health-care services and in health-care treatment
decisions. In 2004, about 250 million Americans
had health insurance, just over two thirds through
private coverage and the remainder through pub-
lic programs such as Medicaid and state low-cost
health plans.
Nearly all health insurance plans require partic-
ipants to pay a portion of their medical expenses,
typically in the form of annual deductibles and
service co-payments. A deductible is payment at
the front end, for example, the first $2,500.00 of
medical costs each year. A co-payment shares the
cost of each health-care service between the per-
son and the insurer, either as a dollar amount or a
percentage of the charge. Most plans have a cap
on out-of-pocket medical expenses, after which
the insurer pays the full amount for covered serv-
ices. Nonetheless, people who experience serious
illnesses or injuries can accumulate significant
additional medical expenses for services the insur-
ance plan does not cover. As well, most people
pay a portion or all of their health insurance pre-
miums.
Because the US health-care system intricately
intertwines health-care services and health insur-
ance, conflicts arise between care needs and insur-
ance coverage. Doctors and hospitals coordinate
with insurers to obtain approval for most non-
emergency treatments before engaging in them.
Most insurers have lists of approved procedures
and medications to facilitate the administrative
processes and issue payments directly to providers.
Each state has laws and rules that regulate how
these processes take place and establish proce-
dures for handling disagreements with insurer
decisions, and a state insurance commissioner
oversees their enforcement.
Though 85 percent of the US population has
health insurance and thus access to health-care
services, 15 percent does not—about 42 million
people. Those who do not have health insurance
have great difficulty receiving needed health-care
services. The federal government mandates that
providers may not deny care to anyone for life-
threatening illness or injury and for a pregnant
woman’s delivery of her child. All states have pro-
grams to provide basic health-care services for
children and pregnant women. State and local
programs attempt to fill in the gaps in providing
other care, though the need far exceeds available
services.
The intertwining of health insurance and
health services that can be an advantage for peo-
ple who have health insurance becomes a barrier
for the 42 million Americans who do not. They
frequently go without medical care for conditions
that prompt treatment would remedy but that
without early intervention become serious and
even life-threatening. Preemptive treatment, such
as medications to lower blood cholesterol levels or
control BLOOD PRESSURE, as well as preventive
health measures such as ROUTINE PHYSICAL EXAMINA-
TION, often are out of reach. Many health experts
and public health policy planners view the lack of
health insurance as one of the most significant
challenges facing the health of Americans and the
stability of the US health-care system.
See also HEALTH RISK FACTORS; HEALTHY PEOPLE
2010 ; QUALITY OF LIFE.health risk factors The variables that create
increased vulnerability to illness and injury are
numerous and varied. Some health risks are fixed
(immutable), such as those related to heredity,
gender, and age. Many health risk factors are
modifiable (mutable) and correlate to lifestyle and
habit. The combination of fixed and modifiable
risk factors helps one assess an individual’s overall
likelihood of developing health conditions such as
CARDIOVASCULAR DISEASE(CVD),DIABETES, LIVERdis-
ease, KIDNEYdisease, COLORECTAL CANCER, LUNG CAN-
CER, PROSTATE CANCER, CERVICAL CANCER, and BREAST
CANCER. Though researchers separate fixed and
modifiable risk factors from the perspective of
health prevention opportunities, within the body
the effects of all health risk factors intertwine and
affect each other in immeasurable ways.Fixed (Immutable) Health Risk Factors
Age and gender are the primary fixed risk factors
for health. Other fixed health risk factors include
personal and family health history (heredity).
Though it is not possible to change fixed risk fac-
tors, it is possible to influence and somewhat miti-
gate them through lifestyle and by controlling
modifiable risk factors.
Age The risk for many health conditions
increases with age as body systems and structureshealth risk factors 27