4. Lesson Flashcards
Style Health Systems
Bismarck
- The provision by social insurance funds
- Compulsory funding by employers & employees
- Keep workers healthy to improve productivity
Health Systems Style
Bismarck vs. Beveridge Style
Reimbursement Models
Provider Payment Models
- Budget transfers
- Free for services
Capitation
Line item budgeting: Become a budget for the whole year, after they work for free
provider Payment Models
- Case-based
Salary arrangement
Pay for performance
Overview of traditional payment methods in health care systems
DRG
- Tarifsystem für stationäre akutsomatische Spitalleistungen,
- Vergütung der stationären Spitalleistungen nach Fallpauschalen
- Schweizweite seit 01. Januar 2012 in Kraft.
Advantage
- Transparency
Disadvantage
- If the patient is a long time in the hospital = no profit for hosp
- They transfer pat
- Behandlung Pat. aufwendiger, als pauschale Vergütung deckt ->macht Spital Verlust.
- Cases: Sometimes the increase in the severity = more money
- Pat have often more than one diagnosis
- what is new what is old?
- What can they charge?
Tarmed
Bloody discharge
Pat can not be charged anymore - thats why hospital transfer pat often
Bundled payment
What is that?
Hospital treats the basic = charge but after transfer pat
To change that - Bundle
Example: Pay a fix prise for LDH
- Hospital, surgery, rehab = have to split the costs
- Then is up to the different providers who get how much money
(Like DRG -case but a whole episode of care, there is more than one provider).
Pay for performance
Medi for heart failure did not get sold on the market:
Bundle payment makes when sense?
Aim?
Who does it work with the payment?
- Long term treatment
- More than one provider?
AIM: Reduce cost
- Accountable care organization: Groups of doctors, hospitals
- Managed care plan: Health Insurance
- Health maintenance organization (HMO) =
Plausible healthcare system types
Note: If it is private - can not change to state, but possible form stat too private
Healthcare system type
Example with a country:
National Health Insurance
Social Health Insurance
Private Health System
Explain Social Health Insurance?
Basic insurance is the same - non profit for insurance
- nonprofit
They just earn money for further insurance
Groups of countries with different system:
Market-driven <->Public -driven
Which is the best system?
Which is the cheapest?
Lowest inequality in health?
No answer, it depends:
- How well accepted the model is from citizens
- Matter how country work with it
Cheap:
- Public system & Single-payer
- Really expensive = Private system
Lowest Inequality?
- Germany, Netherland, Swiss
- Bad= USA, Mexiko
