New York offers some of the best hospitals and health care centres in the world, but the United States government does not guarantee its citizens regular access to medical care. Hospitals maintain emergency rooms which are required by federal law to treat individuals in need of emergency attention, regardless of their ability to pay. However, outside of emergencies, most individuals rely upon private health insurance plans (often subsidised by their employers) to help manage the extremely high costs of health care, as no universal government health plan exists.

The majority of healthcare occurs in privately run outpatient treatment centres, where people see a primary care physician for regular check-ups, prescriptions, and treatment for common illnesses. Private health insurance companies generally maintain lists of doctors whose fees they will subsidise, and New Yorkers often rely upon word of mouth to choose doctors from the lists which their insurance companies provide them.

Maternity care is also important, and tends to be covered under medical insurance plans. Pregnant women have regular visits with their obstetrician-gynecologists (‘OBGYNs’) during their pregnancies and in the months after giving birth.

Dental care is also a priority for most residents, who, on average, visit the dentist twice a year for cleanings and check-ups. Dental health care insurance is generally available separately from primary medical health insurance.

New York is a major centre for cosmetic surgery in the United States, but cosmetic surgery does not tend to be covered by health insurance plans, unless it is the direct result of a disfiguring accident or illness.

Government Healthcare

The primary sources of government-funded health insurance are Medicare (for individuals 65 and older or with long-term disabilities), Medicaid (for the underprivileged), and the State Children’s Insurance Program (for low-income children of the ‘working class poor’ whose parents are not eligible for Medicaid). However, in order to be eligible for government-funded health care programmes, most legal, non-citizen residents of the United States must first reside in the country for five years.

Private Healthcare

The standard of private health care in New York is high, as it is a major centre for privately run ‘teaching hospitals’ that maintain affiliations with prominent universities. Where to go depends on what you are seeking treatment for. Memorial Sloan Kettering Cancer Center, for example, is the city’s pre-eminent cancer treatment facility, while New York-Presbyterian Hospital at the Columbia University Medical Center offers the best care for stroke victims, according to a November 2006 survey of doctors performed by New York Magazine. Other prestigious private hospital centres include the Hospital for Special Surgery (renowned for its orthopedic care), Mount Sinai Medical Center, NYU Medical Center, Bellevue Hospital Center, New York-Presbyterian Hospital at Weill-Cornell Medical Center, Beth Israel Medical Center, and Lenox Hill Hospital.

It is virtually essential to obtain medical insurance in order to diffuse the increasingly high costs of health care in New York and throughout the United States. Many employers subsidise health insurance as a perk of employment (including for non-citizen residents), but generally only for full-time employees. The various types of health insurance plans available in the United States tend to utilise some form of ‘managed care’ – policies designed to cut down on health care costs by placing restrictions on the services an insurance company will subsidise, and often requiring patients to obtain approval in advance of receiving specialised care.

The major types of insurance plans are: ‘fee-for-service’ plans, health maintenance organisations (‘HMOs’), and preferred provider organisations (‘PPOs’). With fee-for-service plans, individuals pay a monthly premium and, after they have hit a specified ‘deductible’ (minimum amount, usually $200 or more, they must pay out-of-pocket before their insurance kicks in), their insurance pays a percentage of their healthcare costs (usually 60-80%) and they pay the balance. However, there is often an annual cap placed upon the amount the individual will be required to pay himself. Once this pre-specified limit is reached, the insurance company will pay the remainder of all fees and expenses in full, although the individual will still be required to pay the monthly premium. Although they tend to be more expensive, a major advantage of fee-for-service plans is that they allow individuals to utilise any doctor or hospital they wish.

HMOs, by contrast, are less expensive but are also more restrictive. Consequently, they tend to attract the young and healthy, who may only need to visit the doctor once or twice per year. With an HMO, you pay a monthly premium (around $350) and have no deductible to hit; you simply make a standard co-payment, depending upon the type of treatment you receive. However, you must use doctors and treatment facilities on the insurance company’s pre-approved list. The co-payment for a visit to a primary care physician is around $15, an emergency room visit will cost you around $50-100, and the co-payment for prescription drugs can range from anywhere to $10-$100, depending upon the type of drug and whether it is available in a generic (non-brand name) variety.

PPOs offer a compromise between standard HMO care and Fee-for-Service Plans. Like HMOs, they require you to pay a monthly premium of around $350. When you use a doctor on their list of ‘preferred providers,’ you make a standard co-payment, along the lines of what you would pay through an HMO. If you see a doctor who is not on the list, they will still cover a portion of your fees, although less than if you had seen a preferred provider.

Emergency Services

Many New York City hospitals offer 24 hour emergency care, and are required by law to treat emergency care patients, regardless of their ability to pay. In an emergency, you can go directly to the hospital’s emergency ward, where patients are prioritised according to the urgency of care needed. Bellevue Hospital Center, New York-Presbyterian Hospital, Mount Sinai Medical Center, and NYU Medical Center offer particularly excellent emergency care, as reported in a 2006 New York Magazine survey.

Pharmacies

Most pharmacies in New York are located within grocery stories or ‘drug stores’ (such as Duane Reade, CVS, Rite Aid, or Walgreen’s) that carry basic food and household items. Most pharmacies tend to be open at least 12 hours from Monday to Friday (generally from 09:00 to 21:00), with shorter Saturday hours (10:00 to 18:00 or so), and they remain closed on Sundays. However, 24 hour pharmacies do exist at certain branch locations, such as Walgreen’s (145 Fourth Avenue at 14th Street), Duane Reade (1279 Third Avenue at 72nd Street), and CVS (1622 Third Avenue at 91st Street). These pharmacies supply prescription medication around the clock, such as birth control pills, antibiotics, or strong pain relievers. Drugs available ‘over the counter’ (without a prescription) include aspirin, acetaminophen, and mild cold and allergy relief medications. These medications can be purchased in drug stores, grocery stores, or at kiosks located throughout the city, even when pharmacies are closed. It’s always a good idea to call a few pharmacies in your area to find out where your nearest 24 hour pharmacy is.

Health Check-Ups

Most New Yorkers rely on their primary care physicians for regular medical check-ups. However, many non-profit organisations throughout the city offer free or low-cost health services for those who cannot afford regular doctor visits but may not qualify for Medicare or Medicaid. The New York City Free Clinic, affiliated with New York University and located at 16 East 16th Street, offers comprehensive free healthcare. The Planned Parenthood of New York, which offers free family planning services, also provides free health check-ups. The City of New York periodically promotes preventative health care screenings. For example, the city government’s ‘Take Care New York’ health initiative (www.nyc.gov, search for ‘Take Care New York’) offered free walk-in health screenings at public hospitals in all five boroughs every Tuesday in October 2006. Available screenings included diabetes, high blood pressure, cholesterol, asthma, depression, and cancer.