“Social health insurance” means insurance coverage that helps citizens pay for chronic conditions. It also means other health concerns beyond what they can afford, with the help of private insurers. These principles of social health insurance also are a must for our self good-live.
However, there are several problems associated with social health insurance that need to be addressed. This article will help you understand about Principles of social health insurance better.
What is the social health insurance system?
Social health insurance is a social protection program that provides an additional layer of security to individuals and families in times of need.
It also helps the government cover the expenses incurred by individuals in medical treatment or death due to accidents, sickness, or old age.
The National Health Insurance Act (NHIA) was passed in 2001, under which NHIS was launched on 1 January 2003. The scheme covers around 100 million people at present, with plans for expansion over time.
Health insurance is a form of coverage that protects individuals against the financial consequences of certain health-related events. There are two types of health insurance:
Medical Insurance – Coverage provided by employers to their employees in which they pay for medical expenses. This is either through payroll deductions or out-of-pocket. Employers can choose whether to offer medical insurance benefits to their employees. On the other hand, employee contributions are tax-deductible if paid through payroll deduction.
Self Insurance – It is a type of coverage that covers healthcare costs when an individual has insufficient funds or cannot afford healthcare services. This is due to economic hardship. Self-insured plans are usually funded by large groups. For example, unions or employer associations, rather than individuals within the group itself.
What are the principles of health insurance?
The few principles of health insurance are:
- The more you spend, the less you pay in premiums.
- The more benefits you get, the lower your premium is
- You can’t get any benefits if you don’t have health insurance.
- Health insurance companies do not want to be liable for any claim. This is because they will lose money if their customers pay it.
- If an individual has a pre-existing condition. After then they cannot buy health insurance coverage until that condition gets cured or improved.
- Anybody who doesn’t have adequate health insurance coverage is at risk of being bankrupt. Because their medical bills may exceed their assets, and there won’t be enough money to pay them back when the bill comes due.
- There is no limit on how much your policy can cover per illness or injury. But there is a maximum cap on how much your policy can cover over time (e.g., lifetime maximums).
- In most cases, people who choose to go without health insurance end up paying more in hospital costs than they would have had they been insured since even minor illnesses and injuries can lead to major problems later on in life.
What are the key features of social health insurance?
Social health insurance covers the medical expenses of people who are employed in the organized sector. Social health insurance is available to all working adults who their employers cover.
It helps them access free or subsidized health care services, including prescription drugs and emergency care. Social health insurance is offered through private insurers or public agencies like HMOs (Health Maintenance Organizations).
The eight key features of social health insurance include:
1) Health coverage for employees;
2) Free preventive services;
3) Deductibles;
4) Co-payments;
5) Insurance companies’ cost-sharing requirements (the amount they will pay out);
6) Benefits package defined by law;
7) Limits on premium payments;
8) Employee contributions for employee benefits.
Types of social health insurance
In the United States, Social Health Insurance was created to replace traditional fee-for-service models with more patient-centered care. There are two types of social health insurance:
1) State-Based Public Health Insurance –
In most states, social health insurance is funded by both state and federal governments.
2) Private Social Health Insurance –
Some people have chosen to create their private systems, which may be based on Medicare or Medicaid eligibility guidelines. These plans offer a higher level of coverage than traditional government programs. Because they pay benefits directly to providers without going through a central agency.
Also read: How To Talk To Insurance Claims Adjusters
Disadvantages of social health insurance
Some disadvantages of social health insurance are:
(1) Social health insurance is not a solution to all the problems of the uninsured.
(2) It is not possible to ensure that everyone who gets coverage under this program will use it because the cost of providing benefits is far greater than any premium received by those covered. As a result, many people will be excluded from enrolling in this program, which means they won’t have access to these benefits.
(3) some people don’t want or can’t afford coverage under this program. Many would prefer to pay for their own medical care out-of-pocket instead of receiving tax subsidies and expanded Medicaid coverage through this program.
(4) The federal government will assume most of the costs associated with covering these people through other programs like Medicare and Medicaid, at least initially. This means that there may be significant budget deficits within those programs.
Social health insurance vs. private health insurance
Many people wonder which is better to have, social health insurance or private health insurance. Well, it depends on your situation and what you want from your medical care.
Social health insurance is for you if you want a low cost but no access to the best medical care. You can also go to a public hospital with low fees and offer free services such as treating an injury or illness if required by law.
However, this doesn’t mean that there won’t be any charges at all because hospitals usually require payment in cash before service is rendered, and many times it takes time to get reimbursed.
Suppose you are looking for quality healthcare and don’t mind paying higher premiums. Going with private healthcare coverage would be better because the facilities will offer top-notch treatments for less money than other facilities that provide similar services such as MRI scans or CT scans.
Also, you might not need a lot of tests like those recommended by doctors when they treat their patients because they know how everything works already based on their experience over years of working in the field.
Social health insurance vs. national health insurance
- National health insurance covers all citizens of a country who are living in the country when applying for health care services.
- Social health insurance is an additional type of social security coverage provided by some countries to individuals or families that are not covered under national health insurance plans.
- It covers specific groups such as children, students, retirees, and others who cannot be covered under national health insurance programs due to certain reasons like undocumented immigrants or not having legal status in their countries.
- Social health insurance is usually sponsored by employers to cover employees, especially those working in industries with high risks associated with the work environment and diseases caused by exposure to hazardous chemicals used during manufacturing processes, etc.
- Social Health Insurance is less expensive than national health insurance because it does not cover so many services, including dental care, prescription drugs, hospitalization costs, etc.
- The main difference between the two is that the national health care system provides services to everyone in a country, while social health insurance covers only those who can’t afford it.
- The National Health Care System is financed by taxes paid by every individual, family, and company in a country, whereas social health insurance is funded by employers and employees themselves through payroll deductions
Final Thoughts
Hopefully, you can now understand clearly what are some principles of social health insurance.
Based on these principles, social health insurance is designed to protect individuals against the cost of medical expenses they may incur.