Introduction
The study of the issue of the emergence of private health insurance and how it arose in society has exceptional value for study. This is because, this way, it is possible to gain a deeper understanding of the motives of this action. Additionally, it gives an insight into the foundations that were laid at the very beginning. Therefore, this work aims to study the phenomenon of private health insurance. In addition, valuable data will be provided on its impact on the activity of nurses and the formation of new federal laws.
History of Private Health Insurance
Private insurance takes its foundations at the beginning of the twentieth century. In the 1920s, medical institutions began to offer services for which it was possible to pay in advance. The sources under study note that the first employer-sponsored plan was developed by educators from Dallas, who created a program of medical services for which they were willing to pay a fee (“History of private insurance,” 2022). In the future, this initiative was developed under the name Blue Cross.
Another program developed at that time, which served as the basis for the formation of modern private medical insurance, was Blue Shield. A distinctive feature of this approach is that company executives have teamed up to provide physician services to their employees (“History of private insurance,” 2022). A significant contribution to the formation of the studied aspect was made by the Great Depression, during which hospitals fell into a state of crisis due to a sharp decline in prices for healthcare plans and occupation rates. This became the motivation for the development of such programs that would be least dependent on external conditions and would not cease to bring profit to medical institutions.
The main breakthrough in the development of private insurance was the creation of UnitedHealthcare. This initiative was created in the seventies and, to this day, is one of the largest providers in the United States of America (“History of private insurance,” 2022). Managed medical care became widespread at the beginning of the nineteenth century. It is a type of health insurance that also aims to reduce the financial costs of healthcare. It arose as an initiative of several medical specialists who decided to provide their services for a fee. The people who were offered this assistance were members of fraternal orders and trade unions. The payment was carried out annually and included the services of a doctor and additional actions related to improving the well-being of a person.
Federal Laws Connected with Private Insurance
With the development of private health insurance, it became necessary to create federal laws that would protect those involved in it. Thus, one of the most important legislative acts became a federal law called Patient Protection and Affordable Care Act. This initiative affects all groups of the population. Even those individuals who have not yet received coverage. The Affordable Care Act implies that everyone must have health insurance or pay the penalty. A positive feature of the act under study is also that it reins in the cost of health insurance. Hence, people are offered tax credits to facilitate the payment for health insurance.
The second crucial federal law in the framework of the area under discussion is The Consolidated Omnibus Budget Reconciliation Act, or COBRA for short. Unlike the first one, it directly affects employers who offer group medical coverage. The protection of individuals under health insurance is that in case of dismissal or other circumstances, the employee has the right to the continuation of healthcare benefits. The law also implies the existence of three coverage periods, which determine the continuation of coverage. Moreover, this law ends when an employee gets a new job and is covered by new insurance from a new employer.
The third federal legislative action that needs to be mentioned is the Employee Retirement Income Security Act of 1974, or ERISA. This law covers employers who offer health insurance services for employees (Russ, 2019). The scope of the legislative initiative under study is the regulation and control of employee benefit plans. Moreover, it requires employers to provide the necessary knowledge about the plan to employees. As a law that provides support and protection to people under private life insurance, ERICA considers cases of claims and appeals against programs.
The latest federal law becomes the Health Insurance Portability and Accountability Act, abbreviated HIPAA. This approach affects all employers who have more than two employees in their company or organization. The value of HIPAA appears to be that it provides the acquisition of insurance to individuals in the event of a change of workplace or in the presence of certain health conditions that require medical care. Thus, employers and heads of organizations do not have the right to refuse to provide health insurance to employees.
Consumer-Driven Healthcare and the Empowerment of the Healthcare Consumer
The next aspect that requires more detailed consideration is consumer-driven healthcare and the empowerment of the healthcare consumer. As the name suggests, both of these points are aimed at facilitating individuals’ access to health services. Hence, consumer-driven health implies the creation of programs that consider such points as “low premiums, high deductibles, and savings accounts” (Ferguson et al., 2021, p. 1457). Consequently, its advantage is that it reduces the excess spending of financial resources. Moreover, customer-driven health will allow people to make their own informed decisions, which are supported by the acquired knowledge about the care and assistance they need.
When considering customer-driven health, it should be mentioned that its main advantage is the fact that they fully perform its primary function. In other words, this initiative helps individuals gain access to healthcare services at a reduced cost. Henceforth, any person can be provided with the necessary assistance, regardless of their financial situation. The discussed terms of the consumer-driven healthcare concept help in saving spending for those segments of the population who do not have severe problems with their well-being. This is since these segments of the population do not need to spend money since they rarely seek help from medical specialists.
Another advantage of consumer-driven healthcare, which follows from the previous one, is the limitation of cases of unjustified spending on medical services. Moreover, it is worth noting that, if necessary, individuals can contact medical specialists to obtain the necessary advice. In other words, if there is a desire, patients can learn from their attending physicians about possible treatment alternatives or medications that can be changed depending on the person’s financial condition. Therefore, customer-driven healthcare is valuable because it is entirely focused on building a high level of quality of services provided while also maintaining patient loyalty and satisfaction. In addition, it promotes the education of people who will choose the necessary medical services intelligibly and carefully.
Another aspect that also has a special significance is the empowered healthcare consumer. It expires from the practice of consumer-driven healthcare, as it implies a consumer who can make informed healthcare choices based on the knowledge gained. Therefore, in the event of an emergency, such people do not make spontaneous decisions but think about their actions. Furthermore, if a health problem occurs, they will conduct a study of possible alternatives and choose the one that will suit them in all respects.
Opportunities that Emerged for Nurses
With the development of the market for health insurance services, there has been an expansion of opportunities for such medical specialists as nurses. Hence, one of them was the increase in jobs in medical institutions (Salmond & Echevarria, 2017). A large number of hospitals and clinics began to hire nurses within the framework of the federal Affordable Care Act. This is because this legislative initiative has significantly increased the number of patients with medical coverage.
Therefore, with the increase in people whose health and welfare are covered by insurance, the duties of the nurse have also increased. This has opened up more opportunities for continuing or acquiring education, which positively affects the quality of services provided. There is a need to acquire new knowledge and skills that will help improve the health of the population and will contribute to improving the qualifications of healthcare workers.
Conclusion
Therefore, this work dealt with the development of private health insurance and managed care, which was of particular importance for the development of healthcare in America. Additionally, in this process, federal legislative acts were formed, and the role of nurses was increased. Moreover, the work of these medical specialists began to pay more attention to the coordination of medical care. This is done to ensure proper care and treatment, which will reduce the occurrence of problems associated with incorrect or unnecessary services. In addition, nurses began to play a dominant role in ensuring compliance with the concept of patient-centered care.
References
A brief history of private insurance in the United States. (2022). Academic Health Plans.
Ferguson, W., White, B. S., McNair, J., Miller, C., Wang, B., & Coustasse, A. (2021). Potential savings from consumer-driven health plans. International Journal of Healthcare Management, 14(4), 1457-1462.
Russ, E. L. (2019). The Employee Retirement Income Security Act of 1974: An outdated regulatory framework for retirement investors. Iowa Law Review, 105, 399.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12.