L7 Flashcards
What characterises the disparities in international health levels?
per capita income, HC expenditure, gov. involvement, HC systems etc. (see page 2 data)
Measures of HC systems?
Life expectancy (at birth), doctors/10K pop., HC spending per capita etc, morbidity and mortality, HIV/AIDs (see notes from lecture)
3 elements that must be considered when creating a HC financing system?
1) Relationship between the parties (providers, HHs etc.: is there a third party???)
2) Method of raising finance (taxes, insurance, direct payments etc.)
3) Method of reimbursement for providers (prospective/retrospective)
See diagram in notes
RMM
4 main options for raising finance?
1) User charges
2) Private health insurance
3) Social health insurance
4) direct taxation
UPSD
Explain user charges? Where are they favoured and not favoured?
Pay per use, direct payment from user to provider (eg. dentistry/prescriptions in the UK)
favoured by developing countries (eg. India) but not by developed countries because of ‘double-impact’ effect on income of many diseases (eg. cancer: cost of new clothes, cost of not working, transport costs etc.)
Explain private health insurance?
Covers specified risks of ill-health and incurs consequential expense
Premiums paid by consumer(/employer)
Premiums based on risk status
Advantages of private health insurance? (4)
1) Access to services
2) increased choice of services for consumers
3) continuity of care is often better
4) quality and cost efficiency of HC providers
Disadvantages of private health insurance? (3)
1) inequitable (some cannot afford it)
2) some things are covered (‘not-so-bad’ ones)
3) Expertise may be limited (eg. no A&E departments in UK private health insurance)
Explain what social health insurance is? (developed)
Based on solidarity of agents - paid for by gov., employers and workers
Premiums are fixed and not related to risk-level
Compulsory participation; (choose universal/part-coverage)
Contributions to one designated fund (SIF) or a choice of funds
used by France, Germany etc. (not the NHS)
Advantages of Social Health Insurance? (4)
1) Universal (or close to) coverage
2) More affordable premiums
3) employers look after workers
4) equity across high- and low-risk groups in pop.
Disadvantages of SHI? (3)
1) Poor may be excluded unless subsidised
2) Complex to manage
3) Cross-subsidisation encourages free-riders (eg. increase in number of smokers)
Explain direct taxation?
Funds are raised by general tax (or hypothecated tax)
Coverage is universal (eg. UK, denmark, italy)
HC is provided by a public monopoly (eg. NHS)
Advantages of direct taxation scheme? (4)
1) complete coverage
2) free at point of use
3) wide range of health services provision
4) equitable between income and risk groups within the population
4 disadvantages of direct taxation?
1) Moral hazard from consumer
2) Access (poor waiting times between referral and treatment)
3) High cost to the state
4) Challenges in the efficiency and quality of services
3 types of 3rd-party payers?
1) private insurance companies (profit/not-for-profit)
2) gov. authorities
3) social insurance funds (not directly under gov. control)
