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DISCOUNT HEALTH INDUSTRY

The healthcare industry remains in a state of turmoil and crisis. Each year, the cost of insurance skyrockets. The need for affordable healthcare alternatives has never been greater.  The U.S. Census Bureau recently released the following information to the public:

  • 46.6 million people, or 15.9% of the U.S. population, were without health insurance coverage in 2005, up from 45.3 million Americans, or 15.6% of the population, in 2004, an increase of 1.3 million people;
  • The percentage of people covered by employment-based health insurance decreased from 59.8% to 59.5% between 2004 and 2005;
  • 8.3 million children under the age of 18, or 11.2% of all children under the age of 18, were without health insurance in 2005; and
  • In 2005, the uninsured rate for Hispanics was 32.7% compared to 15.9% for all members of the U.S. population, and of the 46.6 million Americans who are uninsured, 14.1 million were Hispanics. 

Source:  U.S. Census Bureau Report on Income, Poverty and Health Insurance Coverage in the United States in 2005.

 

Several factors have contributed to the increase in the number of people who do not have health insurance, including the following:

Over Utilization of the Healthcare System.  American citizens are utilizing healthcare services at an ever-increasing rate.  Behind this phenomenon is the fact that insurance plans and HMOs are structured to encourage usage.  Small co-payments, generally from $10 or $15 per office visit, encourage insured consumers to use the healthcare system more frequently because they do not perceive themselves as having to pay the full cost of the medical products and services received.

Strict State Insurance Regulations.  A number of insurance companies have pulled out of certain states due to state regulations that no longer provide a viable operating environment.  As a result of these health coverage cancellations, those formerly insured individuals and families are required to pay more for their insurance coverage, cannot obtain any coverage because of pre-existing conditions, or simply remain uninsured for healthcare.

Escalating Tensions Between Medical Providers and Payors.  Tensions between medical providers and payors are escalating.  The medical decision is often no longer in the hands of the doctor and the patient.  Rather, administrators at HMOs and insurance companies determine the procedures to be performed through their coverage policies.  In addition, doctors and hospitals, having experienced decreases in their income and profits, are demanding higher compensation, particularly from HMOs.

These increasing costs have led to limitations on reimbursement from insurance companies, HMOs and government sources and have generated demand for products and services designed to control healthcare costs.  Many employers have responded to the increased cost of providing health insurance to their employees by reducing or eliminating available insurance coverage and/or by requiring employees to contribute heavily to premiums, especially for family members.

As a result, more Americans are being forced to self-insure and pay a growing portion of the cost of their healthcare.  Some are entirely uninsured.  Others can only afford or choose only a high deductible or limited benefit health insurance policy.  In either case, this patient population increasingly forgoes medical procedures or relies on emergency care for its healthcare needs and often incurs prohibitive expenses.  Additionally, costs of healthcare (in doctors’ offices and hospitals) for this patient population are often far higher than the amount an insured and the insurance company would pay for the same healthcare services for its insureds.  The uninsured and underinsured patients have had no one to negotiate healthcare service costs on their behalf.

Market demand is significant for any product that can accomplish one or more of the following:

  • provide a low-cost alternative to health insurance for the 90-plus million Americans who have either no insurance or only catastrophic insurance coverage;
  • provide small businesses that do not provide health benefits to employees with an affordable way to provide benefits to their employees;
  • reduce the cost of claims and re-insurance premiums for large corporations, unions and insurance companies;
  • provide quality care at a price that is both affordable to consumers and that will pay providers a reasonable profit for their services; and
  • provide supplemental benefits, such as dental, vision, elective surgery, chiropractic and alternative care, that are not covered by insurance plans.

The need for solutions to the problems facing the healthcare industry led to the development of the health savings industry.  The health savings industry is generally comprised of organizations that offer discount health programs to uninsured and underinsured individuals that enable these individuals to purchase the healthcare products and services they need at discounted prices.  Discount health programs provide these individuals with a low-cost alternative to insurance that assist them in reducing their out-of-pocket healthcare costs.  Discount health programs are typically offered to these individuals in the form of traditional membership service programs.

 
 
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