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Health Insurance: Profits or Patients?

 
 
Jot Evil Rules During Weddings
04:39 / 30.08.08
I have had a very personal experience with this issue when I seriously injured my leg a month ago. My doctor believed I had broken my ankle, and ordered that I undergo an x-ray in order to confirm whether or not I had broken it. My health insurance company said it would not pay for the x-ray unless my doctor said that my ankle was broken. Of course, my doctor could not confirm that my ankle was broken unless I had an x-ray. My doctor, being a nice person, called up the health insurance himself and claimed that he was certain that my ankle was broken, which was completely untrue. They ended up paying for my x-ray and it turned out my ankle was not broken but severely sprained. Anyway, this experience made me start thinking more deeply about the health insurance industry.

In the end, the health insurance companies are about profits, they are accountable to their shareholders and not their patients. I feel like the only case in which they really truly care about their patients is to make sure they do not get sued for being negligent. I remember the story that John Edwards used to always tell about the girl whose life-saving transplant was denied by her health insurance company, and they finally approved her transplant the day she died. In that case she had health insurance but the health insurance picked profits over their patient, and she died for it. I really don't think that a health insurance company should be both in the business of keeping people healthy and making profits.
 
 
frenchfilmblurred
07:39 / 30.08.08
Since I live in the UK where, for now at least, we have a fairly comprehensive nationalised health service, my only window into a health insurance based system is Michael Moore's documentary 'Sicko'. The picture presented there makes me dread the day when that kind of system takes over here. Medical experts who had worked for health insurance companies interviewed in 'Sicko' admitted that the basic purpose of their job had been to ensure that a certain percentage of claims were denied, even though they knew many of those claims were valid.
 
 
Red Concrete
01:05 / 31.08.08
This area is very interesting to me - I work in reasearch in an area which is partly medical, and almost certain to become more medicalised the more it is developed (medical genetics).

Can you clarify a little for me the sequence of events? The doctor in A&E (or whereever you were) would not take an X-Ray before they knew who was paying for it? i.e. Were you waiting for a phone call to see if you could be diagnosed, never mind treated??
 
 
Closed for Business Time
11:12 / 31.08.08
Although not strictly the same: An analogue of this issue arises in NHS-type systems as well. Witness the debates in UK media over whether certain types of very expensive medicines should be freely available to NHS patients, or whether people should pay for it themselves (thereby potentially foregoing free NHS treatment - link). The private sector wants to maximise profits while the public sector wants to minimise costs. The upshot is that patients are denied treatment and procedures that are to varying degrees essential for their well-being.
 
  
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