Week 9 - Health Care Policy in Other Wealthy Countries 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 the 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
- Children’s 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
- Established in 1973, optional supplement to A&B which covers additional services like mental health, prescription drugs and dental and vision care.
- Requires enrolees to enter into a medicare advantage, a type of managed care
Medicare part D
- Established in 2003, alternative to part C only providing prescription and drug coverage
What extra services does medicare provide
- Veterans health administration
- Indian health service
- Medicaid
- Children’s health insurance plan
What percentage of the population does medicare cover
- 18%
Medicaid eligibility
- Provides health insurance for people with low incomes and is funded by the federal and states governments
- Eligibility, coverage, funding and cost sharing vary widely
Children’s health insurance plan
- Those ineligible for medicaid by don’t have or cant afford private insurance
- Up to age 19
Some states include low-income pregnant women
How many children does the children’s health insurance plan cover
- 9.6 million children
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 policy until age 26
Additional features of affordable care act
- Individual mandate with premium subsidies
- Employer mandate
- Federal marketplace of individual insurance from private companies
- New centre for medicare and medicaid innovation
“Safety nets”
- Federally qualified health centres
- Primary and preventive care to 27 million underserved
- Fees based on income
Examples of safety nets
- Charity care and safety-net programs in public hospitals and local health departments
Unsuccessful efforts to establish universal health care in the US
1930s - Roosevelt
1940s - Truman
1960s - Kennedy
1990s - Clinton
Partially successful efforts to establish universal health care in the US
1956 - Johnson (Medicare parts A and B; medicaid)
1973 - Nixon (Medicare part C)
1997 - Clinton (Children’s Health Insurance Program)
2003 - GW Brush (medicare part D)
