Study guide for the final part 3 Flashcards
How does the US have an imperfect market?
It’s a quasi-market where HC is partially managed by free markets
It deviates from free market principles
What occurs in a free market HC system?
Multiple pts and providers act independently, and pts can choose to receive services from any provider.
The price of services is determined by the forces of supply and demand
Pts should have info about the appropriateness of various services
Pts directly bear the cost of services received
How does the US HC system deviate from free market principles in terms of healthcare plans?
Consolidation of pts into health plans has the effect of shifting the power from the pts to the administrator of the plans.
The health plans are the real buyers in the market, and pts have a limited choice of providers.
Describe the concept of moral hazard
Once enrollees have purchased health insurance, they will use HC services to a greater extent than if they were to pay for the services out-of-pocket
How does the US HC system deviate from free-market principles in terms of prices?
Prices are determined by the payers, such as MCOs, Medicare, and Medicaid, not by the forces of supply and demand.
How does the US HC system deviate from free-market principles in terms of providers?
Providers have formed alliances and integrated delivery systems on the supply side as well.
How does the US HC system deviate from free-market principles in terms of information and decision-making?
It is very difficult for pts to obtain info and understand the appropriateness of various medical services.
Decisions by HC use are often determined by the need or the amt of medical care that medical experts believe a person should have to remain or become healthy, rather than by price-based demand
From where can artificial demand be created?
Pts’ self-assessed need, moral hazard, and practitioners’ financial interests (aka provider-induced demand)
When there are multiple payers and different plans for companies, what is the result?
A billing and collection nightmare
System becomes more cumbersome
Characteristics of the National Health Insurance (NHI), Canada
Gov’t finances HC through taxes
Care provided by private providers
Gov’t consolidation of financial, insurance, and payment
Characteristics of National Health System (NHS), Great Britain
Financing: a tax-supported NHI
Gov’t manages the infrastructure for delivery
Gov’t operates medical institutions
Providers: gov’t employees or tightly organized
Characteristics of Socialized Health Insurance (SHI), Germany, Israel, Japan
Financed through gov’t-mandated contributions by employers and employees
Sickness funds collect contributions and pay providers
HC delivered by private providers
Gov’t exercises overall control
What are the components of the systems framework?
System foundation, system resources, system processes, system outcomes, and system outlook
Definition of system foundation
Historical, cultural, social, and economic factors that explain the current structure
What are two types of system resources?
Human
Non-human
