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What is the Health Insurance Industry?

C. Mitchell
C. Mitchell

Broadly speaking, the health insurance industry is the collection of companies, affiliates, and agents that provide health insurance benefits to a given community. Insurance companies are the primary players in the insurance industry, but individual insurance providers, affiliates, and rate specialists also have a role. In some countries, the health insurance industry is tightly regulated and controlled by the government. Other places support a wholly private health insurance industry. Although the insurance industry may look different in different places, it is a ubiquitous part of most societies worldwide.

The insurance industry everywhere is concerned with the provision of insurance services to some sector of the public. At its core, the health insurance industry is predominantly concerned with internal medicine, but the industry can also be interpreted to include other medical specialties like mental health and dental care. For most people, health care and medical services are too expensive to pay for exclusively out of pocket. Even regular preventative care carries a stiff hourly rate in most places, and lab work and illnesses can compound the services needed. The health insurance industry capitalizes on this by providing certain medical services at a reduced rate in exchange for the payment of a monthly premium.

Health insurance.
Health insurance.

A health insurance premium fluctuates with age, health history, and lifestyle habits, among other things. The insurance industry sets a premium rate based on a risk calculation that balances the likelihood of catastrophic medical incident and the cost of expected medical care. Members of the health insurance industry accordingly include rate adjusters and financial analysts alongside actual insurance providers.

A health insurance claim form.
A health insurance claim form.

Medical services that are covered by the health insurance industry vary widely and can often be negotiated. The most basic health insurance plans insure only against a major medical event, while others provide for nearly all aspects of medical coverage, including routine check-ups and standard lab work. Usually, the more comprehensive a plan, the more expensive it is to join. Health plans are typically quite costly, but the health insurance industry tries to balance it so that paying premiums is not quite as expensive as taking the risk of paying for everything directly.

Most countries in the world provide government-sponsored health care to their citizens. Nationalized health services offer basic care and provide essential treatments and, in many ways, work as a sort of automatic insurance program. The health insurance industry is still active in these countries, however, just usually on a private basis. Citizens can usually elect to pay for their own health insurance if they want to receive health care from doctors of their own choosing and to receive treatment in non-government hospitals.

In countries that lack universal health care systems, all health care is private. The health insurance industry in these places is typically more competitive, with a wider variety of companies vying for customer subscription. Most of the time, employers provide some form of health insurance as a benefit of employment. Employees typically bear at least some of the premium costs, but can often choose from a variety of plans.

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    • Health insurance.
      By: mybaitshop
      Health insurance.
    • A health insurance claim form.
      By: JohnKwan
      A health insurance claim form.