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Year 3 - Public Health > Health system financing > Flashcards

Health system financing Flashcards

1
Q

what are the two processes of collecting resources

A
  • Progressive

- regressive

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2
Q

Define what is a progressive way of collecting resources

A
  • the proportion of income that is used to pay for care increases as income rises
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3
Q

Define what is a regressive way of collecting resources

A
  • the proporiton of income that is used to pay care increases as income drops
  • everyone pays the same amount
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4
Q

What are the ways to calculate total health expenditure (THE)

A
  • absoulte number

- or percentage of GDP (this one is used most)

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5
Q

What are the different forms of financing GDP

A
  • Taxation
  • social insurance
  • out of pocket payments (private)
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6
Q

What are the differnet forms of healthcare service provision

A
  • Public

- Private

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7
Q

Name the types of health care access

A
  • comprehensive

- selective - only allowed access to certain times

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8
Q

What questions should you ask when looking at health care fianicing

A
  • is the country a high, middle or low income country
  • what percentage of the health expenditure is the share of a countrys GDP
  • how are the funds collected or how is the system financed
  • how are services provided
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9
Q

What are the two ways to fund a health care system

A
  • Privately fianced
  • publicily fianced
  • mixed
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10
Q

How can you privately finance a healthcare system

A
  • out of pocket payments - co-payement and user fees and full payment
  • Private health insurance - group/individual schemes and MCOs
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11
Q

How can you publicily finance a healthcare system

A
  • Social insurance = single fund or multiple funds

- Taxation based systems = general taxes and hypothecated taxes

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12
Q

if you have less out of pocket payments you are

A

protecting the population more

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13
Q

What are the types of health insurance

A
  • Private health insurance = voluntary
  • Social insurance = compulsory
  • community insurance - voluntary
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14
Q

What does the model of private health insurance assume

A
  • the fee people pay will cover the administration costs and profit margins
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15
Q

What is the negative of private health insurance

A

based on ability to pay

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16
Q

How does private health insurance increase demand

A
  • risk aversion - wont take everyone
  • potential income losses - people will take health care insurance to prevent income losses
  • lack of other protection options - have no where else to get medical care
17
Q

What are the negatives of a private health insurance market

A
  • Adverse selection - due to information asymmetry - might not diclose chronic illness to a provider therefore health insurance uses ratings
  • those who are poor cannot get cover
  • moral hazard due to absence of prices in the point of use - protecting against overuse
  • diseconomies of scale - only have a certain number of providers therefore there is a fragmentation of resources
18
Q

What is a rating in private health insurance

A

Price varies based on

  • experience
  • customer or group rating based on risks - such as age
19
Q

What are the market defences that private health care insurance use to protect themselves

A
  • deductibles - first bill to be paid by the insurer
  • co-payments - every time you access the health service you have to pay a co fee
  • disease or service exclusion lists - excludes specific diseases to be treated
  • managed care - to monitor and supervise interactions between patients and doctors - can see if the doctor is giving you too much care
20
Q

Describe how social insurance works

A
  • linked with employment and the workplace
  • therefore a healthy workforce can be seen as a profit maximising strategy
  • compulsory - some have an income threshold option(in some countries high earners can opt out)
21
Q

What are the advantages of social insurance

A
  • everything from the wages that is collected is spent in healthcare
  • evidence sugessts that spending per capita on health service is higher than in tax based systems
  • increase equitable allocation of resources - access to the services is the same for rich and poor
22
Q

What are the disadvantages of social insurance

A
  • it is a form of employment tax
  • the amount raised will vary folllowing employment rates
  • risk of adverse selection if more than one social insurance fund
23
Q

What happens in a community insurance

A
  • Voluntary health insurance
  • usually targets the informal sector or rural areas where people are not covered or there are user charges
  • has been promoted as a form of financial protection for the most vulnerable and uncovered population
  • usually cover a basic package of services
  • micro-funded by government or NGOs
24
Q

what are taxes

A
  • compulsory payments directed by the state that do not confer any direct individual entitlement to specific goods or services in returns
25
Q

describe a tax based health system

A
  • Known as the beveridge model or the semashko model
  • funded through taxation (direct and indirect taxes, general taxation and earmarked taxes, national or local taxes)
  • universal and typically free at the point of use
  • typically publicly administrated and decentralized
26
Q

What is vertical equity in healthcare financing

A
  • Whether people with different levels of income make appropriately different payments
27
Q

What is horizontal equity in healthcare financing

A
  • the extent to which people with the same income make the same payments
28
Q

How can you measure the progressivity of healthcare financing

A
  • Kakwani’s progressivity index
29
Q

What is the progressivity of healthcare financing

A
  • is a measure of vetical equity or in other words oh how payments vary by income
30
Q

What is a proportional financing system

A
  • The proportion of income paid does not vary with the level of income
31
Q

What are out of pocket payments

A
  • payments that are made directly by a patient to healthcare provider
32
Q

What is the downside to having a high level of out of pocket payments

A
  • if there is a high level then you are exposing the population to a market where they dont have enough information to particpiate
  • causes high inequality
33
Q

Name the type of out of pocket payments

A
  • direct private payments
  • co-payments
  • user fees
  • informal payments
34
Q

Describe the type of out of pocket payments

A
  • direct private payments = e.g. direct payments for private consultations with doctors
  • co-payments = are direct payments made by the users of the health services as a contribution to their cost (usually covered by the insurance company) (flat rate)
  • user fees = direct payments made by users of health services as a contribution to there cost (flat amount)
  • informal payments - unofficial payments or envelope payments or under the table payments or gratitidue payments or bribes - are additional payments in a kind or cash made by users mainly to healthcare workers to ensure prompt attention or a minimum standard of care

Year 3 - Public Health (12 decks)

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