week 9- different health care systems Flashcards
Bismarckian
models; Social insurance model
- Compulsory insurance with few exceptions
- Multiple (non-profit) payers
- Contributions geared to income
- 90% coverage; rest have private insurance
Social insurance model examples
Germany, France, Netherland
Beveridge models; National Health Service model
Single Payer
Nationalization of hospitals and staff
Financed by general capitation
Beveridge models; National Health Service model: examples
U.K., Sweden, Italy
The U.S. Health Care System: An Overview
- Mix of public and private, for-profit and non-profit insurers and
health care providers - Private insurance dominant (67% of population)
- Public spending pays for 45% of all health care spending (covering
34% of population) - Many people are underinsured
how many people in US lack health care
About 8.5% (27.5 million people) lack health insurance
Private insurance ; 55% is provided by
employers
- Often cover entire family
- Majority offer choice of plan
- Benefits vary widely
- Employees typically contribute
to premium - Often involves ”managed care”-choose from a list
Private insurance ; User fees: Employees pay 28% of all costs
- Deductibles (2018 average:
$1846) - Co-pays : fixed amount an individual has to pay to get care, can vary widely
- Services and medical
equipment not covered in
plan
Public Insurance (Single-Payer: Government) – Administered by States (Co-funded by Federal Government)
- Medicare
- Medicaid
Medicare US
- 65+
- people with long-term disabilities
- Parts A, B, C, D (they choose what they want/need)
- Indian health service
part A Medicare
fee for service program for hospital insurance
part B Medicare
fee for service program non hospital services
Medicare C
- start in 1973
- another option instead of AMB (additional services, mental health, prescriptions drugs, dental care)
Medicare D
- 2003
- only prescription drug coverage
Medicaid US
- 1965
- Eligibility, coverage, finding, and cost, depends on states
sharing vary widely
Children’s Health Insurance Plan:
Children’s Health Insurance Plan:
- Those ineligible for Medicaid but
don’t have or can’t afford private
insurance - Up to age 19
- 9.6 million children
- Some states include low-income
pregnant women - 1997
Patient Protection and
Affordable Care Act (2010) (obmama care)
- Insurance regulation
- individual mandate with premium subsidies
- Employer mandate- companies must provide insuresance to employees
- Federal marketplace of individual insurance from private
companies - New Centre for Medicare and Medicaid Innovation
Insurance regulations of obmama care
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
examples of safety nets
- federally qualified health centers
- charity care and safety-net programs in public hospitals and local health departments
- ‘disproportionate care’ payments to hospitals with large number of publicly insured and uninsured
- federal law requires hospitals to treat all patients requiring emergency care regardless of ability to pay or insurance status
federally qualified health centers
- primary and preventive care to 27 million underserved fees based on income
- affordable care act supported
what is the issue with the US federal law and making people pay without caring if they can pay or not
- if they cover it, they have to be treate thus people may go bankrupt
Efforts to Establish Universal
Health Care Coverage in the U.S; Unsuccessful
1930s: Roosevelt unable to pass a health care act
1940s: Truman
1960s: Kennedy
1990s: Clinton
Efforts to Establish Universal
Health Care Coverage in the U.S; Partially Successful:
1965: Johnson (Medicare parts A
and B; Medicaid)
1973: Nixon (Medicare part C)
1997: Clinton (Children’s Health
Insurance Program)
2003: G.W. Bush (Medicare part D)
2010: Obama (Affordable Care Act)
