International Healthcare Systems Flashcards
Canada: What is covered and what isn’t?
All medically necessary care including maternity care and infertility treatment.
Except perscription medications, dental, and optometry.
70% public spending
30% private spending
In Canada, healthcare spending decisions are made at the ___ level.
In Canada, healthcare spending decisions are made at the province level.
Canadian healthcare system name
Medicare
Most Canadian citizens have ___ to supplement their public healthcare.
Most Canadian citizens have private insurance to supplement their public healthcare.
Canadian healthcare wait times
Not substantially longer than in the US with the exception of elective operations, despite what people say. The reason people think the US is better is just because the US doesn’t often report its wait times and so there is not usually a point of comparison.
French healthcare system name
Social Security
Everyone in France must. . .
Everyone in France must pay for mandatory health insurance
French healthcare options
5 options, all non-profit, with one alone covering 85% of all French citizens (the General plan).
All have pretty much the same benefits and the same reimbursement. The only people who don’t have insurance are those who don’t work and aren’t covered by another system, and these people are covered by a separate tax-funded program which reimburses better than these other plans.
Covers ~80-85% of total healthcare costs in France.
Where does funding for French healthcare come from?
~1/3 payroll taxes
~1/3 income taxes
~1/3 tobacco, alcohol, and transfer from other branches of social security program
How is the coverage for the French healthcare system?
Extremely wide, with large benefits for maternity care, childcare, and even things like homeopathy.
French private insurance market
Does exist, and covers ~90% of citizens. Covers many of the costs the French government program does not (~15-20% of total costs)
~70% of French primary care physicians are ___.
~70% of French primary care physicians are self employed.
Just goes to show that the French system is not socialized medicine.
Most people in France pay ___ for healthcare.
Most people in France pay very little compared to other countries for healthcare.
French out-of-pocket maximum from government programs
50 Euros/year
In France, co-pays are regulated by ___.
In France, co-pays are regulated by sickness.
People with chronic conditions have all co-pays waived.
The French healthcare system stands out among international systems on two metrics:
- Quality
- Patient satisfaction
French health expenditure in terms of GDP is. . .
. . . near the highest in the world.
It comes in 3rd, 2nd being Netherlands, and 1st being United States.
Healthcare spending breakdown in Singapore
1/3 public
2/3 private
Singapore “tiered” healthcare system
Tiers: A, B1, B2+, B2, C
If you choose A, you get your own private room and doctor of your choice, but you pay everything out-of-pocket
If you choose C, you stay on a ward with 8 other patients and have an assigned physician, but almost everything is paid for you
Singapore health savings accounts
All workers are mandated to put a certain portion of their earnings into savings accounts for their future. For those under 50, the number is 20% of earnings matched by 16% from employers.
Accounts include: An ordinary account (for home, pay for life insurance, pay for education), A special account (for retirement and investment), and a Medisave account (for healthcare costs and approved healthcare insurance programs).
Singapore’s Medisave
Accounts for about 7-9.5% of earnings, earns interest at rate set by government, and has a cap at $43,500.
Once this cap is reached, the savings may be diverted into special or general accounts.
Marriage and Parenthood Package
In Singapore. To encourage people to have kids.
You get $6,000 cash for each of your first 2 children, and $8,000 for your third and fourth children.
The gov’t will also match savings in a child development account up to a certain maximum.
Medishield
Singapore’s catastrophic illness program
While not mandatory, over 90% of population is covered. Very cheap, from $33 annual premiums for a 29 year old to $372 annual premiums for a 69 year old.
Kicks in following decuctible and co-insurance payments.
Annual benefit limit: $50,000
Lifetime benefit limit: $200,000
Medifund
Singapore’s safety net program
Only citizens eligible, only covers Class C wards, and only available after Medisave and Medishield funding has been exhausted for the year.
Eldershield
Singapore program for elderly healthcare coverage
Funds start to be withdrawn from wages at age 40 and continue to age 65.
When money is needed, you can take up to $400/month out up to a maximum of 72 months (6 years) in nursing care.
Switzerland individual mandate
By law, everyone in Switzerland is required to buy health insurance.
If you move there you have 3 months to buy insurance retroactive to your arrival.
Swiss insurance groups
Children up to 19
20-25 year old young adults
26+ adults
More than half of the Swiss chose. . .
. . . basic coverage with a managed care insurer
What is covered in the Swiss system?
Everything but dental, and optometry is only covered for the child category (up to age 19)
In Switzerland, unlike many other countries, insurance is not coupled to ____.
In Switzerland, unlike many other countries, insurance is not coupled to employment.
Swiss Voluntary Health Insurance
While all are required to have health insurance, VHI refers to additional coverages that, for a raised premium, allow more options for care: Better choice of hospitals and doctors and improved hospital amenities.
Swiss regulations on premiums
All base plans have a minimum deductable of 325 Franks and a maximum deductable of 2715 Franks.
Swiss cost sharing
Generally ~10% coinsurance above the deductible
15 Frank copay per diem in hospital
20% copay on perscription drugs
Pricing under the Swiss system is ___.
Pricing under the Swiss system is set by law, and cannot be changed by private physicians or hospitals.
____ are exempt from cost sharing in Switzerland.
Maternity, preventative care, and inpatient pediatric care are exempt from cost sharing in Switzerland.
The Swiss Individual mandate deals with impoverished individuals who cannot afford health insurance by ___.
The Swiss Individual mandate deals with impoverished individuals who cannot afford health insurance by subsidizing.
Public/Private breakdown in Switzerland
Public: 65% of all spending
Private: Remaining 35%
SHI plans must be ___.
VHI plans may be either way.
SHI plans must be nonprofit.
VHI plans may be either way.
It is technically illegal in Switzerland for coverages rates in VHI to be based on ___, but in practice this is hard to enforce.
It is technically illegal in Switzerland for coverages rates in VHI to be based on information known through SHI programs from the same insurance provider, but in practice this is hard to enforce.
20% of healthcare expenditure in Switzerland comes from ____.
20% of healthcare expenditure in Switzerland comes from out-of-pocket payments.
In Switzerland, ___ are mostly in charge of healthcare system decisions
In Switzerland, cantons (not the federal government) are mostly in charge of healthcare system decisions
Quality regulation in Swiss care is almost entirely driven by ___.
Quality regulation in Swiss care is almost entirely driven by individuals from within the profession, not external regulation.
Switzerland ranks ___ largest healthcare expenditure as a portion of GDP.
Switzerland ranks 6th largest healthcare expenditure as a portion of GDP.
It comes in at ~11% GDP
In Switzerland, drugs must be evaulated for ___ as well as effectiveness before they hit the market.
In Switzerland, drugs must be evaulated for cost as well as effectiveness before they hit the market.
It is worth noting that the Swiss healthcare system bears great resemblance to the _____ system.
It is worth noting that the Swiss healthcare system bears great resemblance to the Affordable Care Act Exchange system.
If Swiss physicians rack up costs by perscribing too many drugs or providing too many services, they may be ____.
If Swiss physicians rack up costs by perscribing too many drugs or providing too many services, they may be investigated by the insurance company.
If they cannot justify these services to the satisfactions of the insurers, they may be forced to pay some of the cost out-of-pocket themselves.
Switzerland often ranks highest among all nations in terms of ____.
Switzerland often ranks highest among all nations in terms of healthcare access.
Wait times are short and elective surgeries are high quality.
The Swiss system overall:
It is one of the more expensive systems, but those prices actually translate to quality in this case, unlike in the US or UK.
Referrals under Swiss system
You often need to be referred in order to see a specialist, but you have your pick of the litter as far as specialists.
