Health Systems Policy & Management (II) Health System Models Flashcards
What are the three main factors to keep in mind when comparing health systems?
Financing (public; private; out-of-pocket)
Delivery (public; private non-profit; private for-profit)
Access (universal; not universal)
Describe the financing of the Beveridge model (UK, New Zealand, Spain, Scandinavia).
Public financing via general taxes
Describe the delivery mechanism of the Beveridge model (UK, New Zealand, Spain, Scandinavia).
Publicly owned and some private providers
Describe access to care in the Beveridge model (UK, New Zealand, Spain, Scandinavia).
Universal care
Describe financing in the Bismarck model (Germany, France, the Netherlands, Japan).
Private financing via joint efforts of employers and employees
Describe the delivery mechanism in the Bismarck model (Germany, France, the Netherlands, Japan).
Care mostly via private providers
Describe access to care in the Bismarck model (Germany, France, the Netherlands, Japan).
Universal coverage
Describe financing in the National Health Insurance model (Canada, Taiwan, South Korea).
Public financing via special taxes
Describe the delivery mechanism in the National Health Insurance model (Canada, Taiwan, South Korea).
Care mostly via private providers
Describe access to care in the National Health Insurance model (Canada, Taiwan, South Korea).
Universal coverage
Describe financing in the out-of-pocket model (rural Africa, Southeast Asia).
Most countries are too poor or disorganized to provide financing
Describe the delivery mechanism in the out-of-pocket model (rural Africa, Southeast Asia).
Care via private providers
Describe access to care in the out-of-pocket model (rural Africa, Southeast Asia).
Only those who can pay or access charity care will receive service
Is the U.S. system most like the Beveridge, Bismarck, NHI, or out-of-pocket health system models?
It is a blend of each.
Beveridge - VA system
National Health Insurance - Medicaid and Medicare
Bismarck - those getting insurance from their employers (private )
Out-of-pocket - whoever pays direct costs without insurance
Summarize the main health system models (Beveridge, Bismarck, national health insurance, and out-of-pocket) according to:
financing (public or private),
delivery (public or private),
and access (universal or not).
Does the U.S. system need reform?
Yes, if financing, delivery, and access needs are not being met efficiently, then the system needs to change.
Spiraling costs and the lack of universal coverage indicate a broken system.
What is acute inpatient care?
Hospital care with an average length of patient stay of ≤ 25 days
(⅓ of healthcare expenses and ½ of all healthcare personnel)
What is another name for outpatient care?
Ambulatory care
How are most ambulatory services used (in descending order)?
Primary care offices > Surgical and medical specialty care offices > hospital EDs > hospital outpatient departments
What is a long-term care facility?
An inpatient care location with an average length of stay of > 25 days
E.g. nursing home, rehabilitation center, etc.
What percentage of elderly individuals receive care from family members?
80%
What are the requirements for hospice care?
≤ 6 mo. life expectancy if disease runs its normal course
What is provided in hospice care?
Palliative care; end-of-life counseling for patient and family
Contrast preventative care in fee-for-service and capitation payment systems.
Capitation favors preventative medicine more than fee-for-service
(preventative medicine keeps you from seeing the doctor, which would be lucrative to the provider in the capitation system but detrimental in the FFS system)
