Chapter 11 - state healthcare provision Flashcards
(33 cards)
1
Q
Key principals of New Universalism
A
- quality of healthcare - healthcare systems need to be effective, efficient and allow medical decisions to be made by the medical professional and the patient
- cost and financing - cost of healthcare should not be a barrier to access; adequate funding needs to be set aside for healthcare, and financing of healthcare systems should be equitable across all segments of the population
- social acceptability - healthcare should be responsive to the needs/wants of the population. Access to healthcare should be universal
2
Q
The healthcare of the objectives of the State depend on:
A
- its political stance
- the characteristics of the population
- the quality and quantity of medical services and expertise available
- the state of the country’s infrastructure
- the economy
- the country’s overall state of development
- the existence of other state benefits
- the history of state care in that country
- the social and cultural stance of the country
3
Q
What are the objectives of a government providing healthcare?
A
- protecting the nation’s health
- subsidising the poor
- balancing the budget
- following social culture and/or political promises
4
Q
What are the advantages and disadvantages of a market-focused approach?
A
+ it is cheaper for the state due to saved care costs and simpler admin
+ it encourages competition, in healthcare insurance and provision
+ it encourages the population to take better care of themselves
+ there are no cross-subsidies. This will make it popular with people who see themselves as healthy
+ can be lower taxes
- lower security of benefits and greater uncertainty for the public
- it is not popular with unhealthy and/or poor people
5
Q
Protecting the nation’s health may involve ensuring:
A
- the availability of food, drinking water, nutrition and hygiene
- basic medical services and education about healthy living
- a comprehensive medical services system encompassing modern and efficient medical facilities
- education
- research and import of the latest technologies
6
Q
Balancing the budget
A
- provision of healthcare is part of state expenditure whether it provides to all or restricts it to those who otherwise could not pay
- the cost of provision can be funded through specific health charges or via general taxation, or a mixture of the two
- cost of healthcare inflation will rise faster than general inflation. Mortality improvements are likely to result in increased morbidity and increased healthcare costs for the elderly
7
Q
Following social culture and/or political promises
A
- government’s approach may be determined by political party ethics
- foundations of healthcare provision tend to be part of a developed nation expectation and so change in power does not affect the basis of national medical delivery
- state healthcare programmes may be part of national culture and changes may be difficult to introduce, especially in the short term
8
Q
Challenges for the State in designing, managing and financing a healthcare system
A
- demographic challenge
- technological challenge
- challenge of sisyphus
- burden of disease
- access to skilled medical professionals and infrastructure
- competition or regulation in healthcare
9
Q
Methods of resource allocation
A
- cost analysis
- cost-effectiveness analysis
- cost-utility analysis
- cost-benefit analysis
- willingness to pay
10
Q
Cost analysis
A
- simplest method of economic evaluation of a healthcare system
- assess the cost of various healthcare systems providing different services, types and levels of benefits to different segments of the population
- useful in estimating the required budget as well as assessing whether a particular healthcare system is affordable or sustainable over time.
- cost of all resources required to be provided under a system need to be included
11
Q
Advantage of cost analysis
A
- can provide a breakdown of current and future costs, changes in costs as a result of changes in scale and cost recovery from lives insured
12
Q
Disadvantage of cost analysis
A
doesn’t take the value of the healthcare system in terms of improved health of those insured into account. This could lead to a focus on cost minimisation.
13
Q
Cost analyses should include
A
- initial and recurrent costs
- fixed and variable costs
- direct and indirect costs
- estimates of future costs and how they are expected to change
14
Q
Cost-effectiveness analysis
A
- assesses the cost of the healthcare system relative to the non-monetary benefits of the healthcare system.
- useful for allocating a fixed budget between a fixed set of alternatives
- effectiveness of the system can be measured with reference to benchmark statistics
15
Q
Advantages of cost-effective analysis
A
- the benefits relative to the costs can be relatively easy to understand (e.g. every R10,000 spend, expected lifetime at birth increases by 1 year)
- the benefit doesn’t have to be converted to monetary terms, which avoids the issue of valuing the life that has been saved
16
Q
Disadvantages of cost-effective analysis
A
- the need for all healthcare systems assessed to have the same measure of effectiveness
- inability to account for multi-dimensional effects e.g. reduced healthcare expenditure and increased lifespan
- possibility that CEA will underestimate the value of various healthcare interventions
- the fact that the CEA doesn’t reflect the utility of the healthcare service to the population covered
17
Q
Cost-utility analysis
A
- assesses the cost of a healthcare system relative to changes in quality of life, as well as changes in mortality
- emphasis is placed on healthy years of life saved rather than simply counting the number of lives saved
- change in quality of life is normally measured in Quality Adjusted Life Years, Disability Adjusted Life Years and Healthy Years Equivalent
- CUA is sensitive to utility function chosen, which may not reflect the value that different segments of the population place on health outcomes
18
Q
QALYS
A
Combines the quantity and quality of life. Sums years spend in different health states using weights
19
Q
Cost-benefit analysis
A
- puts a monetary value on the cost of the healthcare system and its outcomes
- costs can be compared to changes in quality of life of various segments of the population as well as the impact on economic productivity
- advantage: can be evaluated on its own merit, rather than being compared to different systems
- disadvantage: conversion of health status into a monetary value per unit is challenging and controversial
20
Q
Willingness to pay
A
- can be used to measure the value an individual places on a health system, medical scheme
21
Q
Methods to determine willingness to pay
A
- direct methods - conducted through questionnaires or interviews. However, interviews are hypothetical in nature and may be influenced by emotional responses. May not reflect actual behaviour
- indirect method - by observing their behaviour and identifying how much they are apparently willing to pay. However, there are many confounding factors associated with the behaviour of an individual
22
Q
Advantages and disadvantages of means-tested State health benefits
A
Advantages
- may be a cost-effective way for the State to target benefits to those most in need.
- may be redistributive if taxes are raised for those with more wealth/income and means-tested benefits are paid to those with little wealth/income
- those who fail the means-test may be encouraged to return to work
Disadvantages
- people may be discouraged from providing for themselves
- may create a benefit trap where increases in a person’s income merely reduces the value of the State benefits
- may encourage people to hide existing wealth so they have more chance of satisfying the means-test
- those who receive benefits may be discouraged from returning to work
- it may be perceived as unfair to those who do provide for themselves
- means-tested benefits are not taken up by all who are entitled to them
- receipt of benefit has a stigma that identifies people as poor
- it is perceived by some as degrading ie state benefits should be a universal right rather than a payment to the poor
23
Q
Methods of state healthcare provision
A
- provided to all or means tested
- provided directly by its own medical establishments or provided by commercial establishments
- lump sum or regular income
- flat-rated (to provide an incentive to return to work) or earnings-related (to reward those who have contributed more)
- linked to some form of CPI
- different for different stages of disability
- different for different lifestages/circumstances
24
Q
Advantages of State providing own establishments
A
- can keep a closer eye on cost and claim control
- will not need to pay for profits of commercial enterprise
25
Advantages of State relying on commercial establishments
- can benefit from their expertise, experience and economies of scale
- can transfer much of the administration
- commercial establishments may be more responsive to customer needs, eg introduction of new treatments
- different providers will compete for the business
26
Views that may be kept in mind when designing State benefit
- a salary-related benefit to reward those who have contributed more taxation and to reflect their likely higher financial responsibilities
- a flat benefit, to provide an incentive to return to work to minimise the cost on the State and to encourage self-provision through insurance
27
Tensions faced by the State in developing and managing a healthcare system
1. feasibility (quality, cost and access)
2. sustainability over time
3. satisfaction in terms of addressing the expectations of stakeholders
28
Methods for State funding of welfare expenditure
1. PAYG
The current working population effectively pays the total costs for those currently needing benefits. If there is a shortfall in any budget year, the State will fund the difference from general tax revenues.
2. Forward funding
Take a longer term view. Build up a provision for these costs before they arise.
29
In order to work out whether funding from tax revenue is necessary, the State must:
1. Establish the degree of State subsidy
2. Estimate coming year's outgo
3. Estimate coming year's tax revenue
4. Adjust this so as to incorporate healthcare outgo
30
Forward funding process
1. Take a view on some future period
2. Analyse the level of State provision at this point
3. Produce a model of State outgo at this and intervening years
4. Estimate population and workforce trends
5. Forecast taxation revenues accordingly
6. Calculate a specific healthcare fund such that earmarked taxation will, over the period, meet the intended State healthcare provision
31
Advantages and disadvantages of forward funding
Advantages
- the fund is not as sensitive to demographic changes compared to PAYG
- they system fosters forward planning, so that the government should be able to take the necessary action in enough time to ensure the cost of paying the benefits remains well covered
- the public will have more confidence that the State will be able to provide healthcare benefits when their need arises. Makes them more willing to contribute and increases popularity of the government
Disadvantages
- the money could instead be used, with immediate effect, elsewhere
- more complex to administer
- assets need to be held and managed
32
Incentives for self-provision
- tax relief on premiums for appropriate insurances
- exclude some or all of the population from certain aspects of the State benefit system
- can offer a reduction on general taxation where appropriate insurance is in place
- can reduce the cost of private purchase by direct subsidy to the providers
33
What does the role of the national healthcare system and hence health insurance depend on?
- historically evolved cultures and expectations
- budget constraints
- differing priorities to differing population segments
- the approach taken to funding and self-provision
