Healthcare: US and Germany Flashcards
(25 cards)
What characterises the US healthcare model?
A fragmented system with a mix of private insurance, employer-sponsored plans, and public programs like Medicare and Medicaid.
How do most non-retired Americans obtain health insurance?
About 55% receive employer-sponsored insurance.
What is the third-party problem in US healthcare?
It refers to overconsumption of healthcare because costs are borne by insurers, not patients directly.
What was the historical origin of employer-sponsored insurance in the US?
The WWII Stabilisation Act led employers to offer health insurance to attract workers.
What are managed care organisations (HMOs)?
Integrated finance and healthcare provision systems that monitor costs and restrict provider networks.
What impact do HMOs have on efficiency?
They can reduce costs through monitoring but may limit coverage and provider choice.
What are PPOs in the US healthcare system?
Preferred Provider Organisations offer more provider options but have higher premiums.
What is Medicaid?
A means-tested program providing healthcare to low-income individuals, with cost control via eligibility criteria.
How is Medicare funded?
Through payroll taxation and monthly premiums; it covers those aged 65+ but does not cover all costs.
What are causes of high healthcare expenditure in the US?
Ageing population, high labour costs, drug prices, litigation risk, and third-party payments.
How does the ACA address equity?
It aimed to increase insurance coverage and access through mandates, exchanges, and pre-existing condition protections.
What is the individual mandate under the ACA?
A requirement for all Americans to have insurance or face a tax penalty (abolished in 2019).
What is productive inefficiency in US healthcare?
Spending more on inputs without proportional health gains, due to administrative costs and overuse.
What is the Bismarck model?
A universal insurance system funded through payroll contributions with regulated provider competition.
What are ‘sickness funds’ in the Bismarck model?
Non-profit insurance funds that pool risks and ensure minimum coverage and open enrolment.
How does the Bismarck model promote equity?
Through income-based contributions and universal access to healthcare services.
What is community rating in the Bismarck system?
Insurance premiums based on income rather than health status to avoid risk selection.
How does Germany’s system prevent cream-skimming?
Open enrolment policies and minimum coverage requirements limit risk-based selection.
What is meant by regulated competition?
Government sets rules on benefits, fees, and provider standards to ensure fairness and efficiency.
How does the US system compare to the Beveridge model?
The US is more fragmented and market-based, while the Beveridge model is tax-funded with universal access.
What is the health production function (HPF)?
A curve showing maximum attainable health outcomes given healthcare inputs.
How does income inequality affect US health outcomes?
High inequality leads to health disparities and lower average health outcomes.
What role does litigation risk play in US healthcare costs?
Fear of lawsuits increases administrative costs and defensive medicine practices.
Why is US healthcare considered less equitable?
Because access and quality often depend on income and insurance status.
