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HLTH305 > Week 9: German, UK and US health care systems > Flashcards

Week 9: German, UK and US health care systems Flashcards

1
Q

What model does Germany’s health care system follow?

A

Bismarckian model

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2
Q

Bismarckian model

A

A social insurance funding system where individuals and employers contribute to a designated health insurance fund

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3
Q

Components of Bismarckian model

A

Compulsory insurance w few exceptions
Multiple (non-profit) payers
Contributions geared to income

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4
Q

How are German physicians paid for outpatient services?

A

On a fee-for-service basis by sickness funds

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5
Q

How is the German health care system organized?

A

Multi-payer

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6
Q

What other countries use the bismarckin model?

A

France and the Netherlands

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7
Q

How much coverage is provided with the Bismarckian model?

A

90% coverage and the rest have private insurance

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8
Q

What model does the United Kingdom health care system use?

A

Beveridge model

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9
Q

Beveridge model

A

A national health service system that is run by the government

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10
Q

How is the United Kingdom health care system organized?

A

Single payer

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11
Q

How is the Beveridge model financed?

A

General revenues

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12
Q

Exception to the single payer system of the United Kingdom model

A

General practitioners who are independent contractors with the national health service model to provide primary care on a capitation basis

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13
Q

What other countries use the beveridge model?

A

Sweden and Italy

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14
Q

Overview of the U.S health care system

A

Mix of public and private, for-profit and non-profit insurers and health care providers

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15
Q

What is the dominant way in which health care is provided in the U.S.?

A

Private (67% of population)

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16
Q

How much does public spending pay for health care spending in the US?

A

45%

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17
Q

How many people lack health insurance in the US?

A

8.5%
Many people are underinsured

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18
Q

How much of private insurance is provided by employers?

A

55%

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19
Q

Private insurance

A

Often cover entire family
Majority offer choice of plan
Benefits vary
Employees contribute to premium
Involves managed care

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20
Q

User fees involved in private insurance

A

Employees pay 28% of all costs
- deductibles
- co-pays

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21
Q

What is not covered under private insurance plan?

A

Services and medical equipment

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22
Q

Premium

A

Monthly payment to an insurance company for insurance coverage

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23
Q

Managed care

A

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.

24
Q

Highest coverage of care with managed care

A

When you choose from a list of “in network providers” for private insurance

25
Q

Deductibles

A

Annual amount of money an insured person has to spend out of pocket before their insurance coverage begins

26
Q

Co-pays

A

Fixed or percentage-based amount of money an insured person has to pay per appointment or procedure

27
Q

Medicare

A

US health insurance program administered by states and co funded by federal government
Covers 18% of population

28
Q

Who is eligible to recieve Medicare?

A

People 65+
People with long term disabilities

29
Q

Part A of Medicare

A

Fee for service for hospital insurance

30
Q

Part B of Medicare

A

Fee for service program for non-hospital medical services

31
Q

Part C of Medicare

A

Covers additional services like mental health, drugs, dental and vision care

32
Q

Part D of Medicare

A

Alternative to part C that provides only prescription and drug coverage

33
Q

Who else does Medicare provide some coverage for?

A

Veterans’ health administration
Indian health service

34
Q

Medicaid

A

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

35
Q

Children’s health insurance plan

A

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

36
Q

What do some states include in the children health insurance plan?

A

Low-income pregnant women

37
Q

Patient protection and Affordable care act insurance regulations

A

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

38
Q

What else was established with the affordable care act?

A

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

39
Q

Individual mandate with premium subsidies

A

Requires that everyone has health insurance and those who can’t afford it receive subsidies

40
Q

Purpose of safety nets

A

Alternative plans for people who cant afford insurance

41
Q

What are the different safety nets?

A
  1. Federal qualified health centres
  2. Charity care and safety-net programs in hospitals
  3. Disproportionate care payments
  4. Treating all patients
42
Q
  1. Federal qualified health centres
A

Provides primary and preventative care to 27 million underserved individuals
Fees based on income

43
Q
  1. Charity care and safety-net programs
A

Public hospitals and local health departments receive charity care and safety-net programs

44
Q
  1. Disproportionate care payments
A

Hospitals with a large number of publicly insured and uninsured receive disproportionate care payments

45
Q
  1. Treating all patients
A

The federal law requires hospitals to treat all patients requiring emergency care regardless of ability to pay or insurance status

46
Q

Unsuccessful efforts at establishing universal health care coverage in the US

A

1930s: Roosevelt
1940s: Truman
1960s: Kennedy
1990s: Clinton

47
Q

Partially successful efforts to establish universal health care coverage in the US

A

1965: Johnson
1973: Nixon
1997: Clinton
2003: G.W. Bush
2010: Obama

48
Q

Johnson

A

Medicare parts A and B
Medicaid

49
Q

Nixon

A

Medicare part C

50
Q

Clinton

A

Children’s health insurance program

51
Q

G.W. Bush

A

Medicare part D

52
Q

Obama

A

Affordable care act

53
Q

Which country would you expect the most hassle when accessing health care after you lose your job?

A

United States

54
Q

Which countries health care system is the most similar to the affordable care act?

A

Germany

55
Q

What would make the US medicare program more similar to Canada’s?

A

Change who is eligible to be covered

56
Q

Public system in the US

A

SINGLE PAYER
Medicare
Medicaid
Children’s health insurance program
Veterans administrations
Indian Health service

57
Q

Public spending and how much of population

A

Pays for 45% of all health care spending
Covers 34% of population

HLTH305 (10 decks)

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