Introduction To Healthcare – Doctors, Health Insurance & More

Healthcare is a broad term with several definitions. According to the American Medical Association Code of Ethics, healthcare is a “fundamental human good” that reduces pain and suffering, gives people an opportunity to pursue their goals, and helps prevent early deaths. ⁽¹⁾ The Occupational Safety and Health Administration (OSHA) defines it as the provision of health services to individuals. ⁽²⁾ In a practical sense, healthcare is all the services designed to prevent, diagnose, treat, or heal a disease, injury, or mental health condition.

In the United States, many services are delivered in a primary care setting, while others are delivered by specialists. Primary care includes preventive screenings, annual physical check-ups, and exams designed to identify the cause of a patient’s symptoms. ⁽³⁾ Practitioners offer these services in clinics, hospitals, long-term care facilities, schools, and other settings. Unlike specialists, primary care providers don’t focus on just one body system or disease. Instead, they care for the whole patient, making healthcare more accessible to adults and children.

Specialists diagnose and treat complex problems, making them an important part of the healthcare system. Each medical specialty focuses on one organ, system, or disease, giving patients access to advanced care. These are some of the most common specialties:

• Obstetrics and gynecology (OB/GYN): OB/GYN professionals focus on women’s health issues. They perform Pap smears, care for pregnant women, deliver babies, and diagnose disorders of the female reproductive tract. ⁽⁴⁾
• Cardiovascular: This specialty focuses on helping people who have heart problems. Cardiovascular specialists diagnose and treat heart attacks, heart rhythm disorders, and other conditions of the heart and coronary arteries. ⁽⁵⁾
• Dermatology: A dermatologist diagnoses and treats conditions affecting the skin, nails, and hair. For example, they check the skin for signs of cancer, perform skin biopsies, and help people with rashes, hair loss, and related problems. ⁽⁶⁾
• Gastroenterology: Gastroenterologists diagnose and treat disorders of the digestive system, including the stomach, intestines, liver, and gallbladder. ⁽⁷⁾

What Is a Healthcare Provider?

A healthcare provider is a person or medical facility that is licensed to provide health-related services. This includes doctors, nurse practitioners, physician assistants, chiropractors, podiatrists, clinical psychologists, and nurse midwives. ⁽⁸⁾ Each of these professionals has different duties, but their overall goal is the same: to provide services that help patients improve their health and well-being.

These are just a few examples of the healthcare facilities available to patients:

• Hospitals: A hospital provides a wide range of services to residents of a community. Depending on the way a hospital is structured, it may have multiple, separate units dedicated to different types of care. ⁽⁹⁾ For example, a hospital may have an emergency department, an intensive care unit (ICU), and/or a unit designed to care for patients recovering from orthopedic surgery.
• Imaging centers: An imaging center is a standalone facility staffed by radiologists who take and review images for diagnostic and treatment purposes. These images may include CT scans, PET scans, MRIs, and bone-density scans.
• Mental health treatment centers: Mental health is just as important as physical health, so many facilities offer treatment-based services for addiction, depression, anxiety and other mental health conditions.
• Rehabilitation centers: Some patients need additional support after an invasive surgery or serious illness. Rehabilitation centers have physical therapists, occupational therapists, and other healthcare professionals available to help these patients regain their strength and improve their physical functioning.
• Clinics: Not every patient with an illness or injury needs to stay in a hospital. These patients receive outpatient treatment at clinics and other medical offices. Some clinics are owned by corporate health systems, while others are owned by individual doctors.
• Birthing centers: Some people choose to have their babies in a birthing center rather than a hospital. Because these centers follow the midwifery model of care, they’re typically more comfortable and provide more holistic support during labor and delivery. ⁽¹⁰⁾

How to Choose a Healthcare Provider

Choosing a doctor or healthcare provider isn’t something that should be taken lightly. In addition to recognizing the symptoms of a wide variety of illnesses and injuries, a healthcare provider must be able to treat patients with respect and compassion.

The first step is to look for a list of in-network healthcare providers. “In-network” is an insurance term that means an individual or medical facility has agreed to participate in a specific health insurance plan. ⁽¹¹⁾ Health insurance is complicated, so just because a healthcare provider is in-network with one plan doesn’t mean they’ll be in-network with a similar plan—even if the two plans are offered by the same insurance company.

After securing a list of in-network providers, it’s helpful to ask friends and family members for referrals. Another option is to ask a primary care provider (PCP) for a referral. PCPs often refer their patients to specialists, so they tend to have strong working relationships with gastroenterologists, cardiologists, gynecologists, dermatologists, and other specialty care providers.

Location, office hours, and fees are also important considerations. A provider could be one of the best doctors in the state, but if it’s difficult to get to their office or they never have any appointments available, they may not be the right choice. Patients with complex health problems also need to think about what they’ll do if they need care on evenings and weekends. A provider who does evening rounds at the hospital or offers extended office hours may be a better fit than someone who has limited hours of operation.

How Much Is Healthcare?

The cost of healthcare depends on many factors, including the patient’s location, health history, and insurance status. In the United States, which has multiple public and private insurance options, the cost also depends on what type of coverage a patient has. In 2022, private health insurance came with an average premium of $7,911 for an individual and $22,463 for a family. ⁽¹²⁾ For insured individuals, the premium is only one part of the cost equation. Many plans also have cost-sharing requirements, which means a patient may have to pay a copay every time they visit the doctor or pay for a percentage of each hospital bill. For example, on a plan with an 80/20 coinsurance split, the patient would have to pay 20% of the cost of any service with a coinsurance requirement.

For older adults and some younger adults with disabilities, Medicare is an option. Medicare Part A, which covers inpatient care, has a $0 premium for most enrollees. Part B has a monthly premium of $164.90 per month, which is much less than most people pay for private health insurance. ⁽¹³⁾ Although Medicare has a low premium, there are other out-of-pocket costs to consider, such as deductibles and coinsurance. Medicaid is designed for elderly people, children, and some adults with limited financial resources. ⁽¹⁴⁾ The cost of Medicaid coverage depends on several factors, including where a covered person lives and how much money they earn. Some people pay nothing toward their coverage, while others pay a small premium each month. Medicaid typically has low copays for prescriptions, office visits, and other medical services.

What Is Healthcare Management?

Much of healthcare focuses on providing clinical services to patients of all ages. In contrast, healthcare management is defined as all the nonclinical services needed to keep a hospital or other medical facility running. ⁽¹⁵⁾ Healthcare administrators typically handle the following duties:

• Setting goals for a healthcare facility
• Making sure the facility is staffed appropriately
• Communicating with staff members
• Attending board meetings
• Managing electronic health records
• Complying with relevant laws