Health Care System in the Industrialised Countries and the Role of Private Insurance

9. Service offered by the private health insurance

Generally, insurance companies offer a broad range of services. In a number of insurance forms, benefit is negotiated as a (complete or partial) reimbursement for the costs borne to use health care services. Reimbursement of medical costs is the most important indemnity cover. Depending on the policy, reimbursed costs can be for diagnostic examinations, medical fees, hospitalization costs, purchase of medications, dental expenses, physiotherapeutic treatments, etc.
In addition, benefit can be provided just for specific diseases, like dread diseases that occur only in case of serious illnesses.
At any rate, when insurance covers those who are excluded from state-run services, the range of services it provides is quite diversified, but in some countries the provision of these services is subject to special regulations. As a matter of fact, in Germany and in the Netherlands standard policies are sold according to the terms set by Law to avoid the risk that part of the population remain without medical coverage.
In case of additional medical coverage, demand should meet the needs of those citizens who cannot find an adequate response within the state-run health care system. Regardless of the organizational structure of the public health system, the emphasis on ‘quality’ has been gradually increasing all over the world. In this respect, statistics about Italy are merciless. In terms of quality of service provided, Italy ranks 11th among the thirteen most industrialised countries in Europe, followed only by Portugal and Greece (EuoroHealth Consumer Index, 2005).
Despite inefficiencies and poor services, it should be highlighted that the Italian system and those of the other European countries can cover the entire population. This is not the case in the United States, where many people are in fact excluded from highly technological health care services because of their low income.
However, long waiting times for medical services, uncomfortable hospital accommodation, and limited freedom in choosing service providers can encourage people to buy private insurance. In Italy, Denmark, Australia, Ireland, New Zealand and the United Kingdom citizens must endure long waiting times for specialist examinations, surgeries or simple diagnoses given the lack of flexibility in the public system due to cost rationalization policies.
Insurance directs citizens to health care facilities that can provide the required services promptly, and in some countries it gives people the option of having more comfortable accommodation in private rooms in public facilities. In Austria, Ireland, Portugal and in the United Kingdom, hospitals offer private beds; in Australia, public facilities can accommodate and treat private patients. In so doing, insurance becomes an additional source of financing.
Under some insurance schemes, private insurance is used to replace earned income (e.g. daily allowance for temporary disability) and turns into a benefit paid when the insured is fully or partially unable to work because of his/her illness; under other schemes, the amount of money agreed upon is independent of financial loss resulting from the changes in the health status (for instance, a lump sum the event of permanent disability).
Among the innovative policies launched by insurance companies, Second Opinion Best Doctors and Long Term Care are worth mentioning. The first policy offers access to a network of specialists, mostly active in university centres, who check the correctness of prior diagnoses, suggest the most suitable therapy, excel in medical research, and in case of special needs provide information on the most advanced health facilities at the international level.

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