WEEK 9: HEALTH POLICY IN OTHER COUNTRIES

Question 1

What is the Bismarckian model?

Answer 1

Social insurance model
- compulsory insurance with few expectations
- multiple non-profit payers
- contributions geared to income
- 90% coverage, rest have private insurance
EXAMPLES:
- Germany, France, Netherlands

Question 2

What is the Beveridge model?

Answer 2

National Health Service model
- single payer
- nationalization of hospitals and staff
- financed by general revenues
- general practitioner capitation
EXAMPLES
- U.K, Sweden, Italy

Question 3

The U.S healthcare system overview

Answer 3

• mix of public and private, for-profit and non-profit insurers and health care providers
• private insurance dominant
• public spending pays for 45% of all health care spending
• about 27.5 million people lack health insurance
• many uninsured

Question 4

Private insurance

Answer 4

55% provided by employers
- often cover entire family
- majority offer choice of plan
- benefits vary widely
- employees typically contribute to premium
- often involves manage care

User fees - employees pay 28% of all costs
- deductibles
- co-pays
- services and medical equipment not covered in plan

Question 5

Public insurance - single-payer: govt

Answer 5

Administered by states - co-funded by federal govt
- Medicare
- Veteran’s Health Administration
- Indian Health Service
- Medicaid
- Children’s Health Insurance Plan

Question 6

Patient Protection and Affordable Care Act (2010)

Answer 6

Insurance regulations
- pre-existing conditions provision
- ban on annual/lifetime coverage caps
- cap on annual out-of-pocket costs
- cover children on parents’ policy until 26

• individual mandate with premium subsidies
• employer mandate
• federal marketplace of individual insurance from private companies
• new centre for Medicare and Medicaid innovation

Question 7

What are “safety nets”

Answer 7

• federally qualified health centres
• 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 needing emergency care regardless of ability to pay or insurance status