SECTION I: HEALTH CARE SERVICES

1 - What are Health Care Services?

Health care can mean any service, supply, equipment or prescription that you get to help you stay healthy. It includes preventive care (like your yearly check-up), care for an illness or injury, a hospital stay, surgery, visits to a doctor's office, lab tests and X-rays, and even prescription drugs.

You may make use of some other types of services to help take care of your health, like buying over-the-counter medicine or keeping track of your own blood pressure. In this guide, though, "health care" means only those treatments that you get from a trained and licensed health care practitioner, like your doctor or nurse practitioner.

2 - Who Provides Health Care Services?

Health care services include many services provided by different kinds of trained and licensed providers. These services can be in places like a hospital, a doctor's office or a health clinic. Under Massachusetts law, all hospitals must be licensed by the state. Other health care providers must be licensed by the state Board of Registration in Medicine or a related board. Your health plan may cover many of these providers, but remember that you may pay the costs if the provider is not in your health plan's network.

Appendix I, "Finding Health Care Providers," tells you about types of health care providers and the agency that you may contact to learn more about a provider.

3 - How Much Does Health Care Cost?

Depending on the health care you need and the treatment you have, your costs could be high. In general, the more services you get, and the more intensive the treatment, the more it will cost.

Massachusetts does not set the prices for health care services. Different providers may charge different amounts for a similar service. Many insurance companies negotiate the rates they pay to providers. If you are insured, you get the benefit of those negotiated rates. If you don't have insurance, you may have to pay a higher rate.

Inpatient care is the most expensive kind of care. Inpatient care is when you are admitted to a hospital. In 2004, the average cost of a hospital stay for a Medicare patient in Massachusetts was $4,474 per day. [1] Although most stays are short and some stays cost much less than the average, many can last a long time and cost more than this average.

The average cost for some other types of care were:

  • Urgent-care facilities - $225 per visit average
  • Emergency rooms - $800-$1000 per visit average
  • Primary care doctor office visit - $80 - $100 per visit average [2]

These are average costs and depend on the level of care you get, the number of times you get care and the type of doctor or provider you see. These costs also reflect the rates that the insurance company might pay. If you don't have a health plan, the cost of the services might be even higher than these averages.


[1]Source: Massachusetts Division of Health Care Finance and Policy derived from 1998 Urban Institute report titled "Long Term Care for the Elderly: Profiles of Thirteen States" based upon 1994 data.

[2]Source: www.teladoc.com.