2 - International Comparison Flashcards
Define healthcare
- Prevention, tx, and management of illness
- Preservation of mental and physical well-being through the services offered by the medical and allied health professions
Define healthcare system
Set of agencies and relationships that lead to the delivery of healthcare
Describe principles of production function
- Production function can loosely apply to an individual and more accurately to society as a whole
- Production function is subject to “diminishing returns”
- As greater amounts are invested into the system, the incremental impact of each unit becomes less
- At high levels of health care, the curve flattens out, so the marginal health improvement approaches zero (called “flat of the curve” medicine)
What is the purpose of stewardship in a healthcare system?
Provides guidelines and standards that must be upheld (ex: drugs are Rx and can’t just be purchased; surgeons must sterilize instruments)
How do healthcare systems in different countries differ?
- Financing for healthcare
- Provision of healthcare services
- Payments for healthcare services
- Effectiveness of healthcare services
Describe the “tax-funding” type of healthcare system
- Majority of cost of collectively provided healthcare is paid out of direct and indirect taxation
- “Single-payer” model
- Ex: Canada, UK
Advantages to the tax-funding healthcare system
- Generally uniform standards of healthcare provision
- Generally uniform access to healthcare services
- Reduced administrative costs for provision of services
Disadvantages to the tax-funding healthcare system
- Subject to economic changes w/in the country
- Subject to the will of the electorate in the country
- Politicization of healthcare delivery
Describe the “social insurance” type of healthcare system
- Funds raised through a non-government or quasi-governmental bodies, w/ fixed membership charges or membership charges linked to wages
- Ex: Belgium, Germany, France
Advantages to the social insurance healthcare system
- Generally uniform standards of healthcare provision
- Generally uniform access to healthcare services
- Reduced administrative costs for provision of services
Disadvantages to the social insurance healthcare system
- Subject to economic changes w/in the country, specifically in the job market
- Challenges in dealing w/ marginalized populations (ex: unemployed)
Describe the “private insurance” type of healthcare system
- Premiums are individualized and generally risk rated (greater risk = pay more)
- Can be conventional market insurance (no outside manipulation) or controlled private insurance (some artificial manipulation to achieve social equity)
- Controlled prevents insurance companies from not covering pre-existing conditions
- Ex: US (formerly conventional, then controlled, now shifting to conventional), Switzerland (controlled)
Advantages to the private insurance healthcare system
High standards and access of healthcare provision (for some)
Disadvantages to the private insurance healthcare system
- Generally non-uniform access to healthcare services
- High administrative costs for provision of services
Describe the “co-payment or user fees” type of healthcare system
- Almost every country has some element of direct payment for collectively funded healthcare services
- Refers to any payments made for care
- Found in all of the different funding structures
- Exists to partially fund the system, but mainly to combat “moral hazard”
- Most countries have this, except Canada
Define moral hazard. What are the 2 forms?
- How an individual may change how they utilize healthcare services based on whether they have to pay or not
- Ex-ante and ex-poste
Describe ex-ante moral hazard
Changes to the probability of requiring healthcare services based on whether you pay or not (ex: whether or not you choose to play a sport based on if you have to pay if you get injured)
Describe ex-poste moral hazard
Changes in the use of healthcare services based on whether you pay or not
Describe the fees per patient or service type of payment for health services
- Most common method of payment
- Used in specialist services in hospital, pharmacy, individual clinician practice
Advantage of fees per patient or service type of payment for health services
Encourages efficient delivery of service
Disadvantages of fees per patient or service type of payment for health services
- Potential quality concerns
- Supplier induced demand
Describe the capitation fees and salaries type of payment for health services
Payment based on population served rather than specific services rendered
Advantages of capitation fees and salaries type of payment for health services
- Easy to administer
- System can be incented to specific endpoints
Disadvantage of capitation fees and salaries type of payment for health services
Volume and access concerns
Describe the block grants type of payment for health services
Larger payments made for a range or a number of services
Advantages of block grants type of payment for health services
- Easy to administer
- Encourages efficient delivery of defined services
Disadvantages of block grants type of payment for health services
- Comprehensive provision concerns
- Risk of “cream skimming” (ex: get a lump sum of money for doing 1000 hip replacements; cream skimming = only doing replacement on healthier people)
Describe the direct payment by patient type of payment for health services
Generally a small component of healthcare payment in industrialized countries for necessary services
Advantage of the direct payment by patient type of payment for health services
Rapid access of services for those who can afford
Disadvantages of the direct payment by patient type of payment for health services
- Equity concerns
- Information asymmetry
Describe the financing of healthcare services in Canada
- Most “essential” services financed through direct and indirect taxation
- Private insurance for non-tax funded services
- No use of social insurance
Describe the payment for healthcare services in Canada
- Absence of user payment in select publicly funded services (hospital, emergency, primary care)
- Extensive use of user payments in other services (pharmacy, optometry, dentistry)
- Predominant fee-for-service reimbursement to clinicians working in primary care
- Predominant salary reimbursement to clinicians working in tertiary care
- Direct payment by pt unusual but pockets of it occurring in specific areas (ex: diagnostic imaging)
Describe the financing of healthcare services in United States
- Tax-funded system for specific pt populations (ex: military, low-income seniors)
- Unregulated private insurance for all other groups until 2013
- 2013 = affordable care act created a social insurance option and controls on private insurance
- 2017 = key controls on private insurance removed
Describe the payment for healthcare services in United States
- Minimal user payment in tax-funded services
- User payment is ubiquitous in people w/ private insurance plans and will remain in the social insurance plan (at varying levels depending on income)
- Predominant fee-for-service reimbursement to clinicians working in independent for-profit primary and tertiary care centers
- Predominant salaried reimbursement to clinicians working in for-profit HMO organizations
- Direct payment very common at both ends of the financial spectrum (for very different reasons)
Describe the financing of healthcare services in the Netherlands
- Highly controlled private insurance market (guaranteed issuance of basic health services; universal coverage by individual mandate; all enrolees charged the same amount)
- Private insurance for supplemental services
- No use of social insurance
Describe the payment for healthcare services in the Netherlands
- User payment allowed for all services
- Predominant fee-for-service reimbursement to clinicians working in primary care
- Block grants becoming standard for provision of tertiary services and some primary services
- Direct payment by pt now uncommon
Describe efficiency of the healthcare system
- How efficient the system is at funding its services (tax based vs. insurance based)
- How efficient the system is at delivering its services (technical efficiency vs. allocative efficiency)
Define technical efficiency
System that delivers a given service at minimum cost
Define allocative efficiency
System that delivers what consumer wants at a minimum cost
Describe equitability of the healthcare system
- Equity of fundraising (does the system equally divide the funding of the healthcare system based on ability to pay, or is payment based on level of health)
- Equity of access (do similar px wait similar times for similar tx)
- Equity of outcomes (does any subset of the pt population enjoy substantially better health outcomes than another)
