CH 11 (WM) Flashcards
List the overall objectives w.r.t. any government’s provision of healthcare. [1.25]
- protecting the nation’s health ✓
- subsidising the poor ✓
- balancing the budget ✓
- following social culture and/or political promises ✓✓
State on what does the role of commercial insurance in the provision of healthcare depend on, and list the possible models of co-existence. [1.5]
It depends very much on the nature of State provision.✓✓
Insurance can be:
- an optional alternative ✓
- an optional complement ✓
- a compulsory alternative ✓
- a compulsory complement ✓
Describe private insurance as an optional alternative. [1.75]
Here the State promises a comprehensive system of medical services✓, but insurance can provide a higher quality of service✓
with more individual choice✓ of
- who treats the patient✓, and
- where and when treatment takes place✓✓, and
- possibly a significantly reduced wait for treatment✓.
Describe private insurance as an optional compliment. [0.5]
- Here the State provides a limited range of medical services and leaves it to the individual to fund the balance.✓✓
Describe private insurance as:
a) a compulsory alternative
b) a compulsory complement. [2]
a) Here the State provides everything for members of the population up to a certain salary/wealth level.✓✓ Healthcare insurance is obligatory for all those above this threshold.✓✓
b) Here the State provides certain healthcare procedures “free” at the point of delivery.✓✓ Insurance is mandatory for all other procedures.✓✓
Describe the first three challenges the State faces in designing, managing and financing a healthcare system. [3.5]
Demographic challenge ✓ – The ageing population✓, which has increased healthcare requirements✓, is resulting in increased costs of healthcare systems internationally✓.
Technological challenge ✓ – Innovation in medical treatment and delivery of healthcare✓✓ is increasing demand for healthcare✓. Determining how new technology is accessed✓, and therefore who gains access✓, is a key feature of the healthcare system✓.
Challenge of Sisyphus ✓ – The life expectancy gains in older age groups✓, and focus on innovation✓, leads to constant budget pressure✓.
Describe the challenges, numbers 4 to 6, the State faces in designing, managing and financing a healthcare system. [4]
Burden of disease✓ – The general health status of the population may increase the costs of providing healthcare✓✓ (eg a high prevalence of HIV)✓.
Access to skilled medical professionals and infrastructure✓✓ – The cost and duration✓ of medical training is extensive✓, and medical professionals may leave for other countries after completing their (often subsidised) training✓✓.
Competition or regulation in healthcare ✓✓ – Market failure in the healthcare market leads to the need for regulation in the healthcare market✓✓. A balance needs to be struck between the level of competition and the level of regulation✓✓.
State the different ways the state can incentivise the self-provision of healthcare. [3.75]
- The State can offer tax relief on premiums for appropriate insurances.✓✓
- The State can exclude some or all of the population from certain aspects of the State benefit system.✓✓
- The State can offer a reduction in general taxation where appropriate insurance is in place.✓✓
- The State can reduce the cost of private purchase of healthcare services by direct subsidy to the providers.✓✓
Most countries use at least one of the above methods in their State healthcare provision, although the last two methods are rarely used in practice.✓✓
Describe the role of the state in protecting the nation’s health. [4.75]
A healthy and productive workforce✓ should promote productivity✓ and a growing GDP✓.
Protecting the nation’s health may involve ensuring✓:
* the availability of food✓, drinking water✓, nutrition✓ and hygiene✓
* basic medical services and education about healthy living✓✓
* a comprehensive medical services system encompassing modern and efficient medical facilities.✓✓
The State’s role will depend on the style and culture of politics within the country.✓✓
It may also include aiding research and the import of the latest health technologies.✓✓
The extent to which it can achieve its objectives depends on✓:
* the nation’s wealth ✓
* other priorities in the budget.✓
Describe the workings of a system that applies a “means test” for healthcare services. [3.75]
The State’s role in meeting the cost of healthcare or offsetting the financial loss due to ill-health will vary from nation to nation.✓✓
It may be the sole provider of healthcare from inception to recovery✓✓, or it may only pay fully for healthcare in cases of financial hardship✓✓.
In the latter case, State benefits would be “means tested”.✓
The means test assesses the proportion of the total benefit that the State judges the individual should be able to provide from their own income and savings.✓✓
Means-tested benefits are provided either to people who earn less than a certain amount✓✓, or to those who have accumulated less than a certain level of wealth✓✓, or sometimes only to those who meet both of these criteria✓✓.
State the advantages of means-testing. [2.5]
- May be a cost-effective way for the State to target benefits to those most in need✓✓. The State may provide little or no benefit to individuals with sufficient private means, and instead direct resources to the less well-off✓✓ to ensure that everyone achieves a certain minimum standard of living when in ill-health✓.
- May be redistributive if taxes are raised from those with more wealth / income✓✓, and means-tested benefits are then paid to those with little wealth / income✓.
- Those who fail the means-test may be encouraged to return to work.✓✓
State the disadvantages of means-testing. [4.25]
- People may be discouraged from providing for themselves.✓✓
- May create a poverty trap whereby increases in a person’s income (or assets) merely reduces the value of the State benefits.✓✓
- May encourage people to squander (or hide) existing wealth so that they have more chance of satisfying the means-test.✓✓
- Those who receive benefits may be discouraged from returning to work.✓✓
- It may be perceived as unfair to those who do provide for themselves.✓✓
- Means-tested benefits are not taken up by all who are entitled to/or need them.✓✓
- Receipt of benefit has a “stigma” that identifies an individual as “poor”, and hence may discourage him or her from claiming the benefit.✓✓
- It is perceived by some as “degrading”✓✓, ie State benefits should be a universal right rather than a payment to the poor✓.
*“Discourage” appears under 3 points.”
State the advantages of State providing own establishments. [1]
- Can keep a closer eye on cost and claim control.✓✓
- Will not need to pay for profits of commercial enterprise.✓✓
State the advantages of State relying on commercial establishments. [2.25]
- Can benefit from their expertise, experience and economies of scale.✓✓
- Can transfer much of the administration.✓✓
- Commercial establishments may be more responsive to customer needs✓✓, eg introduction of new treatments✓.
- Different providers will compete for the business.✓✓
Define a PAYG system of funding healthcare. [2]
The basic idea behind a pay-as-you-go (PAYG) system is that the current working population effectively pays the total costs for those currently needing benefits.✓✓
If there is a shortfall in any budget year✓✓ (ie if the cost of providing cover is in excess of the contributions collected from the working population)✓✓, then the State will fund the difference from general tax revenues✓✓.
