Intro To Healthcare Systems

Question 1

Define systems

Answer 1

A set of connected things or devices that operate together

Question 2

Define healthcare systems

Answer 2

All activities whose primary purpose is to promote, restore + maintain health

Question 3

What are the 4 types of healthcare financing?

Answer 3

Out of pocket payments
Private health insurance
Social health insurance
Tax based financing

Question 4

What is out of pocket payments?
Examples

Answer 4

• Direct payments by patients for medical care
• No reimbursement by insures or government
• e.g. medication, consultation with doctor

Question 5

Advantages + disadvantages of out of pocket payments

Answer 5

Advantages:
- contains health service demand
.
Disadvantages:
- people may under use health services
- serious illness could result in catastrophic health expenditures
- costs those on the lowest income proportionately more than highest
- exacerbates health inequalities

Question 6

What is private health insurance?

Answer 6

• individuals contribute to a fund by paying voluntary premiums in advance to an insurance company
• costs of healthcare are then covered as required

Question 7

What are advantages + disadvantages of private health insurance?

Answer 7

Advantages:
- protection against catastrophic expenditure
- patients have a choice of insurer + competition may drive up standards of care
- reduces burden on public finances
.
Disadvantages:
- exacerbates health inequalities
- moral hazard of over consumption + over provision of healthcare
- adverse selection: lower risk will not purchase, meaning average level of risk high

Question 8

What is social health insurance?

Answer 8

• insurance system where employers + employee contribute to fund
• employees contribute a proportion of salary + employer match this
• government contributes to those out of work
• provided by private healthcare providers

Question 9

Advantages + disadvantages of social health insurance

Answer 9

Advantages:
- protection against catastrophic expenditures
- universal coverage through government contribution
- access based on needs
.
Disadvantages:
- high administration costs
- may be opt out for higher earners

Question 10

What countries have social health insurance?

Answer 10

Germany
Japan

Question 11

What is taxation?

Answer 11

• Healthcare is funded through general taxation
• provided mostly by state controlled providers + doctors

Question 12

What countries use taxation for healthcare funds?

Answer 12

UK
Sweden

Question 13

What country uses out of pocket payments primarily?

Answer 13

Bangladesh

Question 14

Advantages + disadvantages of taxation

Answer 14

Advantages:
- universal coverage
- access based on need
- fewer inequalities
- lower administer ion costs
- controls on spending + prioritisation
.
Disadvantages:
- healthcare budgets less predictable
- overuse of healthcare
- less choice of providers

Question 15

Structure of healthcare systems in England

Answer 15

• national bodies: department of health + social care > NHS
• regional level: integrated care boards + partnerships
• local level: primary care networks, local authorities
• service providers: hospitals, primary care, private care, social care

Question 16

Structure of healthcare system in Scotland

Answer 16

• 14 NHS boards in Scotland
• plan, commission + deliver NHS services + take overall responsibility for health of populations

Question 17

Structure of healthcare systems in Northern Ireland

Answer 17

• 5 health + social care trusts
• integrated health + social care systems to manage services

Question 18

Structure of healthcare systems in wales

Answer 18

• 7 local health boards
• commission + provide services in their areas with responsibility for health of local population

Question 19

What are integrated care systems?

Answer 19

Partnerships that bring together providers + commissioners of NHS services across geographical area

Question 20

Function of integrated care systems

Answer 20

• plan health + care services to meet needs of population
• integrate care across different organisations

Question 21

Advantages of integrated care systems

Answer 21

• focus of collaboration not competition
• improving care for people with long term conditions
• potential to tackle inequalities

Question 22

Criteria to consider when priority setting

Answer 22

• burden of disease
• equity
• cost effectiveness
• clinical effectiveness
• clear framework
• process for appeals, evaluation + audits