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HEALTH CARE AND THIRD-PARTY PAYERS
The fundamental principle of insurance underwriting is that the cost of health care can be predicted for large populations. This is the principle by which health care premiums (payments) are determined. Policyholders pay premiums into a pool, which fills as reserves until needed. When you are sick or injured, the insurance company pays out of the pool, regardless of your total amount of contribution. Depending on circumstances, you may never pay for what your medical care costs or you may pay much more for insurance than your medical bills ever total. The idea is that you pay in affordable premiums so that you never have to face catastrophic bills. In today\'s profit-oriented system, insurers prefer to have healthy people in their plans who pour money into risk pools without taking money out.
Unfortunately, not everyone has health insurance. Almost 40 million Americans are uninsured at any given point in time - that is, they have no private health insurance and are not eligible for Medicare, Medicaid, or any other health program that would cover the cost of their care. The number of the uninsured has been growing since the late 1970s. Lack of health insurance has been associated with delayed health care and increased mortality. Underinsurance (i.e., the inability to pay out-of-pocket expenses despite having insurance) also may result in adverse health consequences. Findings from the CDCs latest Behavior Risk Factor Surveillance System (BRFSS) indicate that a large proportion of all adults are either uninsured or underinsured. People lacking any type of health insurance make up nearly 17 percent of the nonelderly population, or 15 percent of the total population. Another 20 to 40 million Americans are estimated to be underinsured (at risk for spending more than 10 percent of their income on medical care because their insurance is inadequate).
Contrary to the common belief that the uninsured are unemployed, 75 percent of the uninsured are either workers or the dependents of workers. One quarter of all the uninsured are children under the age of 16. College students are one of the largest groups of the uninsured not in the labor force. This presents a difficult dilemma for both universities and students when they must seek care because most university insurance plans are designed as short-term, non-catastrophic plans having low upper limits of benefits. As a full-time student, you should consider purchasing a higher level catastrophic plan to protect yourself in the event of a rare, but very costly, illness or accident.
For the uninsured and many of the underinsured, health care may not be available through any source because of their inability to pay. Many either will not or cannot seek care from charitable providers, so they fail to receive the medical care they need. People without health care coverage are less likely than other Americans to have their children immunized, to seek early prenatal care, to obtain annual blood pressure checks, and to seek care for serious symptoms of illness. Many experts believe that this ultimately leads to higher system costs because the conditions of these people deteriorate to a more debilitating and costly stage before they are forced to seek help.
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GENERAL HEALTH
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