12. International Flashcards
Current Obesity trends in the US?
A bunch of major cities are leveling off obesity levels
Overall trend between US and the rest of the world?
MEDICAL SPENDING ALONE DOES NOT DRIVE OUTCOMES. While US spends a shitload more on health care, it spends less on social service supports (unemployment, housing subsidies, early childcare, job training)….Other countries seem to spend less and get better life population health outcomes, partly cuz they?re spending more on social services
Cultural differences between nations?
Culturally specific differences on how we perceive disease. Comparisons of differences in medical practice based on these cultural traits turns out…it?s true.
What tends to slow cost increases? Implications?
Global budgeting! Price controls!
Primary care organization in world?
Primary care is similarly organized in most countries. PCPs are independent practitioners still practicing in relatively small solo organizations. Most recent data show rapid movement into larger partnerships in US (small movement internationally)…but basic model in US and most other countries is small ?cottage industry?
PCP role - ROW?
Internationally PTs are expected to register with PCP who serves as gatekeeper. Gate keeping disappeared 2000-2010 in US. You gotta register…you’re MY DOC.
Who owns hospitals - ROW?
Most hospitals publically owned internationally…separate small for-profit systems and private systems are showing up where people have opted out of public insurance
Who owns hospitals - US?
IN US, most hospitals are not-for-profit, some owned by govts (state university), some have hospital districts, relatively small are private, for-profit (even though they participate in public funding schemes)
PCP payments ROW? Difference between US?
Most PCPs in MOST countries are FFS. In some countries it?s mixed with capitation or salary. HOWEVER, in most of these systems there?s a national fee schedule (instead of docs setting fees)
Hospital payments ROW?
Global budges determine what hospitals get every year
Specialists in ROW v. US?
Some salaried by hospital (incorporated into global budgeting); mix of private ffs (and public system). US is either FFS or salaried (based on a MEDICAL GROUP THAT CHARGES FFS). Again, voluntary in the US, but nationally enforced fee schedules in ROW.
Why does US stick to private so much?
Distribution Economic/political forces, inertia, insecurity of what would really work
Government’s role in ROW? (3)
1) Half have a national health service (which has assumed full responsibility for financing the health care system - even though it’s by different routes). 2) Some have REGIONAL govt responsibility (like, provinces in Canada, Switzerland, etc). 3) Some have mandatory coverage through different insurance mechanisms (either centered around employment or NON-COMPETITIVE INSURANCE SYSTEM)
Example of country in non-competitive insurance system?
Japan.
Govt role in health system, in general?
Mixed bag. Public v. private. Insurance rules regulated at STATE level, although ACA is beginning to set national standards
Financing, ROW? (3)
National consumption taxes (that’s why shit’s a lot more expensive elsewhere), general taxes, earmarked taxes (stays out of national budgeting process, just goes directly to system)
Financing, US?
MCARE Payroll tax goes into a MCARE trust fund, general tax revenue, premiums
Premiums in ROW?
Not usually. May have copays associated with insurance, but very few pay a premium out of pocket.
Role of private insurance, ROW?
Not part of the CORE usually, but it may be used for private facility coverage, dental, fancy shmancy stuff.
Preventable deaths between US and ROW?
When compared to other countries, the US has a higher level of preventable deaths. Also, US is improving slower than the other countries.
Preventable deaths?
Deaths which could have been prevented if the pt had timely access to appropriate medical care
Health care spending per capita in US v. ROW, between 1980 - 2010?
Twice as high in 1980 too, although we?re bunched more closely together then. The rate seems to have risen a shitload between 2000 - 2008. Costs are going up dramatically everywhere, just not as dramatic as in US.
What happened between 2000 and 2008?
A lot more Rx drug use (MCARE D), new technologies, prices went up more rapidly, reimbursement….80s and early 90s, had some cost-containment programs (through HMOs, constricted networks and rules). Docs hated this shit, rebelled….told pts to get out of most restrictive networks. Then the economy took off in the 2000s, and there was a pushback against restraint (new technologies, raise prices, health planning disappeared)
How does OOP v. private v. public spending look for US v. ROW?
For the most part, other countries are spending sort of close to what we?re spending wrt public spending. However, PRIVATE is significantly different in US (insurance, and out of pocket)
