Ever have a "special" day, like when your kitchen wall is caved
in by an errant truck?
That's when you really find out how good your home insurance is. Traditional
home policies do not cover maintenance, but are bought to protect against
uncommon and often expensive episodes without thought as to who will fix things.
Health insurance is different. Health insurance is more like a subscription
for important "maintenance" services provided by highly trained
clinicians, including those needed in the occasional "special" crisis.
Health insurance changes during the "enrollment period." Premiums
typically increase, even renewing the same policy. Not only does the premium
change, but also the actual facilities and providers one can access may change.
When one's house wall caves in, a contractor chooses needed craftsmen.
With health insurance the focus should also be on the specific providers.
We should look for quality facilities and experienced specialists. Instead,
like with home maintenance, some of us are "do it yourselfers,"
using minute clinics or "urgi-centers" for vaccinations or the
It is when a grave or acute illness strikes that access to "special"
expert care becomes crucial. Yet we may not get the best, based on our
choice of insurance.
The safety, quality and expertise of healthcare providers are increasingly
scored by true outcomes, standard quality metrics and patient satisfaction.
Those who are younger are interested in easy access and low cost of premiums.
The more senior population seeks superior expertise for conditions that
come with aging, such as heart disease, cancer, stroke and memory problems.
But even younger folks experience trauma, or brain tumors, for which special
care is needed.
Buying a health plan can limit access to certain facilities, and certain
physicians, depending on whether they are in the "network" being
offered. Though one may have access to their favorite hospital through
the plan, a preferred specialist may not be part of the package.
Some plans allow access to a hospital, but not its affiliated outpatient
facilities, such as its ambulatory surgery centers or imaging centers.
Thus, the patient may be exposed to one level of quality in the hospital,
but a different level in a facility required through the plan. Seamless
communication of patient data among such non-integrated sites of care
That is why it's so important to pay close attention to your options.
Choosing a world-class hospital and a multidisciplinary team of experts
focusing on significant specific health conditions, teams that are measured
by rigorous standards, including safety, health outcomes and patient satisfaction
is critical to the confidence in the health insurance plan one selects.
Look for a hospital with low-complication rates and a dedication to comprehensive,
multidisciplinary treatment. You want evidence-based treatment regimens
and world-class programs that offer cutting edge technology and access
to clinical research.
Thus, when considering your choice of health plans, look for one that
provides a health system not just with affordable and easy access to maintenance
needs, but also one that integrates the best in coordinated, specialized
care focusing on a particular patient condition: A plan where all of the
systems, facilities and expert physicians are accessible. Choose a plan
providing a health system that measures its successes and constantly strives
So on that special day when your house wall caves in, you may look for
a contractor simply trusting his "subs" capabilities. Think
of your health system as a contractor, and make sure that its "subs"
are not only a great maintenance crew, but contain integrated specialists
and facilities focusing on the types of conditions you may need now or
in the future.
During open enrollment, make sure that your choice of health plan is right,
and your trusted contractor with proven subs is included, because any
given day can become "special."
Dr. Michael Brant-Zawadzki is a senior physician executive at Hoag Hospital.