Four Nations Flashcards
What countries provide universal health care
- Germany
- Canada
- UK
- Japan
What is sickness funds (Germany)
14.6% of earnings goes to the fund
*covers even if retired, change jobs, lose job
*86% of Germans are covered by sickness funds which means they pay higher fees to see physicians
What are some of the concepts of germanys medical care
- There is a separation of ambulatory care and hospital based care
- Own PCP, no referrals needed
- It follows the dispersed model of medical care organization
How does reimbursement work in Germany
- The sickness funds pay PAs a global sum that and pays physicians based on a fee schedule
- There is increased pay for those who care for patients with greater health problems
What was enacted to help Germany with cost control
Concerted action
1. There are twice annual meeting that will review the guidelines of fees of all components of health care
*physicians fee are controlled and capped
*areas of negotiations are state, regional, and local levels
What are the disadvantages of germanys health care
- Most elective procedures or prescriptions are not covered
- Physicians salary are less than US
- Private insurances don’t always cover preexisting conditions
What are the components of Canadas health care
Hospital insurance act (hospital services only; universal medical insurance)
1. Tax-financed, public,single-payer health care system
2. Each province: provincial government is payer
*funding is from federal and provincial tax revenues
3. Each Canadian receives the same insurance, financed the same way
4. Benefits are broad
*same drug coverage limited to elderly or low income
What does Canadian health insurance prohibit
- Prohibits private health insurance for those covered in provincial benefits
- Completely separates health insurance from employment
*unlike Germany
What are some stats about Canadas medical care
- 50% of physicians are FP
- Patients have the free choice of physician, there are referrals through FP
- FP are able to see inpatients
- There are longer wait times for elective procedures
How does reimbursement work for Canada
- Fee for service
*Amounts are created by provincial governments and medical associations
*emphasis on volume over quality - No direct bill to patients
- Hospitals are private, non-profit
*they is an annual global budget = no itemized bills - Regulates pharmaceutical prices
How does Canada deal with cost control
- Comprehensive care to the entire population means less cost
- There are caps on physician payments
What are the differences in cost of health care compared to the US (Canada)
- Administrative costs are 300% greater than in US
- Use of high tech services
- Cost per day in hospitals
- Physician fees/pharmaceutical prices
What are the disadvantages of Canadas health insurance
- Regionalized technology
- Wait time
What are the components of UK health insurance
National Health Service
1. Funded majorly by taxes
2. Completely separates health insurance from employment
3. Allows private insurance (unlike Canada)
*only accepted at private facilities
*the patients with private insurance still pay taxes into NHS
How does the medical care work in the UK
GP with a gatekeeper system
*referrals are necessary, except in emergencies
1. Use NHS must have a GP
2. Regionalized system throughout
3. Social services
4. Home care is highly developed
How does reimbursement work in th eUK
GP capitation, some fee-for-service and pay for performance
1. Specialists have salaries
2. Pay for performance
How does the UK try to deal with cost control
- Single payer governmental system to limit budget
*limited administration fees
*can set budget without input from other entities - Mode of payment of physicians
*capitation and salary for physicians set
- Limit number of specialist slots
*do less of everything
What are the disadvantages of UK health care system
- Pay for performance
*improvement in asthma, diabetes, not heart disease
*extent of improvement in quality is unclear
*neglect of services not associated with bonuses
*decreases of continuity of care - Wait times
What are some of the components of Japans Health insurance
National health insurance act
*emplyment inked social insurance program (similar to Germany)
*different categories of plans
What does the size of the employer do with health insurance (Japan)
- Society managed plan (large)
*employee and employer contribute to the funds - Government managed insurance plan (Small employer)
- Citizens health insurance (self-employed, retired)
- Smaller insurance plans for government employees and other special categories of workers
How does medical care work in japan
- No restrictions on hospitals, no pre authorization needed
- Physician ownership common; family owned
- Lower admission, lower surgery rates, but hospital stays much longer *average 17 days vs US 6
What are the 3 types of health care settings in japan
- Independent clinics (some with small inpatient wards)
- Smal hospitals (inpatient and outpatient department)
- Larger public and private hospitals with outpatient and inpatient departments
How does reimbursement work in Japan
- Physicians have fee for services
- Hospitals have per diem hospital payment based on diagnosis
- Government strictly governs the cost of everything
*need to see 60+ patients daily to make up fork low fees
How does Japan deal with cost control
- Government fee schedule
- Heavily relies on payroll taxes, large employed population
*future is uncertain with aging population
What are some of the disadvantages of japan health care
- Less flexibility of choice
- Quality of care not systemically measured
- See large volumes of patients daily to make up for low fees
