Health financing Flashcards
Examples of insurers (3rd party payers)
- government
- sickness funds
- medical schemes
- employer insurance
- regions
- NHS (central government)
- NGOs
- private insurers
Cross subsidisation?
what an individual contributes to the system goes in a pool/fund, which is then utilised by anyone who has a need for healthcare (so what a person spends on healthcare does not just benefit them);
some other definitions:
Cross subsidization is the practice of funding one product with the profits generated by a different product.
Cross subsidization is the practice of charging higher prices to one type of consumers to artificially lower prices for another group.
Risk related premiums in private vs social insurance
riskier groups pay higher premiums in private insurance (e.g. the elderly, people with chronic conditions); in social insurance systems premiums are usually flat/fixed (and some people are exempt, e.g. unemployed ppl)
VAT
The Value Added Tax, or VAT, in the European Union is a general, broadly based consumption tax assessed on the value added to goods and services. It applies more or less to all goods and services that are bought and sold for use or consumption in the European Union.
What are medical savings accounts and an example of country that uses them?
A medical savings account (MSA) is an account into which tax-deferred amounts from income can be deposited. The amounts are often called contributions and may be made by a worker, an employer, or both, depending on a country’s laws.
- Singapore
Examples of measures for cost containment?
- imposing patient fees (e.g. cost sharing through co-insurance rate and co-payment)
- having gatekeepers (e.g. GPs to specialist care)
What are incentives for efficiency and quality in healthcare usually associated with?
usually associated with what kind of reimbursement strategy is being used// whether the providers are ‘rewarded’ for quality, quantity etc.
Tax-based vs social insurance system distinction
- social health insurance premiums go specifically to the health providers; in a tax based system you can’t actually tell how much of what you paid goes to healthcare (as opposed to e.g. education, defence etc).
- from a patient-to-3rd party payer perspective, the two systems are quite similar (people pay insurance or get taxed based on their income)
- the main difference is in the 3rd party payer to HC provider relationship: in tax-based systems, the two are much more integrated (integrated financing and provision), in social insurance, they’re more separate entities (financers contract with/commission providers)
- the professor said social insurance is similar to ‘earmarking taxes’ - Earmarking means taking all or a portion of total revenue from a tax or group of taxes and setting it aside or “protecting” it for a designated expenditure purpose. (so having a specified deduction people need to pay for healthcare) - whereas in general tax systems, the tax payer does not know how much of that went for healthcare
Payment principle - Budget or ‘block grants’
allocating a budget to a provider, without specifying what needs to be done/in which quantities
Fee for service
Under the fee-for-service arrangement, providers are paid for each item (e.g. each drug of antibiotics) or item of service provided (e.g. an X-ray or medical examination). If the fee-for-service system is not controlled, providers will have an incentive
· to charge as much as the market will bear, regardless of whether those who are paying are individuals, private companies, or the social health insurance organization;
· to produce as many units as possible in order to increase the income.
Bed day payments
Daily rates (also referred to as “per diem fees” or “daily charge”) are used mainly for payment to hospitals in respect of in-patients. They are also normally used for the facilities which provide long-term care, since the daily rate is based on a calculation of the total cost of the facility for a year, divided by the number of patient days used.
Capitation
mainly used in primary healthcare, you get a certain amount of money for each patient you have listed (sometimes adjusted, so more money is provided for listed patients who are elderly, have chronic diseases etc)
(no incentive to actually see a patient)
Payment per case (or episode)
bundle payments
The costs for treating patients with certain diagnosis are calculated and the provider receives a payment which covers all diagnostic and curative services connected to certain groups of diagnosis. This kind of payment often is used in specialist care and in hospitals. It may also be used in combination with other payment methods. The per case payment best known in the world is the DRG-payment (Diagnosis Related Groups)
(problem = defining a case)
Payment per performance
complex to implement, performance usually assessed as patient outcomes, can be challenging to standardise due to different conditions the patients might be in initially
Vertical integration
Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment.
