International Healthcare Systems

Question 1

Canada: What is covered and what isn’t?

Answer 1

All medically necessary care including maternity care and infertility treatment.

Except perscription medications, dental, and optometry.

70% public spending

30% private spending

Question 2

In Canada, healthcare spending decisions are made at the ___ level.

Answer 2

In Canada, healthcare spending decisions are made at the province level.

Question 3

Canadian healthcare system name

Answer 3

Medicare

Question 4

Most Canadian citizens have ___ to supplement their public healthcare.

Answer 4

Most Canadian citizens have private insurance to supplement their public healthcare.

Question 5

Canadian healthcare wait times

Answer 5

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.

Question 6

French healthcare system name

Answer 6

Social Security

Question 7

Everyone in France must. . .

Answer 7

Everyone in France must pay for mandatory health insurance

Question 8

French healthcare options

Answer 8

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.

Question 9

Where does funding for French healthcare come from?

Answer 9

~1/3 payroll taxes

~1/3 income taxes

~1/3 tobacco, alcohol, and transfer from other branches of social security program

Question 10

How is the coverage for the French healthcare system?

Answer 10

Extremely wide, with large benefits for maternity care, childcare, and even things like homeopathy.

Question 11

French private insurance market

Answer 11

Does exist, and covers ~90% of citizens. Covers many of the costs the French government program does not (~15-20% of total costs)

Question 12

~70% of French primary care physicians are ___.

Answer 12

~70% of French primary care physicians are self employed.

Just goes to show that the French system is not socialized medicine.

Question 13

Most people in France pay ___ for healthcare.

Answer 13

Most people in France pay very little compared to other countries for healthcare.

Question 14

French out-of-pocket maximum from government programs

Answer 14

50 Euros/year

Question 15

In France, co-pays are regulated by ___.

Answer 15

In France, co-pays are regulated by sickness.

People with chronic conditions have all co-pays waived.

Question 16

The French healthcare system stands out among international systems on two metrics:

Answer 16

• Quality
• Patient satisfaction

Question 17

French health expenditure in terms of GDP is. . .

Answer 17

. . . near the highest in the world.

It comes in 3rd, 2nd being Netherlands, and 1st being United States.

Question 18

Healthcare spending breakdown in Singapore

Answer 18

1/3 public

2/3 private

Question 19

Singapore “tiered” healthcare system

Answer 19

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

Question 20

Singapore health savings accounts

Answer 20

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).

Question 21

Singapore’s Medisave

Answer 21

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.

Question 22

Marriage and Parenthood Package

Answer 22

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.

Question 23

Medishield

Answer 23

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

Question 24

Medifund

Answer 24

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.

Question 25

Eldershield

Answer 25

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.

Question 26

Switzerland individual mandate

Answer 26

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.

Question 27

Swiss insurance groups

Answer 27

Children up to 19

20-25 year old young adults

26+ adults

Question 28

More than half of the Swiss chose. . .

Answer 28

. . . basic coverage with a managed care insurer

Question 29

What is covered in the Swiss system?

Answer 29

Everything but dental, and optometry is only covered for the child category (up to age 19)

Question 30

In Switzerland, unlike many other countries, insurance is not coupled to ____.

Answer 30

In Switzerland, unlike many other countries, insurance is not coupled to employment.

Question 31

Swiss Voluntary Health Insurance

Answer 31

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.

Question 32

Swiss regulations on premiums

Answer 32

All base plans have a minimum deductable of 325 Franks and a maximum deductable of 2715 Franks.

Question 33

Swiss cost sharing

Answer 33

Generally ~10% coinsurance above the deductible

15 Frank copay per diem in hospital

20% copay on perscription drugs

Question 34

Pricing under the Swiss system is ___.

Answer 34

Pricing under the Swiss system is set by law, and cannot be changed by private physicians or hospitals.

Question 35

____ are exempt from cost sharing in Switzerland.

Answer 35

Maternity, preventative care, and inpatient pediatric care are exempt from cost sharing in Switzerland.

Question 36

The Swiss Individual mandate deals with impoverished individuals who cannot afford health insurance by ___.

Answer 36

The Swiss Individual mandate deals with impoverished individuals who cannot afford health insurance by subsidizing.

Question 37

Public/Private breakdown in Switzerland

Answer 37

Public: 65% of all spending

Private: Remaining 35%

Question 38

SHI plans must be ___.

VHI plans may be either way.

Answer 38

SHI plans must be nonprofit.

VHI plans may be either way.

Question 39

It is technically illegal in Switzerland for coverages rates in VHI to be based on ___, but in practice this is hard to enforce.

Answer 39

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.

Question 40

20% of healthcare expenditure in Switzerland comes from ____.

Answer 40

20% of healthcare expenditure in Switzerland comes from out-of-pocket payments.

Question 41

In Switzerland, ___ are mostly in charge of healthcare system decisions

Answer 41

In Switzerland, cantons (not the federal government) are mostly in charge of healthcare system decisions

Question 42

Quality regulation in Swiss care is almost entirely driven by ___.

Answer 42

Quality regulation in Swiss care is almost entirely driven by individuals from within the profession, not external regulation.

Question 43

Switzerland ranks ___ largest healthcare expenditure as a portion of GDP.

Answer 43

Switzerland ranks 6th largest healthcare expenditure as a portion of GDP.

It comes in at ~11% GDP

Question 44

In Switzerland, drugs must be evaulated for ___ as well as effectiveness before they hit the market.

Answer 44

In Switzerland, drugs must be evaulated for cost as well as effectiveness before they hit the market.

Question 45

It is worth noting that the Swiss healthcare system bears great resemblance to the _____ system.

Answer 45

It is worth noting that the Swiss healthcare system bears great resemblance to the Affordable Care Act Exchange system.

Question 46

If Swiss physicians rack up costs by perscribing too many drugs or providing too many services, they may be ____.

Answer 46

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.

Question 47

Switzerland often ranks highest among all nations in terms of ____.

Answer 47

Switzerland often ranks highest among all nations in terms of healthcare access.

Wait times are short and elective surgeries are high quality.

Question 48

The Swiss system overall:

Answer 48

It is one of the more expensive systems, but those prices actually translate to quality in this case, unlike in the US or UK.

Question 49

Referrals under Swiss system

Answer 49

You often need to be referred in order to see a specialist, but you have your pick of the litter as far as specialists.