2 Healthcare outside the UK Flashcards
Cost of healthcare definition
How much does a country spend each year on healthcare (per capita and as an overall % GDP)
Average spend on healthcare in OECD countries in 2019?
$4,224/year or 9% GDP
Why is healthcare an investment?
Well citizens can contribute to a better economy
5 reasons healthcare spending is rising
- Ageing population
- Rise in chronic conditions
- New and more effective treatments
- Medical inflation
- Pharmaceutical costs
Medical inflation definition
Growth of medical treatment costs over and above general inflation levels
OECD
Organisation for Economic Co-operation and Development
2021 UK healthcare spending
11.9% or $5,387/capita
2021 USA healthcare spending
17.8% or $12,318/capita
2021 OECD average healthcare spending
8.8% or $4,224
Top 5 countries with highest healthcare spending as % GDP
- USA
- Germany
- France
- UK
- Switzerland
Top 5 countries with highest healthcare spending per capita
- USA
- Germany
- Switzerland
- Sweden
- Netherlands
Country with highest spend as percentage GDP
USA (17.8%)
Country with lowest spend as percentage GDP
Turkey (4.6%)
Country with highest spend per capita
USA ($12,318)
Country with lowest spend per capita
Turkey ($5,387)
Equalisation systems/risk sharing
In countries where insurance is mandatory, insurers have to pay premium income into a common health fund to subsidise other insurers.
Country with the highest % spend on voluntary payment schemes
Australia (13.4%)
USA % spend on voluntary payment schemes
5.4%
UK % spend on voluntary payment schemes
4.8%
What % of health spending in France comes from public insurance schemes
84.7% in 2020
Main public healthcare fund in France?
Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) - 92% population
France % spend GDP on health (2020)
12.2%
Germany % spend GDP on health (2020)
12.8%
UK % spend GDP on health (2020)
12.0%
French PMI system
– Most healthcare spending is publicly funded
– Have to make co-payments (10%-30% or 35-85%) – insurance can cover this
Why can GDP and $/capita be misleading?
- Health expenditure slow changing relatively slow changing
- Currencies can change against the dollar
Irish healthcare system
– No universal entitlement to public healthcare
– Eligibility varies according to residency, age and socio-economic status
Two-tier system in Ireland
Those with an income below a defined threshold or with certain medical conditions (32% – 2019) qualify for a Medical Card
Medical Card
Provides access to primary care and hospital services free of charge and medicines with limited co-payments
GP Visit Card
– Available for 1/10
– Covers GP charges
% PMI of total health spending in Ireland
14%
Lifetime community rating
Premium payable is based on age when joining the plan – cover cannot be cancelled.
% USA population covered by insurance
91%
Medicare
For aged 65 and over
Medicaid
For low income groups
What % total health spending in USA paid by the Government?
50%
9 Ways to compare countries’ healthcare systems
- Life expectancy and improvements
- Infant mortality
- Number of doctors/1,000
- % GDP on healthcare
- Priv v public funding split
- Priv v public provision split
- Proportion covered by insurance
- How equitable systems are
- Customer satisfaction surveys & self-reported good health
PHE stands for?
Public Health Expenditure
THE stands for?
Total health expenditure
Top 3 PHE as a percentage of THE
1.Germany
2. USA
3. France
Top 3 PMI as a percentage of THE
- France
- USA
- Australia
Economist Intelligence Unit Healthcare Rankings
– Japan & Switzerland best
– UK = 15
– USA = 22
Bismarck systems
Systems based on social insurance, where there is a multitude of insurance organisations
Beveridge systems
Systems where financing and provision are handled within one organisational system
Top 3 EHCI rankings
- Switzerland
- Netherlands
- Norway
(UK 16th)
How many expatriates around the world?
30m
How many expats from the UK?
1m + 1/2m retired
How many people own a property abroad?
1.4m
5 typical inclusions of IPMI insurers
- Home nursing
- All expenses
- Surgeon fees
- Road ambulance
- Drugs and dressings
10 Additional benefits on IPMI plans
- Chronic conditions
- Pre-existing conditions
- GP costs
- Dentistry
- Pregnancy & childbirth
- Health screenings
- 24/7 A&E
- Evac
- Repat
- Security info
Pricing structures for IPMI
- Specific country or region
- Europe only;
- Rest of the world (exc. North America)
- Rest of the world (all)
7 characteristics of IPMI policies
- Premiums depend on area
- Multiple currencies
- Maximum sum insured
- Deductibles are common
- In Europe, premiums attract IPT based on insured residing location
- Local rules pay apply
- Local taxes may be payable
Travel insurance ratings (5)
- Age
- Country
- Additional risks
- Duration of cover
- Pre-existing conditions
Max sum insured for travel insurance
Usually £5m-£10m
Pre-existing conditions and travel insurance
May be covered, but must be disclosed
Difference between IPMI and travel insurance
With travel, you are expected to return home to continue treatment asap
4 circumstances when international treatment is covered on UK PMI plans?
- Where treatment abroad is no more expensive
- Emergency treatment while working or on holiday
- Where the insurer gives specific permission for the insured to travel abroad for treatment
(when travelling expenses may also be covered); - Insurer hospital arrangements
Healthcare arbitrage
Choosing to have treatment abroad in the lowest cost country offering similar quality