Module 3 Flashcards
(118 cards)
1
Q
What defines an economic good?
A
A good or service that has a benefit to society and for which there is some degree of scarcity.
Scarcity creates a willingness to pay.
2
Q
What role does scarcity play in economics?
A
Scarcity creates willingness to pay.
It affects demand.
3
Q
How do markets balance supply and demand?
A
Using price and competition.
This mechanism helps to allocate resources efficiently.
4
Q
Is healthcare considered a normal economic good?
A
No, healthcare is not a normal economic good.
It is characterized by need rather than want.
5
Q
What does inelasticity of demand in healthcare imply?
A
Price does not influence demand.
People generally will not have treatment if they don’t need it.
6
Q
What is asymmetry of information in healthcare?
A
Information may not be easily understood by patients.
Health care providers act as agents in patients’ best interest.
7
Q
What is the definition of Moral Hazard?
A
If something is free (or subsidized) you are more likely to consume it than if you had to pay for it yourself
This concept highlights the behavioral changes that can occur when financial incentives are altered.
8
Q
What is a pro of Moral Hazard?
A
Encourages use of services by the people who need it, regardless of ability to pay
This can lead to improved health outcomes.
9
Q
What is another pro of Moral Hazard?
A
Encourages use of prevention by all
Preventive care can lead to better long-term health outcomes.
10
Q
What is a con of Moral Hazard?
A
Encourages use of unnecessary services
This can lead to increased costs for the healthcare system.
11
Q
What is another con of Moral Hazard?
A
Encourages use of expensive/inappropriate services
This can further drive up healthcare costs.
12
Q
What is the specific definition of insurance?
A
Guarantee of compensation for specified risk in exchange for payment of premium
This definition emphasizes the contractual nature of insurance.
13
Q
What is a more general definition of insurance?
A
A mechanism for ‘risk pooling’
Risk pooling allows for the sharing of risks among a group.
14
Q
What do insurance programs do?
A
Pool resources together
This pooling helps provide financial protection against risks.
15
Q
What does insurance offer protection against?
A
Risk, usually financial risk
This protection is essential in managing unexpected events.
16
Q
Is risk perfectly predictable in insurance?
A
No
Risk is usually unequal across the population and not perfectly predictable.
17
Q
What is the role of insurers regarding risk?
A
Insurers have an interest in reducing risk
This is fundamental to the sustainability of insurance programs.
18
Q
What does health insurance refer to?
A
Programs that pool resources to provide protection against the cost of medical services
This includes both contributory insurance and public health insurance.
19
Q
What are the two types of health insurance mentioned?
A
Contributory insurance and health care provided through general taxation
Public health insurance is a key component of many healthcare systems.
20
Q
Why is health care not considered a normal economic good?
A
Health care is not a normal economic good due to several factors
21
Q
What is a reason we purchase insurance for catastrophic events?
A
Insurance is purchased for events that are hard to predict
22
Q
What is information asymmetry in the context of health care?
A
Information asymmetry refers to a situation where one party has more or better information than the other
23
Q
What does moral hazard refer to in health care?
A
Moral hazard is the tendency of insurance to lead to riskier behavior because the insured does not bear the full cost
24
Q
What factors contribute to the lack of competition in health care?
A
Factors include limited number of providers and insurers, and limited ability to shop around
25
Fill in the blank: Health care is not a normal economic good due to _______.
[several factors]
26
True or False: Limited ability to shop around contributes to competition in health care.
False
27
What is the financing model where patients do not pay when they receive services?
General taxation
## Footnote
Revenue is collected through various forms of taxation (e.g. sales tax)
28
What type of insurance is typically employment-based, mandatory, and not-for-profit?
Social insurance
## Footnote
This model is designed to provide coverage primarily through employment.
29
In which financing model does the policy holder choose a policy and it is not mandatory?
Private insurance
## Footnote
This model allows for consumer choice in selecting insurance coverage.
30
What does out-of-pocket payment refer to in financing models?
Payment made directly by patients for healthcare services
## Footnote
This model requires individuals to pay for services without insurance coverage.
31
What are the possible combinations of financing mechanisms?
Various combinations of general taxation, social insurance, private insurance, and out-of-pocket payment
## Footnote
These combinations can be tailored to specific healthcare systems.
32
What is a pro of the general taxation financing model?
Best at pooling risks, low admin costs, progressive
## Footnote
This model spreads the financial risk across the entire population.
33
What is a con of the general taxation financing model?
No natural incentive to limit demand
## Footnote
This can lead to overutilization of healthcare services.
34
What is a pro of the social insurance model?
Politically feasible (in Europe), more information to consumers about care costs
## Footnote
This model often leads to better informed patients regarding their healthcare expenses.
35
What is a con of the social insurance model?
Less risk pooling, administratively complex, no coverage for unemployed
## Footnote
These factors can limit its effectiveness in providing universal coverage.
36
What is a pro of private insurance and out-of-pocket payment?
Consumer choice
## Footnote
Individuals can select policies that best fit their needs.
37
What is a con of private insurance and out-of-pocket payment?
Regressive, high admin costs
## Footnote
These models can disproportionately affect lower-income individuals.
38
What are the three types of private insurance?
Supplementary, complementary, duplicative/parallel
## Footnote
Supplementary covers services excluded from public plans, complementary pays for extras in the public system, and duplicative/parallel pays for services also covered under the public system.
39
What does supplementary insurance cover?
Services that are excluded from public plans
## Footnote
This type of insurance provides additional coverage that is not included in government-funded health care.
40
What is the purpose of complementary insurance?
Pays for 'extras' in the public system
## Footnote
This insurance helps to cover additional services that enhance the public health care experience.
41
What is the most controversial type of private insurance?
Duplicative/parallel insurance
## Footnote
This type of insurance is debated as it pays for services that are already covered under the public system.
42
What is the primary funding method for public health insurance in Canada?
General taxation
## Footnote
Provinces use taxes to fund public health insurance plans covering hospital and physician services.
43
What services does supplementary private insurance typically cover?
Dental care, vision care, pharmaceuticals
## Footnote
These services are often not fully covered by public health insurance and require additional private insurance.
44
What type of payments are considered out-of-pocket?
Over-the-counter pharmaceuticals and uncovered services
## Footnote
Patients pay directly for these services or products if they do not have private insurance.
45
What is a parallel private system?
A privately-financed system that is a duplicate or alternative to the public sector
## Footnote
This system operates alongside public financing, providing an alternative for those who can afford it.
46
What does co-payment refer to in healthcare financing?
Financing for services that is partially subsidized through public payment, with the remainder coming from out-of-pocket or private insurance
## Footnote
Co-payment arrangements help share costs between public funds and individuals.
47
What does group-based eligibility mean in public coverage?
Certain population groups are eligible for public coverage while others rely on private financing
## Footnote
This system can create disparities in access to healthcare based on demographic factors.
48
What characterizes sectoral healthcare financing?
Certain healthcare sectors are entirely publicly financed, while others rely heavily on private financing
## Footnote
This division can affect the availability and quality of services in different sectors.
49
What is a potential effect of parallel private systems on public system wait times?
Waits could be shorter if the private system acts as a 'Safety valve'
## Footnote
This occurs when the private system absorbs excess demand from the public system during peak times.
50
What could lead to longer wait times in the public system when parallel private systems are present?
Providers may be drawn into the private system or incentivized to keep waits long in the public system
## Footnote
This is because a longer wait in the public system can increase demand for private services.
51
How does private financing affect overall demand for health services?
Private financing increases overall demand through complications and follow-up care
## Footnote
This can lead to increased utilization of health services, both public and private.
52
What does the balance of evidence suggest about parallel private systems and their effect on public system wait times?
Parallel private systems do not shorten waits in the public system
## Footnote
They tend to attract healthier patients and perform less complex procedures, which increases the complexity of cases in the public system.
53
What is a consequence of co-payments in health services according to research from the US?
Introducing even small co-payments deters health services use, leading to negative health outcomes
## Footnote
This indicates that financial barriers can significantly impact people's willingness to seek care.
54
How does private financing affect public expenditure?
Private financing (insurance) creates an increase in public expenditure
## Footnote
This is due to the bundling effect, where costs associated with private insurance can deter individuals from using publicly insured services.
55
Fill in the blank: The cost of a prescription may deter someone from a _______ visit.
physician
56
What is the relationship between private spending and public spending on health?
Private spending is negatively correlated with public spending on health as a share of total public spending.
## Footnote
This indicates that as private spending increases, public spending tends to decrease.
57
What is the crowding out effect in health financing?
The crowding out effect refers to the phenomenon where increased private finance leads to a reduction in public finance.
## Footnote
This often results in public systems being harmed rather than helped.
58
What is the overall impact of resorting to private finance on publicly financed health systems?
A resort to private finance is more likely to harm than help publicly financed systems.
## Footnote
The effects of private finance can vary depending on its form.
59
True or False: Public and private finance in health care are completely independent sources of funding.
False
## Footnote
The relationship indicates that they can substitute or crowd each other out.
60
What are the sources of federal money?
Money comes from:
* general taxation
* personal income tax
* corporate income tax
* GST
## Footnote
GST stands for Goods and Services Tax, a value-added tax in Canada.
61
What are the primary allocations of federal money?
Money goes to:
* Transfers to provinces (Canada Health Transfer Payment)
* Armed forces
* Residents of federal correctional facilities
* Some services for First Nations and Inuit
## Footnote
The Canada Health Transfer Payment is a federal transfer that supports the healthcare system in provinces.
62
Fill in the blank: Federal money comes from _______.
general taxation, personal income tax, corporate income tax, GST
63
True or False: Federal money is used for direct payments to individuals.
True
64
What is one specific program that federal money is allocated to?
Canada Health Transfer Payment
65
Fill in the blank: Federal money goes to armed forces and _______.
residents of federal correctional facilities
66
What type of services does federal money provide for First Nations and Inuit?
Some services
67
What does the Non-Insured Health Benefits Program (NIHB) provide?
Health care coverage not covered through other programs
68
Who is eligible for the NIHB?
Eligible persons include:
* A First Nations person registered under the Indian Act
* An Inuk recognized by an Inuit land claim organization
* A child less than 18 months old whose parent is a registered First Nations person or a recognized Inuk
69
What services are covered by the NIHB?
Coverage includes:
* Vision
* Dental
* Mental health supports
* Medical supplies
* Medication
* Transportation
70
Who may be responsible for providing NIHB benefits?
A First Nations or Inuit community, self-government, or health authority
71
Which organization has assumed regional NHIB responsibilities in British Columbia?
First Nations Health Authority
72
From where does provincial funding for health care come?
Money comes from:
* General taxation (income taxes, consumption taxes, corporate taxes)
* Resource royalties (in some cases)
73
What are the main expenditures of the provincial funding?
Money goes to:
* Service provision (physicians, drugs)
* Regional health authorities (who fund hospitals)
74
What are the sources of funding for healthcare?
Workers’ Compensation Boards, Automobile insurers (ICBC), Out-of-pocket payments, Private insurance, Voluntary and charitable donations
## Footnote
These sources include various types of funding mechanisms used to support healthcare services.
75
What is one source of funding that involves payment of premiums?
Private insurance
## Footnote
Private insurance is funded via payment of premiums by individuals or employers.
76
Name a source of funding that involves contributions from individuals or organizations.
Voluntary and charitable donations
## Footnote
Donations can come from hospital foundations, disease-based foundations, and volunteers.
77
What type of funding is provided by Workers’ Compensation Boards?
Workers’ Compensation Boards provide funding for workers injured on the job
## Footnote
This funding helps cover medical expenses and rehabilitation costs.
78
What does ICBC stand for in the context of funding?
ICBC stands for Insurance Corporation of British Columbia
## Footnote
ICBC is an automobile insurer that provides funding related to vehicle accidents.
79
Fill in the blank: _______ payments refer to money spent directly by patients for healthcare services.
Out-of-pocket
## Footnote
Out-of-pocket payments are made by patients when they pay for healthcare services not covered by insurance.
80
What types of funding can support health research?
Voluntary and charitable donations, Private insurance
## Footnote
These sources can provide financial support for health research initiatives.
81
What can voluntary and charitable donations be used for in healthcare?
Capital or equipment, Health research, Other services
## Footnote
Donations can be allocated to various needs within the healthcare system.
82
83
How does economic growth impact healthcare spending?
With more economic growth and income comes more spending on healthcare
## Footnote
Economic growth often leads to increased disposable income, allowing individuals to allocate more funds to healthcare services.
84
What has been the trend in healthcare spending as a percentage of GDP since the 1970s?
The percentage of GDP that goes to health has been increasing since the 1970s but not consistently
## Footnote
Fluctuations may be influenced by various economic factors and policy changes.
85
What is the ratio of public to private spending on healthcare for every $100 spent?
$71 is public and $29 is private
## Footnote
This indicates a significant reliance on public funding for healthcare.
86
What major sectors make up the majority of health spending?
Hospitals, doctors, and pharmaceuticals make up the majority of health spending (almost 60%)
## Footnote
These sectors are critical components of healthcare systems and consume substantial resources.
87
Is healthcare spending uniform across population segments?
No, spending isn't uniform across population segments
## Footnote
Variations can occur due to factors such as income level, geographic location, and demographic characteristics.
88
What is fee-for-service?
Health professional paid set amount for a service provided to a particular patient.
## Footnote
'Wages are determined piecemeal, on a fee-for-service basis, allowing doctors to set their own hours, decide the number of patients they see and ultimately determine how much money they make.' - Rachel Mendeson, 2010.
89
What is the salary payment model?
Health professional is employee of organization and responsible for services as outlined in employment contract.
90
What is capitation in healthcare payment?
Payment according to number of patients, which can include a premium for complex cases and may be adjusted for sociodemographic differences.
91
True or False: In capitation, the practice is paid whether a consult occurs or not.
True.
92
What are incentive payments or pay-for-performance?
Payment provided for reaching target outcomes (e.g. number of cervical cancer screenings proportional to eligible patients).
93
Fill in the blank: A _______ payment model is a combination of different payment methods.
[blended]
94
What is the typical payment arrangement for primary care physicians in most provinces?
Fee for service with some use of quality incentives.
## Footnote
British Columbia has moved to a blended model, with Nova Scotia and Manitoba following.
95
How are physicians reimbursed in Ontario?
Primarily through capitation payments adjusted for the age and sex of rostered patients.
## Footnote
Capitation payments are a fixed amount paid per patient, regardless of the number of services provided.
96
What is the typical payment arrangement for specialist physicians?
Largely fee for service with some alternative payment arrangements for academic hospitals and certain specialties.
## Footnote
Emergency medicine is an example of a specialty that may utilize alternative payment arrangements.
97
Are specialist physicians typically paid separately from the hospitals they work in?
Yes, they are often paid separately.
## Footnote
This separation can lead to different payment structures for specialists compared to hospital systems.
98
Fill in the blank: In British Columbia, the payment model has moved to a _______.
blended model
99
True or False: Most primary care physicians are reimbursed solely through capitation payments.
False
## Footnote
Most provinces primarily use fee for service with some quality incentives.
100
What is block funding in healthcare?
Institution paid a certain amount per year to provide service, generally calculated based on previous year’s amount and types of services offered, adjusted for demographic change, health care costs, and inflation.
## Footnote
Block funding is designed to provide a stable financial environment for institutions while addressing changes in service demand and costs.
101
How is block funding adjusted?
Adjusted for:
* Demographic change
* Health care costs
* Inflation
## Footnote
These adjustments ensure that funding reflects current needs and economic conditions.
102
What is activity-based funding?
Payments are allocated based on the type and volume of services provided, and the complexity of the patient served.
## Footnote
This funding model incentivizes institutions to provide more services and cater to complex cases.
103
True or False: Activity-based funding provides a fixed amount of money regardless of services rendered.
False
## Footnote
Activity-based funding varies based on the services provided and patient complexity.
104
Fill in the blank: Block funding is generally calculated based on the previous year’s amount and types of services offered, adjusted for _______.
demographic change, health care costs, and inflation
## Footnote
These adjustments are crucial for maintaining the financial viability of healthcare institutions.
105
What type of payment arrangement is typical for long-term care homes?
Global budgets in most provinces; some per diem adjustment funding for case mix in Ontario and Alberta.
## Footnote
Global budgets provide a fixed amount of funding, while per diem adjustments account for variations in care needs.
106
What is the payment mechanism for home and community care?
Mix of global budgets and a variety of other payment mechanisms.
## Footnote
This indicates flexibility in funding sources to meet diverse care needs.
107
How are prescription drugs typically paid for?
Prescription and dispensing fee – essentially fee-for-service.
## Footnote
Fee-for-service means providers are paid for each individual service rendered.
108
What type of payment arrangement do hospitals primarily use?
Largely historically based global budgets.
## Footnote
Some provinces, like Ontario, have adjusted a share of the global budget funding for case mix and have made limited use of activity-based funding models.
109
True or False: Most provinces use a fee-for-service payment model for long-term care homes.
False
## Footnote
Long-term care homes primarily use global budgets.
110
Fill in the blank: Home and community care uses a mix of _______ and a variety of other payment mechanisms.
[global budgets].
111
What adjustment has Ontario made to hospital funding?
Adjusted a share of the global budget funding for case mix and limited use of activity-based funding models.
## Footnote
Case mix adjustments ensure that funding reflects the different levels of care required by patients.
112
What are bundled payments?
Single payments disbursed to groups of provider entities involved in delivering a defined 'episode' of care for a particular health condition or procedure
## Footnote
Bundled payments aim to streamline costs and improve care coordination.
113
Define population-based integrated payment models.
Single, time-defined payments to groups of providers for a population of enrolled patients or residents of a particular geographic area, regardless of whether they use health services or not
## Footnote
This model is similar to capitation but applies to all services.
114
True or False: Bundled payments are meant for individual providers only.
False
## Footnote
Bundled payments are disbursed to groups of provider entities.
115
In population-based integrated payment models, what is the payment based on?
The population of enrolled patients or residents of a particular geographic area
## Footnote
Payments are made regardless of service utilization.
116
Fill in the blank: Bundled payments are designed for a defined ______ of care for a particular health condition or procedure.
episode
117
What is a key feature of population-based integrated payment models compared to traditional payment models?
Payments are made regardless of whether patients use health services or not
## Footnote
This approach encourages providers to focus on overall population health.
118
What adjustment method is mentioned for US examples of population-based integrated payment models?
Retroactive adjustment of usual payments
## Footnote
This allows for balancing payments based on actual service usage.
