Week 9: German, UK and US health care systems Flashcards
What model does Germany’s health care system follow?
Bismarckian model
Bismarckian model
A social insurance funding system where individuals and employers contribute to a designated health insurance fund
Components of Bismarckian model
Compulsory insurance w few exceptions
Multiple (non-profit) payers
Contributions geared to income
How are German physicians paid for outpatient services?
On a fee-for-service basis by sickness funds
How is the German health care system organized?
Multi-payer
What other countries use the bismarckin model?
France and the Netherlands
How much coverage is provided with the Bismarckian model?
90% coverage and the rest have private insurance
What model does the United Kingdom health care system use?
Beveridge model
Beveridge model
A national health service system that is run by the government
How is the United Kingdom health care system organized?
Single payer
How is the Beveridge model financed?
General revenues
Exception to the single payer system of the United Kingdom model
General practitioners who are independent contractors with the national health service model to provide primary care on a capitation basis
What other countries use the beveridge model?
Sweden and Italy
Overview of the U.S health care system
Mix of public and private, for-profit and non-profit insurers and health care providers
What is the dominant way in which health care is provided in the U.S.?
Private (67% of population)
How much does public spending pay for health care spending in the US?
45%
How many people lack health insurance in the US?
8.5%
Many people are underinsured
How much of private insurance is provided by employers?
55%
Private insurance
Often cover entire family
Majority offer choice of plan
Benefits vary
Employees contribute to premium
Involves managed care
User fees involved in private insurance
Employees pay 28% of all costs
- deductibles
- co-pays
What is not covered under private insurance plan?
Services and medical equipment
Premium
Monthly payment to an insurance company for insurance coverage
Managed care
Type of healthcare insurance plan that coordinates and manages healthcare services for its members to provide cost-effective and high-quality care
Involve contracts between insurance company and a network of healthcare providers.
Highest coverage of care with managed care
When you choose from a list of “in network providers” for private insurance
Deductibles
Annual amount of money an insured person has to spend out of pocket before their insurance coverage begins
Co-pays
Fixed or percentage-based amount of money an insured person has to pay per appointment or procedure
Medicare
US health insurance program administered by states and co funded by federal government
Covers 18% of population
Who is eligible to recieve Medicare?
People 65+
People with long term disabilities
Part A of Medicare
Fee for service for hospital insurance
Part B of Medicare
Fee for service program for non-hospital medical services
Part C of Medicare
Covers additional services like mental health, drugs, dental and vision care
Part D of Medicare
Alternative to part C that provides only prescription and drug coverage
Who else does Medicare provide some coverage for?
Veterans’ health administration
Indian health service
Medicaid
Provides health insurance to people with low incomes and is funded by federal and state governments; single payer
Covers 18% of population
Eligibility requirements vary
Children’s health insurance plan
Provides coverage for children up to age 19 who’s parents are ineligible for Medicaid and cant afford private insurance
Covers 9.6 million children
What do some states include in the children health insurance plan?
Low-income pregnant women
Patient protection and 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
What else was established with the affordable care act?
Individual mandate with premium subsidies
Employer mandate
Federal marketplace of individual insurance from private companies
Establishment of a web site where people can learn about and sign up for health insurance
New Centre for Medicare and Medicaid Innovation
Individual mandate with premium subsidies
Requires that everyone has health insurance and those who can’t afford it receive subsidies
Purpose of safety nets
Alternative plans for people who cant afford insurance
What are the different safety nets?
- Federal qualified health centres
- Charity care and safety-net programs in hospitals
- Disproportionate care payments
- Treating all patients
- Federal qualified health centres
Provides primary and preventative care to 27 million underserved individuals
Fees based on income
- Charity care and safety-net programs
Public hospitals and local health departments receive charity care and safety-net programs
- Disproportionate care payments
Hospitals with a large number of publicly insured and uninsured receive disproportionate care payments
- Treating all patients
The federal law requires hospitals to treat all patients requiring emergency care regardless of ability to pay or insurance status
Unsuccessful efforts at establishing universal health care coverage in the US
1930s: Roosevelt
1940s: Truman
1960s: Kennedy
1990s: Clinton
Partially successful efforts to establish universal health care coverage in the US
1965: Johnson
1973: Nixon
1997: Clinton
2003: G.W. Bush
2010: Obama
Johnson
Medicare parts A and B
Medicaid
Nixon
Medicare part C
Clinton
Children’s health insurance program
G.W. Bush
Medicare part D
Obama
Affordable care act
Which country would you expect the most hassle when accessing health care after you lose your job?
United States
Which countries health care system is the most similar to the affordable care act?
Germany
What would make the US medicare program more similar to Canada’s?
Change who is eligible to be covered
Public system in the US
SINGLE PAYER
Medicare
Medicaid
Children’s health insurance program
Veterans administrations
Indian Health service
Public spending and how much of population
Pays for 45% of all health care spending
Covers 34% of population
