health care policy in other wealthy countries Flashcards
Bismarckian models
social insurance model
– compulsory insurance with few exceptions
– multiple (non profit) payers
– 90% coverage; rest has private insurance
* people chose which fund to join
examples are Germany, France, Netherlands
Beveridge Models
National health service model
- single payer
- nationalization of hospitals and staff
- financed by general revenues
- General practitioner capitation
Examples are UK, Sweden, Italy
difference between CAD and US care
US is mostly private health and usually required to pay a proportion of healthcare they receive
US health care system
mix of public, private, for profit, and non-profit insurers and health care providers
private insurance dominant (67% of population)
public spending pays for 45% of all health care spending (covering 34% of population)
about 8.5% (27.5 million people) lack health insurance
many people are underinsured
US private insurance
55% is provided by employers
often cover the entire family
*majority offer choice of plan
* benefits vary widely
* employees typically contribute to premium
* often involves managed care
User fees: Employees pay 28% of all costs
* deductibles, co-pays, services and medical equipment not covered in plan
**Employers don’t play a role in Canada but they do in the US
US public insurance (single-payer:government)
Administered by states (co-funded by federal government)
medicare and medicaid
Medicare
for people 65+, people with long term disabilities, parts A,B,C,D
veterans health administration
Indian health services
medicaid & children’s health insurance plan
health coverage for low income people
children’s health insurance plan
* those ineligible for Medicaid but don’t have or can’t afford private insurance
- up to age 19
- some states include low income pregnant women
Part A (medicare)
fee for service for hospital insurance
Part B (medicare)
fee for service for non hospital services
Part C (medicare)
optional supplement to A and B which covers additional services like mental health, drugs, dental care
- but you have to enrol in medical advantage, a type of managed care
Part D (medicare)
alternative to C - only prescription drug coverage
Patient protection and affordable care (2010)
aka Obamacare
* Insurance regulations
– ban on annual and lifetime coverage caps
– cap on annual out of pockets costs
– cover children on parents policies until age 26
Individual mandate with subsidies and employer mandate
Federal marketplace of individual insurance from private companies
safety nets
those providers that organize and deliver a significant level of health care and other needed services to uninsured, Medicaid and other vulnerable patients
federally qualified health centres
charity care and safety-net programs in public hospitals and local health departments
federal law requires hospitals to treat all patients requiring emergency care regardless of ability to pay or insurance status
