Comparison of Health Insurance Plans and Quality of Healthcare Services

Compare Health Insurance Plans

After an individual makes a thorough review of what benefits are provided under the healthcare plan and thereafter decides as to what is important to him/her, the next step in the process is to make comparisons between the healthcare insurance plans available in US markets. While analyzing such insurance plans, many factors should be considered viz. the products or services offered under the plan, choice of healthcare providers, location, cost of treatments, coverage, exclusions and reimbursement under such plans. The quality of healthcare products and services being offered under the plan is an important factor that should be accorded due weightage.

Knowing about the Quality of Health Insurance Plans

To understand the quality measures provided by health insurance plans, two important processes need to be considered:

a) Measures to be adopted

b) Accreditation

a) Measures to be adopted

Quality is hard to measure especially quantitatively, but more and more details regarding quality measures is being made available to the general public. Before purchasing a health insurance policy or product, there are certain parameters that need to be given importance. The individual should feel free to ask relevant questions desired by him/her. Whenever an individual purchases any health insurance plan it is always recommended to check out individual doctors and hospitals provided under the particular health plan.

The Managed Care Plans are regulated by federal and state agencies across USA. Indemnity plans are regulated by State Insurance Commissions. Further details regarding insurance policies can be derived from State Department of Health or Insurance Commission, USA. It is imperative to know that if the Managed Care Plan in which an individual is interested has been "accredited" or not. It is also important to know the current rating of a particular insurance product or service in the market.

Some states require compulsory accreditation if plans serve special groups. Moreover, some employers will only contract with health insurance plans that are accredited by reputed national standard agencies in USA. Several national organizations continuously review and accredit health insurance plans and institutions for enhancing the customer satisfaction and maintenance of standards across healthcare organizations. An individual has the liberty to approach such organizations to check and cross-verify whether the healthcare policy he/she is considering to buy or the institution in the plan, is accredited or not.

Another approach is to enquire the quality of healthcare products and services provided under that particular health insurance plan. For this purpose, the following points need to be analyzed:

Are the services being provided under the plan are up to the mark or are there any deficiencies in the services?
How competent are the doctors, medical professionals, hospitals and other healthcare institutions covered under the scheme? Are they able to deliver the products and services in a timely manner?
Are the quality standards maintained and upgraded from time to time?
Does the plan review the qualifications of doctors before they are added to the plan?
What strategies are employed to identify a problem?
By identification of the problem, has it resulted in any change or difference in the concerned product or services?
What are the strategies employed to review the services provided under the plan?
How are the problems or customer grievances addressed?
Are such genuine customer complaints resolved in a time bound manner?

There are certain Managed Care Plans that conduct a survey regarding their members by highlighting their healthcare experiences by the service providers. An individual has the liberty to ask for survey reports conducted from time to time and study them so as to decide regarding the health insurance product or service to be availed.

Some health insurance plans and independent agencies are also beginning to produce "report cards." These reports often include satisfaction survey results and other details pertaining to quality of services provided under the plan, whether the health insurance plan provides access to preventive care for eg. Immunization for children and Pap smears for women etc. Report cards may also include data regarding the number of individuals members that continue with the health insurance plan or leave the plan, how many medical professionals are accorded board certification under the plan or how long an individual requires to wait for getting an appointment. Such report cards can only give an idea of how a health insurance plan works and may or may not give a descriptive picture of the plan's quality.

Finally, before purchasing a particular health insurance product or service, an individual can approach the current members of the health insurance plan and discuss with them the pros and cons about the product. A prospective customer can ask them about their individual experiences under the plan for eg. waiting period for seeking appointments with the concerned doctors, assistance and helpfulness of medical staff, the services offered to an individual and the care received under the health insurance plan etc. can be enquired.

b) Accreditation

The list of Accreditation bodies across USA is enlisted below:

i) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

JCAHO evaluates and accredits nearly 20,000 health care organizations and programs including almost 12,000 hospitals and home care organizations, and more than 7,000 other health care organizations that provide long term care, behavioral health care, laboratory and ambulatory care services across USA. The Joint Commission also accredits health insurance plans, integrated delivery networks and other managed care entities. There are various parameters specified under the SOPs (Standard Operating Procedures) for assessing the quality of products and services provided by various healthcare organizations.

ii) National Committee for Quality Assurance (NCQA)

NCQA accredits HMOs (Health Maintenance Organizations) and other managed healthcare organizations including service providers.

iii) American Accreditation HealthCare/Commission/URAC

It accredits PPOs (Point-of-Service) and other managed healthcare networks including service providers.

iv) Accreditation Association for Ambulatory Health Care

It accredits outpatient health care settings such as ambulatory surgery centers, radiation, oncology centers, student health centers, rehabilitation centres and de-addiction centres.

v) Community Health Accreditation Program

It provides accreditation to community, home health, domiciliary treatment, hospice programs, public health departments and nursing centers.

vi) Consumer Coalition for Quality Health Care

It is a national, non-profit organization of consumer activists advocating for consumer protection and quality assurance programs and policies for the welfare of the masses.

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