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EPH3021: (Public) Health Care Systems in EU > Case 2: Beveridge vs Bismarck > Flashcards

Case 2: Beveridge vs Bismarck Flashcards

1
Q

What is social health insurance (SHI)?

A

Health insurance with compulsory coverage by nonprofit insurance organisations & not allowed to deny coverage due to age, gender, or poor health

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2
Q

*How are SHI contributions collected?

A
  • on earnings (wages, salaries) & overall income
  • Contributions paid by employees, by employers, or both & collected by government or by multiple health insurance funds.
  • Non-contributors (e.g. unemployed, retired individuals, non-working dependents) may be covered by contributions, too.
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3
Q

What do do individuals pay compulsory insurance for?

A

Pay compulsory insurance contributions related to their income & not to their risks

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4
Q

What are the guiding principles of SHI?

A
  • Solidarity
  • Redistribution
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5
Q

How has SHI moved toward UHC?

A

SHI has moved toward UHC & that traditional values of solidarity & social security have even been strengthened over the past decades

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6
Q

How is TFHS funded?

A

From direct & indirect taxes colled by central, regional or local governements.

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7
Q

What does the size of the budget for TFHS depend on?

A

Political considerations & negotiating ability of health ministry which allows for control over level of spending on health but can lead to underfunding.

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8
Q

What are the pros of the bismarck model?

A
  • All funds designated to HC
  • More choice of providers = competitive market = higher quality
  • Higher income often = better health insurance
  • Better quality of care than Beveridge
  • Less strain on PH care system
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9
Q

What are the cons of the Bismarck model?

A
  • Access to HC is lower, not everybody insured
  • Inequalities in insurance types, related to income
  • complex & expensive administration
  • ageing populations = more pensioners = fewer people working
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10
Q

What are the pros of the beveridge model?

A
  • idea of UHC already implemented in model
  • less adminstrative costs
  • access to HC with citizenship
  • People with higher income = higher taxes
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11
Q

What are the cons of the beveridge model?

A
  • migrants, non citizens, access is difficult
  • lower quality of care
  • higher OOP for specific diseases
  • longer waiting lists
  • limited choice of providers
  • if unsatisfied with public HC = get private insurance = health inequalities coz not everyone can afford private insurance.
  • economic crisis = HC cuts = unresillient HC system
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12
Q

What is health insurance?

A

Contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium

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13
Q

What is the solution for market failure?

A

Health insurance is solution to market failure (HC becomes too expensive)

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14
Q

What is people’s demand for health insurance driven by?

A
  • Risk aversion (prevention)
  • risk of needing treatment
  • level of potential income loss
  • price
  • ability to pay
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15
Q

Why do people buy health insurance?

A
  • To cover unpredictible health costs
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16
Q

What are 2 forms of market failure in insurance markets?

A
  • Adverse selection
  • Moral hazard
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17
Q

Main market failure between health insurers and consumers?

A
  • Moral hazard
  • Adverse selection
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18
Q

What is moral hazard?

A

Tendency of poeple with insurance to change behaviour in way that = higher costs for insurance companies.

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19
Q

dd

A

delete

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20
Q

What are the problems with moral hazard?

A
  • less attention paid to prevention coz costs for medication covered by insurance. e.g. high BP medication available & covered
  • more health care consumption
  • individual behaviour is costly to monitor (insurance can’t observe for each individual necessity to see doctor)
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21
Q

When does moral hazard occur?

A

After insurance purchase & people changer behaviour once they have insurance. e.g. more inclined to visit GP for every small thing if insured.

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22
Q

How is moral hazard solved?

A
  • co-payments
  • deductibles
  • co-insurance
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23
Q

What are co-payments?

A

fee paid by insured patient each time they access a medical service (e.g. part of the costs for a drug)

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24
Q

What are deductibles?

A
  • amount person pays before insurance coverage begins to have an effect (e.g. in NL 385/yr)
  • Insurers can use this to distinguish high & low risks.
  • Policy with high deductible & low premiums will be attractive to low risks but NOT to high risks.
    Policy with low deductibles & high premiums will be attractive to high risks but NOT to low risks
25
Q

What is co-insurance?

A

fixed % that insured pays after deductible is exceeded

26
Q

What is adverse selection?

A

Adverse selection arises from consumers having more complete information on their own health status than insurers, which may result in selecting plans that give them the greatest utility

27
Q

What is risk selection?

A

insurance companies more interested in selling insurance to low risk individuals because they make profit from them

28
Q

delete

A

delete

29
Q

When does adverse selection occur?

A

before insurance purchase

30
Q

How to solve adverse selection?

A
  • Compulsory insurance
  • Different prices for different risk groups
  • Package differentiation
  • Prevented by ‘cream skimming’ or ‘cherry picking’ healthy individuals to enrol in insurance
31
Q

What are problems with adverse seleciton?

A

insurance price (premium) is same for each consumer independent of costs involved → insurer doesn’t know the expected costs → consumers will only buy insurance if they expect a benefit

32
Q

What is supplier induced demand?

A
  • providers of care influence demand for medical services due to supply-side influence & increased healthcare spending
  • When patients covered by insurance = less sensitive to costs of HC & providers can recommend additional services
33
Q

What are 3 main areas of government activity?

A
  1. Redistribution of wealth & income
  2. Stabilisation of macroeconomy (keep unemployment, inflation & economic growth at reasonable levels)
  3. Correction of microeconomic market failure.
34
Q

What is diseconomies of scale?

A

Situations where increasing size of HC providers & insurers, decreases efficiency & increases costs

35
Q

delete

A

delete

36
Q

What is voluntary private health insurance (VPHI)?

A

set of health services that are financed by a third-party through private non-income related payments called premiums

37
Q

What are the types of private health insurance?

A
  • Principle
  • substitute
  • complementary
  • supplementary
  • duplicate
38
Q

Explain the private health insurance type “principle”

A

when public health insurance is not available

39
Q

Explain the private health insurance type “substitute”

A

when a person opts-out of public coverage

40
Q

Explain the private health insurance type “complementary”

A

private health insurance covers co-payments incurred in the public system but not covered by public insurance

41
Q

Explain the private health insurance type “supplementary”

A

covers costs other than co-payments not covered by public insurance

42
Q

delete

A

delete

43
Q

What are determining factors that affect probability of having private health insurance?

A
  • quality of HC system in country - waiting lists, access to appointments, etc
  • Individual health status
  • Risk preferences
44
Q

delete

A

ddellete

45
Q

What is the purpose of VPHI?

A
  • access to or faster treatment
  • waiting list avoidance
  • choice of physician or hospital
  • out-of-pocket reimbursement
46
Q

What is horizontal equity?

A

3 popular ways of defining horizontal equity in healthcare:
* Equal access to health care for equal need
* Equal use of health care for equal need
* Equal health care expenditure for equal need.

47
Q

How is equal access influenced?

horizontal equity

A

by distance, cost, language or cultural issues

48
Q

What does equal use require?

horizontal equity

A

policymakers to ensure those with same level of need actually use same amount of service.

49
Q

What does equal expenditure require?

horizontal equity

A

requires 2 people with equal needs to be allocated the same amount of expenditure.

50
Q

What is the goal of horizontal equity?

A

ensuring people with same level of disadvantage are treated the same.

51
Q

What is vertical equity?

A

unequal individuals are treated unequally with respect to the inequality

52
Q

Why is vertical equity more complicated to implement than horizontal equity?

A

because it involves difficult judgements about how to meet different needs differentially

53
Q

What does equality of access require for different communiteis?

A
  • Travel distance to facilities is equal
  • Transport and communication services are equal
  • Waiting times are equal
  • Patients are equally informed about the availability and effectiveness of treatments
  • Chargers are equal (with equal ability to pay)
54
Q

What is UHC?

A

provides protection from paying for HC OOP at time of service use & especially protection from suffering catastrophic health expenditures

55
Q

What are 3 concepts in relation to equitable financing for UHC?

A
  • progressive
  • regressive
  • proportional
56
Q

What dimensions is UHC challenged in?

A
  1. Breadth of coverage: # of people who have access to affordable & quality care
  2. Depth of coverage: range of accessible services available to population in need
  3. Height of coverage: proportion of HC costs covered by financing system
57
Q

Explain the concept progressive in equity in HC financing

A

contributions to HC where richest segment of population contributes a higher proportion

58
Q

Explain the concept regressive in equity in HC financing

A

contributions to HC where richest segment of population contribute a lower proportion

59
Q

Explain the concept proportional in equity in HC financing

A

everyone contributes same proportion of their income

EPH3021: (Public) Health Care Systems in EU (7 decks)

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