Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EPH3021: (Public) Health Care Systems in EU > Case 3: Patient involvement in HC payments > Flashcards

Case 3: Patient involvement in HC payments Flashcards

1
Q

What are the main themes that affect the patients decision to use HC?

A
  1. financial barriers
  2. structural barriers related to complex design of cost-sharing programs
  3. individual considerations of patient
  4. perceived lack of control regarding treatment choices within given treatment trajectory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is cost-sharing (AKA user fees/patient contributions)?

A
  • practice of sharing cost of HC between patients & insurers or other third-party payers.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do cost-sharing payments aim?

A

increase awareness of healthcare costs among those insured, but may also have counter-effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why do we do cost-sharing?

A
  • rising costs of healthcare → additional source of funding
  • overusing from the patients → make them more cost-conscious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What elements does cost-sharing to contribute to sustainability of HC systems rely on?

A
  1. generates additional sources of funding: through cost-sharing, some of HC costs might be shifted from public budgets to patients.
  2. improve efficiency in publicly financed HC: expected that when patients faced with price of HC services = reduce utilisation of unnecessary & low-value health care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

*Why are co-payments the easiest way to do cost-sharing?

is it true?

A
  • co-payment design is key factor influencing financial protection. It is the most important factor in countries where financial hardship is driven by outpatient medicines and the scope of the benefits package is adequate.
  • Patient will always know how much they have to pay
  • View of healthcare provider & insurer: if we know the cost of the service, then we can apply co-insurance & deductible but if don’t know then can only have co-payments.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is cost-sharing done?

A
  1. Co-payments
  2. Deductibles
  3. Coinsurance
  4. Reference prices
  5. extra billing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are co-payments

A
  • patient pays a flat rate fee for a service, not a percentage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are deductibles?

A
  • fixed amount that patients pay OOP before their insurance coverage kicks in → have to pay from your own money!
  • Doesn’t apply to GP with the idea not to discourage the use of primary care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is coinsurance?

A

% of the service cost covered by the patient

  • More expensive services means the patient pays more and therefore discourages utilisation
  • kicks in AFTER deductible has been met
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are reference prices?

A

same as extra billing but for medicines where insurance covers up to certain amount for medicine/medical device but if want more expensive one, then have to pay yourself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is extra billing?

A

depending on specialist, can be charged differently for the services.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the incentives for cost-sharing?

A
  • increase patient responsibility
  • reducing moral hazard → only go if you really need to go to the doctor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the pros of cost-sharing?

A
  • efficiency
  • slowing down the rise of healthcare spending
  • lower premiums in general
  • having an impact on quality of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the cons of cost-sharing?

A
  • Increase hospital costs → high cost-sharing, less prevention through GP because people are not going to the GP because of the cost-sharing. When rise in hospitalisation = primary care (GP, etc) is ignored.
  • Reduction of HC utilisation due to cost-sharing have = adverse health effects for those with the lowest income & in poor initial health
  • quite complex and hard to understand cost-sharing (elderly, low-income)
  • more administrative costs
  • no patient choice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is OOP?

A

a payment you make with your own money, whether or not it is reimbursed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

delete

A

delete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the purpose of OOP?

A
  1. as a source of revenue
  2. to help reduce demand for services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who is protected through lower or zero OOP requirements?

A
  • low-income persons (all countries)
  • Children
  • those with high expenditures
  • people with particular diseases
  • older adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are problems with OOP?

A
  • Financial barrier to access = unmet need = financial hardship.
  • Regressive
  • Voluntary health insurance → not covered in OOP spending
  • Long term care not included
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the problem with using OOP expenses as measure of inability to access care?

A

can be flawed coz only reflects those who actually accessed care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

**What are informal payments?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is impoverishing health spending measured?

A
  1. No OOP payments
  2. Not at risk of impoverishment after OOP payment
  3. At risk of impoverishment after OOP payments
  4. Impoverished after OOP payments
  5. Further impoverished after OOP payments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Explain “no OOP payments” as a measurment of impoverishing health spending

A

Households with no OOP payments experience no drop in household consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Explain “not at risk of impoverishment after OOP payments” as a measurment of impoverishing health spending

A

non-poor households with OOP payments that don’t push them below 120% of poverty line

26
Q

Explain “At risk of impoverishment after OOP payments” as a measurment of impoverishing health spending

A
  • non-poor households with OOP payments that push them below 120% of the poverty line.
  • Dotted ‘impoverishment line’ indicates threshold where a household falls from not being impoverished to experienced impoverishment (marked in yellow).
27
Q

Explain “Impoverished after OOP payments” as a measurment of impoverishing health spending

A

Households who drop from impoverishment below the basic needs line (orange)

28
Q

Explain “further impoverished after OOP payments” as a measurment of impoverishing health spending

A

poor households (those whose equivalent person total consumption is below the poverty line) who suffer OOP payments.

29
Q

What is catastrophic health spending?

A

OOP payments greater than 40% of household capacity to pay for HC

30
Q

Why is catastrophic spending higher for higher income individuals?

A

coz probably have bigger houses, mortgages so to meet their needs = need higher income.

31
Q

What is UHC according to the WHO?

A

all people have access to full range of quality health services they need, when & where they need them, without financial hardship

32
Q

What are the objectives of UHC?

A
  • Access to high quality services
  • Financial protection
33
Q

What is financial hardship?

A
34
Q

What is financial protection?

A

achieved when direct payments made to obtain health services don’t expose people to financial hardship & don’t threaten living standards.

35
Q

How is financial protection measured?

Indicators!

A
  1. impoverishing health spending
  2. catastrophic health spending
36
Q

What happens when there is a lack of financial protection?

A

Can lead to or deepen poverty, undermine health & exacerbate health and socioeconomic inequalities.

37
Q

What features do health systems with strong financial protection & low levels of unmet need share?

A
  • no large gaps in coverage
  • coverage policy is carefully designed to minimise access barriers & OOP payments esp for poor people & regular users of health services;
  • public spending on health is high enough to ensure relatively timely access to a broad range of health services without informal payments;
  • OOP are low (=less or close to 15% of current spending on health)
38
Q

Why monitor financial protection in Europe?

A
  • Because all health systems involve some form of out-of-pocket payments, financial hardship is a possibility all across Europe.
  • Lack of financial protection may lead to or deepen poverty, weaken health & worsen health and socioeconomic inequalities
39
Q

What is access?

A

opportunity/ease with which consumers/communities can use appropriate services in proportion to their needs

40
Q

What viewpoints can access be described from?

A
  1. View of the users of care
  2. View of the providers of care
  3. As an attribute of health services
  4. View of healthcare resources that influence utilisation of care
41
Q

How can the dimensions & abilitie of the Levesque model be viewed as?

A
  • both causes & consequences of (not)interacting with HC
  • facilitators/barriers to access to HC at various stages involved in an episode of care.
42
Q

Are the dimensions of the Levesque model independent?

A

Dimensions aren’t independent & often interact during episodes of illness and care (e.g. availability can interact with affordability of transportation)

43
Q

What are the 5 dimensions of accessibility of services?

A
  1. approachability
  2. acceptability
  3. availability & accommodation
  4. affordability
  5. appropriateness
44
Q

What is approachability as a dimension?

A

identify some form of services that exist, they can be reached & they have impact on health of individual.

45
Q

What is acceptability as a dimension?

A
  • Cultural & social factors determining possibility for people to accept aspects of the service & judged appropriateness for the persons to seek care.

E.g. Society forbidding sex between unmarried men & women would reduce acceptability of care & acceptability to seek care for women if health service providers are mostly men.

46
Q

What is availability & accommodation as a dimension?

A
  • Health services (either physical space or those working in health care) can be reached both physically & in timely manner.
  • Availability combines physical existence of health resources with sufficient capacity to produce services (existence of productive facilities).
47
Q

Where does availability & accommodation as a dimension result from?

A

Results from characteristics of:
* facilities (e.g. density, concentration, distribution, building accessibility)
* urban contexts (e.g. decentralisation, urban spread, transportation system)
* individuals (e.g. duration & flexibility of working hours).

48
Q

What is affordability as a dimension?

A
  • Economic capacity for people to spend resources & time to use appropriate services.

Not only determined by someone’s ability to pay, but from interaction of determinants relating to individual (e.g. place they live, economic resources & social status

49
Q

*What is appropriateness as a dimension?

A
50
Q

**How does accessibility relate to ability?

A

abilities of people to interact with dimensions of accessibility to generate access.

51
Q

What are the dimensions of abilities?

A
  1. Ability to perceive
  2. Ability to seek
  3. Ability to reach
  4. Ability to pay
  5. Ability to engage
52
Q

Explain “ability to perceive” as a dimension

A
  • Ability to perceive need for care among populations.
  • Determined by factors such as health literacy, knowledge about health and beliefs related to health and sickness.
53
Q

Which dimension of accessibility of services does ability to perceive relate to?

A

approachability

54
Q

Which dimension of accessibility of services does ability to seek relate to?

A

acceptability

55
Q

Which dimension of accessibility of services does ability to reach relate to?

A

availability & accommodation

56
Q

Which dimension of accessibility of services does ability to pay relate to?

A

affordability

57
Q

Which dimension of accessibility of services does ability to engage relate to?

A

appropriateness

58
Q

Explain “ability to seek” as a dimension

A

Relates to concepts of:
1. personal autonomy & capacity to choose to seek care
2. knowledge about HC options
3. individual rights that would determine expressing intention to obtain HC.

59
Q

Explain “ability to reach” as a dimension

A
  • Personal mobility & availability of transportation, occupational flexibility & knowledge about health services that would enable person to physically reach service providers.

E.g. Restricted mobility of aged & handicapped, or inability of casual workers to be absent from work to consult medical providers.

60
Q

Explain “ability to pay” as a dimension

A

Capacity to generate economic resources (through income, savings, etc) to pay for HC services without catastrophic expenditure of resources required for basic necessities (e.g. sale of home).

61
Q

Explain “ability to engage” as a dimension

A

Participation & involvement in decision-making & treatment decisions.

62
Q

*How can universal access to health care be achieved through cost sharing?

A

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

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions