Health Systems: A Global Comparative Perspective Flashcards
What is health insurance?
A type of insurance which covers the whole or part of medical expenses. It could be related the cost of medication, or staying in a hospital, etc.
What is a premium?
An amount paid to the insurance company to maintain the cost. Paid to health insurance every month
- When it’s collected, it’s for those who face a bad outcome
- Usually, they are the expected cost for everyone
Why is insurance so important in healthcare?
- B/c illness is uncertain, the more insurance is valued
- Ex: if someone finds out they have cancer and they want to cure it immediately, but don’t have the funds to do so, insurance is there to help them
What are the problems w/ insurance?
- Adverse selection: b/c sick people are more likely to buy than wealthy people. If most wealthy people don’t buy (but sick people do), then costs will rise, more healthy people will drop out, and so on until eventually leading to a collapse. Leads to a “death spiral”
- Moral hazard: by buffering insurance holders against costs, individuals have less reason to pay attention to prices and may change their behavior (use more health care)
What kinds of payment do healthcare providers use?
- Capitation: paid a set amount for every patient they see
- Fee for service: paid for each procedure used to treat a patient
In capitation, who is the risk on?
The provider. B/c it’s the same amount every month regardless of patient use. The more they use, the less the provider is paid
In FFS, who is the risk on?
The insurer. Every additional usage
What is it called when you combine both kinds of payment?
blended capitation model
What is cost sharing?
When you pay funds/bills out of pocket
Types of cost sharing?
- Deductible: what the enrolee pays before the health insurer pays for anything
- Co-pay: what the enrolee pays at the time they receive services
- Co-insurance: percentage of costs of the services that the enrolee must pay after the deductible is fulfilled
What are goals of the healthcare system?
- Improve people’s health
- Treat them w/ dignity
- Protect from financial ruin after medical bills
What are the different health systems in the world?
- Beveridge model
- National health insurance
- Bismarck model
- Out of pocket
What is the Beveridge model?
Single payer national health service. Universal coverage is guaranteed by the gov. through taxes, and anyone who is a citizen has access to care. No doctor bills. “Free” at point of use. The gov. owns the hospitals and employs the doctors
Where/when was the Beveridge model founded?
1948 in the United Kingdom and it spread in the world
Who uses the Beveridge model?
UK, New Zealand, Scandinavia, Cuba, Thailand, Spain, Brazil, Rwanda, Veterans Health Admin, etc.
