A private healthcare organization, or ‘private health insurer’ allows its members to collectively pool their risk of incurring medical expenses. Members pay the insurer a premium as a sort of membership fee for the organization, with the expectation that should the member incur medical expenses as a result of a healthcare issue, the insurer will fully or partially cover the cost of the medical services as a benefit of being a member of the organization.

In the United States, some private healthcare organizations such as a small number of state-level Blue Cross Blue Shield insurers are still not-for profit. Members of the Blue Cross Blue Shield health insurer federation operate in every U.S. state as well as Puerto Rico. Some are publicly-traded (such as WellPoint’s ‘Anthem Blue Cross Blue Shield’), others are for-profit and privately-owned, whilst others are single-state and not-for-profit. Members of the federation collectively provide private healthcare to over 100 million Americans.

A private healthcare organization can also take the form of a health maintenance organization. A health maintenance organization requires its members to select a ‘primary care physician’ as the ‘gatekeeper’ to other medical services. Except in a medical emergency, patients require a referral from the primary care physician to see another doctor or a specialist. Health maintenance organizations operate under three different models: the staff, group and network models. Under the staff model, primary care physicians are salaried employees of the healthcare organization, usually with offices inside the health maintenance organization’s building. In most cases, the salaried physicians are only permitted to treat members of the organization. Under the group model, the healthcare maintenance organization contracts a group practice to treat its members. Under the network model, a health maintenance organization will contract with a combination of individual physicians, group practices and independent practice association (a group of physicians maintaining their own office but also contracting to see organization members).

As demonstrated, there are a variety of private healthcare organizations to become a member of, from the for-profit Blue Cross Blue Shield insurers nationwide to the health maintenance organizations running under a wide variety of models. As with any healthcare decision, research should be conducted into the operations of the different insurers before making a decision.