurance brokers. This list of intermediaries involved in the interactions and care you receive from your doctor doesn't really add value to your quality of care or to the patient experience.
They add significant costs for your doctor, your employer and, ultimately, for you. In reality, inserting these middlemen between you and your doctor makes it more difficult for doctors to do their jobs. Physicians who practice under this model are only paid if they can justify each individual service they provide with codes (CPT procedure codes for specific ICD-10 diagnostic codes) and documentation that the insurance company accepts. A provider contract between your doctor and your insurance company determines the amount that is paid to your doctor in the form of a pay-for-service.
Given the ever-increasing costs of operating a doctor's office, providers can only maintain the viability of the office by increasing the volume of patients they serve. This volume-based care dynamic is why primary care doctors are always in a hurry and access to care is limited. Doctors are often among the most trusted professions, but most doctors practice in an environment that encourages them to request more tests and treatments. Whether you're self-employed or as an employee of hospital systems, your doctor's net salary is largely determined by what the doctor's office bills.
Just as volume-based care adds costs to the system, these misaligned incentives also increase the amount of medical services provided. The real costs of health services and the profit margin at each stage of the delivery system are well hidden. Although there are specific health insurance products for older people, most of them have a co-pay clause. Healthcare providers express concern about how the merger will change the payment process.
The creation of a single database on health insurance would make it easier to eliminate duplication and identify people who do not have coverage, paving the way to universal coverage. The documentary review, in line with the interviews, was used as a complementary source of data collection to investigate the objectives, intentions and reasons for moving towards the merger of health insurance funds and to identify their possible drawbacks and merits. These topics are subdivided into thirty-seven subcategories that represent a wide range of different political aspects, to which special attention must be paid to the merger of health insurance funds. The fragmentation of health funding in Iran has caused each health insurance plan to follow its policies.
For example, although you will only go to the doctor's office when you have serious health problems (in case you are not insured), you can go to the doctor for any details if you have adequate insurance, since it won't cost you too much. According to the interviewees, controlling total health care expenses; improving strategic purchases; eliminating duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of healthcare services provided; making hospitals interact with a single insurance with a single set of instructions for contracting, review and reimbursement; and reducing administrative costs were some of the main benefits of the merger of insurance funds doctor. In contrast to healthcare providers, the interviewees mentioned that, currently, each health insurance plan follows its own rules for hiring and also for reviewing claims and reimbursements. The merger and creation of health insurance plans can influence the interaction with health care providers in a number of ways.
The decision whether or not to take out health insurance can not only affect you, but it can also have a significant impact on your children. It is worth specifying what kind of problems the consolidation of health insurance plans can solve in the area of the health system and health financing. In addition to reducing inequities, the interviewees believed that the merger could improve the collection, management, pooling and allocation of financial resources to purchase health services for beneficiaries. .