Public versus private insurance cover is a dynamic and stochastic process where individuals consider premiums, personal costs, and other preferences. The insurance amenities and restrictions in private insurers are different from public insurers that serve less healthy and wealthy population. The private and public insurance systems have different structures. In the private system, the insurance premiums take into account basic health risk of the insured and that of the dependants.
The patients that subscribe to Medicare receive inferior care for certain medical issues unlike the patients that use private insurance. The patients that use private health insurance have lower average mortality rate than other types of insurance while accessing treatment in the same hospital. For instance, the results of individuals that use Medicare and undergo pancreatic resection experience more deaths in comparison to patients that undergo the same procedure while having private insurance. The data indicates that public insurance patients are prone to receive inferior care than the patients that use private insurance while in the same hospital. The underlying factors that cause mortality rates vary among the patients with different types of health insurance. Private health insurance can increase access to more qualified doctors and apply newer and expensive technologies. The private insured patients have better care since they apply the latest medical technology that is expensive leading to better care in their lifespan. Some of the medical issues such as stroke, pneumonia, and heart failure receive better care while in the private plan than in Medicare. Widespread racial and ethnic disparities in health care and health outcomes in the nation prompt Bronx Health REACH to examine the causes of the disparities and develop the right strategy to address them. Black and Latino people living in New York receive Medicaid and any other public insurance that the Whites. For this case, color face community faces many challenges in the access to high quality care that lead to disparities in health outcomes. Public insured receive care in the public hospitals while the private insured go to the private hospitals regardless of the geographic location Medicaid patients and other public insurance patients receive poor quality care than the private insured patients. The quality of care provided by the hospitals relate to a type of insurance a patient has. Policy-makers must mind this development in the attempt of addressing disparities in care within individual hospitals, The promotion of policies require performance ratings of individual hospitals in regard to quality of care to the patients based on the payment method.
The plan has more benefits with an increase in the premiums. In the public system, individuals pay a certain percentage of their salaries. The plan does not have benefits packages that increase with an increase in the premiums. The private system offers diverse plans and has access to better technology and faster services. In contrast, the public system offers a single benefits package that relies more on the public hospitals that have longer waiting times. Due to the structure differences, between the public and private insurance the selection of the plans depend on individual incomes. Individuals with higher incomes are more likely to select private plans as they derive more benefits when they increase the premiums. A person from the private system can move freely to the public system while it is hard to move from the public to the private system. The private plan has a negative health shock in the pre-existing condition to preclude coverage in any private plan in the future. The public health system in contrast does not have such restrictions. The asymmetry in the restriction can imply that critical sick patients flock in the public health system since mobility from public to private is limited. The workers in the private system maintain private coverage in an unrestricted scenario since that can choose to move to the public system. Private insurers have fear of unforeseen negative future health shocks that can prevent them from ever switching back. Most individuals can switch between systems especially from private to the public system due to higher amenities while they shift from public to private due to lower premiums and out-of-pocket costs. The worsening health status may lead to a change from public to the private system. Additionally, the consequence of a negative future health shock since it is potentially irreversible that makes the model intrinsically dynamic. Persons on the private plan can access quality care than public insured individuals. The employer coverage improves the patient ratings of care in comparison to public insurance plan. Public insured persons do not have consistent physicians attending them, and they encounter instability that can lead to disruptions in the continuity of care. The public insured individuals do not have an issue in the access to care and financial problems. Medicare has the objective of assuring access to the needed care while preventing financial burdens of the medical bills. According to Skaggs et al. (1407), public insured persons have the following access problems filling a prescription, failure to get specialist care, and lack of follow-up care while private plan does not have such problems.
Policymakers call for the remodeling of Medicare to resemble private insurance assumed to work better the public programs. Davis et al. (13) claim that Medicare beneficiaries derive benefits with the health care than persons covered by private insurance. Medicare beneficiaries report fewer problems in the access to care, confidence in access, and few challenges in getting finances due to the medical bills. The remodeling of the public system to resemble private system can undermine a well working model from the view of the beneficiaries. The federal health policy focuses on Medicare reform since 1997. The establishment of the Balanced Budget Act (BBA) comes to correct excess expenditure of Medicare due to baby-boom generation that reaches retirement. Consequently, BBA is a mechanism to control federal budget outlay to achieve savings through financial incentives and compete with the private plans. Medicare beneficiaries have out-of-pocket expenses, and this leads to financial burdens and access to the needed care. Private insurance as depicted by Chang et al. (72) is more effective since it controls the cost and provides beneficiaries with different kinds of choices that the individuals may prefer. The private health insurance spends less than the Medicare spending. A recent survey by Chang et al. (74) finds a high degree of satisfaction with Medicare coverage for adults above the age of 65 than employer-sponsored managed care plans. According to Kearney et al,. (350) Medicare works well in comparison to private insurance to persons under the age of 65 years. Medicare beneficiaries claim that they can obtain health services as and when needed in addition to protection against financial hardships to settle the medical bills. The demographics of the Medicare beneficiaries are mostly in poor health and low-income establishment. Most of the respondents from these setting have critical chronic condition than individuals from private insured that report fewer instances of chronic conditions. Devoe et al. (821) affirm that Medicare beneficiaries unlike private insured have incomes below 200 percent of the federal poverty level. Most of the private insured persons have full time or part time employment unlike few of the Medicare beneficiaries. Levels of satisfaction, access, and cost of the medical bill can vary from different healthcares. The elderly Medicare beneficiaries rate the public health insurers as excellent since they do not have negative experiences with their insurance than the private insurers. Howard and Roy (39) report that 62 percent of elderly Medicare beneficiaries have satisfaction with their care in comparison with 51 percent of persons covered by private insurance. The elderly Medicare beneficiaries have more confidence in their future ability to get care than the private insured. Medicare beneficiaries other than having poor health and lower incomes than the private insured are less likely to report issues of costs, lack of specialist care, or medical issues while visiting a doctor. In addition, public system, persons do not have an issue in settling medical bills unlike the private insurers devote their out-of-pocket expenses from their income to settle medical expenses. Kearney et al. (351) observes differences between health care experiences of public and private insurers to reflect health status and income as well as presence or absence of insurance benefits such as prescription drug coverage. The public insurance persons take into account access to care, quality of care, problems with insurance, and financial burdens unlike their counterparts under private insurance. Devoe et al. (825) claim that persons under public insurance derive more satisfaction with the insurance after accounting for income, drug coverage, and differences in income. The public system has prescription drug benefit in all age groups that associate with positive overall ratings to cover the cost expenses. The public system will lead to a positive rating that will reduce the out of pocket expenses in the private plan.
Policymakers have to listen to the experiences of individuals both in public and private insurance. While public insurance lack prescription benefit, beneficiaries report it to work better than the private plan. The private insured individuals also claim that they can get access to specialist since the private hospitals have specialized modern equipment, and better benefit comes with additional premiums. It is important to bring reforms in the public insurance system to ensure people using it have more confidence.
Chang, Jongwha, et al. "Comparisons of Health Care Utilization Outcomes in Children with Asthma Enrolled In Private Insurance Plans versus Medicaid." Journal of Pediatric Healthcare 28.1 (2014): 71-79
Davis, K, et al. "Medicare versus Private Insurance: Rhetoric and Reality." Health Affairs (2002): W311-24
Devoe, JE, et al. "Comparing Types of Health Insurance for Children: A Public Option versus a Private Option." Medical Care 49.9 (2011): 818-827
Howard, DH, and K Roy. "Private Care And Public Health: Do Vaccination And Prenatal Care Rates Differ Between Users Of Private Versus Public Sector Care In India?." Health Services Research 39.6 Part 2 (2004): 2013-2026
Kearney, MH, et al. "Birth Outcomes And Maternal Morbidity In Abused Pregnant Women With Public Versus Private Health Insurance." Journal Of Nursing Scholarship 35.4 (2003): 345-349.
Pardo, C, and W Schott. "Public Versus Private: Evidence On Health Insurance Selection." International Journal Of Health Care Finance & Economics 12.1 (2012): 39-61.
Skaggs, DL, et al. "Access to Orthopedic Care for Children with Medicaid versus Private Insurance in California." Pediatrics 107.6 (2001): 1405-1408.