Four Nations

Question 1

What countries provide universal health care

Answer 1

1. Germany
2. Canada
3. UK
4. Japan

Question 2

What is sickness funds (Germany)

Answer 2

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

Question 3

What are some of the concepts of germanys medical care

Answer 3

1. There is a separation of ambulatory care and hospital based care
2. Own PCP, no referrals needed
3. It follows the dispersed model of medical care organization

Question 4

How does reimbursement work in Germany

Answer 4

1. The sickness funds pay PAs a global sum that and pays physicians based on a fee schedule
2. There is increased pay for those who care for patients with greater health problems

Question 5

What was enacted to help Germany with cost control

Answer 5

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

Question 6

What are the disadvantages of germanys health care

Answer 6

1. Most elective procedures or prescriptions are not covered
2. Physicians salary are less than US
3. Private insurances don’t always cover preexisting conditions

Question 7

What are the components of Canadas health care

Answer 7

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

Question 8

What does Canadian health insurance prohibit

Answer 8

1. Prohibits private health insurance for those covered in provincial benefits
2. Completely separates health insurance from employment
   *unlike Germany

Question 9

What are some stats about Canadas medical care

Answer 9

1. 50% of physicians are FP
2. Patients have the free choice of physician, there are referrals through FP
3. FP are able to see inpatients
4. There are longer wait times for elective procedures

Question 10

How does reimbursement work for Canada

Answer 10

1. Fee for service
   *Amounts are created by provincial governments and medical associations
   *emphasis on volume over quality
2. No direct bill to patients
3. Hospitals are private, non-profit
   *they is an annual global budget = no itemized bills
4. Regulates pharmaceutical prices

Question 11

How does Canada deal with cost control

Answer 11

1. Comprehensive care to the entire population means less cost
2. There are caps on physician payments

Question 12

What are the differences in cost of health care compared to the US (Canada)

Answer 12

1. Administrative costs are 300% greater than in US
2. Use of high tech services
3. Cost per day in hospitals
4. Physician fees/pharmaceutical prices

Question 13

What are the disadvantages of Canadas health insurance

Answer 13

1. Regionalized technology
2. Wait time

Question 14

What are the components of UK health insurance

Answer 14

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

Question 15

How does the medical care work in the UK

Answer 15

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

Question 16

How does reimbursement work in th eUK

Answer 16

GP capitation, some fee-for-service and pay for performance
1. Specialists have salaries
2. Pay for performance

Question 17

How does the UK try to deal with cost control

Answer 17

1. Single payer governmental system to limit budget
   *limited administration fees
   *can set budget without input from other entities
2. Mode of payment of physicians
   *capitation and salary for physicians set

• Limit number of specialist slots
  *do less of everything

Question 18

What are the disadvantages of UK health care system

Answer 18

1. 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
2. Wait times

Question 19

What are some of the components of Japans Health insurance

Answer 19

National health insurance act
*emplyment inked social insurance program (similar to Germany)
*different categories of plans

Question 20

What does the size of the employer do with health insurance (Japan)

Answer 20

1. Society managed plan (large)
   *employee and employer contribute to the funds
2. Government managed insurance plan (Small employer)
3. Citizens health insurance (self-employed, retired)
4. Smaller insurance plans for government employees and other special categories of workers

Question 21

How does medical care work in japan

Answer 21

1. No restrictions on hospitals, no pre authorization needed
2. Physician ownership common; family owned
3. Lower admission, lower surgery rates, but hospital stays much longer *average 17 days vs US 6

Question 22

What are the 3 types of health care settings in japan

Answer 22

1. Independent clinics (some with small inpatient wards)
2. Smal hospitals (inpatient and outpatient department)
3. Larger public and private hospitals with outpatient and inpatient departments

Question 23

How does reimbursement work in Japan

Answer 23

1. Physicians have fee for services
2. Hospitals have per diem hospital payment based on diagnosis
3. Government strictly governs the cost of everything
   *need to see 60+ patients daily to make up fork low fees

Question 24

How does Japan deal with cost control

Answer 24

1. Government fee schedule
2. Heavily relies on payroll taxes, large employed population
   *future is uncertain with aging population

Question 25

What are some of the disadvantages of japan health care

Answer 25

1. Less flexibility of choice
2. Quality of care not systemically measured
3. See large volumes of patients daily to make up for low fees