On average, one in ten people consult a private doctor for a health problem, according to a 2018 survey. The reasons vary: it could be a long wait for an appointment, or simply better facilities or a more pleasant environment. Statistics show a steady rise in the number of examinations in private practices and, of course, the amount spent. However, this can be costly. What can be done to ensure that the private sector can be used predictably alongside the public health system? That is what health insurance is for.
Private care can therefore help to maintain health and combat disease, alongside and complementing the public system. It should not be confused with health insurance, which is part of life insurance or even home insurance, where the patient receives a daily fee for hospital care. In the case of private health insurance, the client – or beneficiary – is entitled to receive specific services by paying a predetermined premium. What these services are depends on the personalised package chosen by the client. The more expensive the package, i.e. the higher the monthly premium, the wider the range of services. These policies therefore allow access to specific medical services.
Comparison of health insurance
It is not easy to compare different health insurance policies. Insurance companies put together several packages with different premiums and different services. This means that individual packages may not necessarily be the same, which means that a mere comparison of premiums can be misleading. The age of the policyholder and their lifestyle also make a difference – the younger they are and the less disease-prone they are, the lower the premium they can negotiate. But these parameters are not easily comparable.
Health insurance can be taken out not only by individuals but also by companies. The latter is definitely preferable, because the company can then design an individual package – this can be done for as few as five to ten people. As the company package includes several clients, it is possible to negotiate a lower insurance premium for them. The larger the number of insured persons, the more this is the case, as a risk community is formed between the beneficiaries, i.e. the employees and even their family members. In other words, although all insured persons are entitled to a range of services, the law of large numbers means that not everyone will take advantage of this. In other words, it will cost proportionally less per insured person.
Health insurance is therefore available to individuals and companies alike, but full health insurance cannot be imagined without the public pillar, only as a complement to it.
How does insurance work in practice?
For most schemes, insurance works by contracting with health institutions that provide care to insured patients. The contracting party can be a private doctor or private practice, or even a hospital or clinic. If the client is a patient, he or she receives the services in these institutions, and the institution and the insurer settle the accounts. This is no longer the client’s business.
A fixed number of tests per year
It is important that, in principle, these services are only available if they are really necessary. In other words, only screenings can be booked in advance, as a preventive measure. Typically, one CT scan, blood test, ultrasound can be requested per year, but only to investigate symptoms and treat illness already present. Complex, preventive services such as manager screenings are available in premium packages and some company packages.
Significantly shorter waiting times
But it also means that you don’t have to wait weeks for a check-up. Before the epidemic, for example, you had to wait several weeks for a CT scan or an MRI scan, and several months for the latter. This time is likely to have increased as many tests have had to be postponed, so they have built up over the past few months. Although it is compulsory for chronic patients to have this test within 14 days, delays in other cases can also hamper recovery.
In private care, these tests can be done within a day or two. But it is no different with ultrasound or even orthopaedic or nephrology tests. What takes several weeks in the public care system can often be done in days in the private sector. In addition, an X-ray examination may be a factor if the public equipment is 40 years old and the private equipment is, say, only four.