Week 9 Flashcards
Bismarkian models
-social insurance model
Social insurance model
-multiple entities pay for health care
-compulsory insurance with few exceptions
-contributions geared to income
-non-profit organizations that pay for health care
What countries follow a social insurance model
-germany
-france
-netherlands
Beveridge models
-national health service model
National health service model
-single payer
-nationalization of hospitals and staff
-financed by general revenues
-general practitioner capitation
What countries follow a national health service model
-UK
-sweden
-italy
Is the US public or private system dominant
-private
-67% of population
How many people in the US lack health insurance
-8.7%
What percentage of private insurance is covered by employers
-55%
What is included in private insurance covered by employers
-entire family coverage
-offer choice of plan
-benefits vary widely
-employees typically contribute to premium
-often involves managed care
What percentage of private insurance is covered by employees
-28%
How is private insurance paid by employees
-deductibles
-co-pays
-services and medical equipment not covered in plan
Types of public insurance in the US
-medicare
-medicaid
-childrens health insurance plan
Medicare eligibility
-people 65+
-people with long term disabilities
How many parts of medicare are there
-A-D
Medicare part A and B
-fee for service
Medicare part C
-extra costs like mental health, vision care etc
Medicare part D
-prescription and drug coverage
What extra services does medicare provide
-veterans health administration
-indian health service
What percentage of the population does medicare cover
-18%
Medicaid eligibility
-varys widely
Childrens health insurance plan
-those ineligible for medicaid but don’t have or cant afford private insurance
-up to age 19
-some states include low-income pregnant women
How many children does the childrens health insurance plan cover
-9.6 million
When was patient protection and affordable care act created
-2010
Affordable care act insurance regulations
-pre-existing conditions provision
-ban on annual and lifetime coverage caps
-cap on annual out-of-pocket costs
-cover children on parents’ policies until age 26
Additional features of affordable care act
-individual mandate with premium subsides
-employer mandate
-federal marketplace of individual insurance from private companies
-new centre for medicare and medicaid innovation
“Safety nets”
-for people who fall through cracks of previous coverage options
Examples of safety nets
-federally qualified health centres
-charity care and safety net programs
-disproportionate care payments to hospitals with large number of publicly insured and uninsured
-federal law requires all patients requiring emergency care to be treated regardless of ability to pay
Unsuccessful efforts to establish universal health care in the US
-roosevelt
-truman
-kennedy
-clinton
Partially successful efforts to establish universal health care in the US
-johnson
-nixon
-clinton
-bush
-obama
