Comparing Select HCS; Structures, costs, and quality

Question 1

Types of health care (the 4 we look at)

Answer 1

1. Sweden
2. germany
3. UK
4. USA.

Question 2

Sweden Health care

Answer 2

• 10.9% of GDP (85% was public spending)
  
  • Compulsory and mostly tax based that provides coverage for the entire population
  • Private insurance is limited (1%) to reduce wait times for specialists and elective surgery
  • Municipalities are the ones in charge of locial social services (childcare, school health care and long term care for elderly)
  • Regionally based and publicly operated
  • Most health care providers are publicly employed

Question 3

Germany

Answer 3

• Compulsory nation wide health insurance
  
  • Three options
    a) 88% mandatory health insurance based on income
  • There is 109 sickness funds
  • Sickness funds are organizations that go to HCP with high leverage as they are big buyers
  • Makes quality and efficiency way better as they are highly regulated
    b) 11% private insurance: more benefits and choice
    c) 1% govt schemes: military, police, public sector employees

Question 4

United Kingdom

Answer 4

• 10.2% of GDP in 2019 (79% public funded and mainly through general taxation)
  
  • low use of private insurance (10.5% of pop. Account for 3% of expenditures. Around17% OOP)
  • Comprehensive services which are mostly from salaried public providers in govt facilities which are called NHS trusts
  • GPs act as gatekeepers
  • Local purchasing bodies: care trusts, care partnership negotiate contracts with many HCP, health boards

Question 5

USA

Answer 5

• A market oriented approach with competition based quality and price
  
  • Most expensive Health (16.8% of GDP)
  • A lot of people are not insured or underinsured
  • High copays and deductibles

Question 6

Funding of the USA system

Answer 6

• Public (49%): medicare (23%), Medicaid (17%), other programs (CHIP, VA, military, HIS, 9%)
  
  • Private: (51%): private insurers and plans (37%), OOP (14%)
  • 15% of people have multiple insurance plans while 8.5% have no insurance

Question 7

What is medicare (USA)

Answer 7

• National insurance program for citizens over 65 and the disabled
  
  • Financed by taxes, premiums: Part a: hospital care which is age based, Part B: physician services which is 75% paid by the feds and based on premiums after 65
  • Part D: prescription drugs which are premium based

Question 8

What is medicaid (USA)

Answer 8

• For the old, disabled, pregnant women or have depended children
  
  • The poorest of the poor
  • 10% of Americans while 60% of the poor are excluded, fed share is 50-85%

Question 9

Private insurance in USA

Answer 9

• 75% of the population has some for which is usually through there workplace
  
  • Private insurance companies offer many different packages and ratees

Question 10

Affordable care act (USA)

Answer 10

• Obamacare
  
  • 2010
  • Gave more accessibility to both public and private insurance for those who are uninsured or under insured
  • Public insurance: expand eligibility for medicaid
  • Private insurance: insurers have to guarantee acceptance (this eliminates not being insured for pre existing conditions), many substantial govt subsidies, mandatory participation
  • Uninsured rate dropped from 16% in 2010 to 9% in 2016

Question 11

What are Performance indicators to a good health care

Answer 11

1. Access to care: affordability and timeliness
   
   2. Care process: preventive care, safe care, coordinated care and patient engagement and preferences
   3. Administrative efficiency: documentation and administative tasks required of patients and providers
   4. Equity: income related disparities
   5. Health care outcomes: how goo the outcomes of the health care are

Question 12

Health access and quality (HAQ) index

Answer 12

• It is based on mortality rates from conditions/ causes which should not be fatal with the presence of medical care
  
  • Also called amenable (avoidable) mortality