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1

Moral Hazard

lack of incentive to guard against risk were one is protected from its consequences

2

Canadian Health Act

Through this Act, the federal government ensures that the provinces and territories meet certain requirements, such as free and universal access to publicly insured health care.

3

Five principles of the Canadian Health Act

UPPAC: Universality, portability, public administration, accessibility, comprehensiveness

4

When was the Canadian Health Act passed?

1984

5

Free Market

Free markets are characterized by a spontaneous and decentralized order of arrangements through which individuals make economic decisions/an economy with unobstructed competition and only private transactions between buyers and sellers.

6

What are the three aspects of HC systems

Financing, Delivery and Allocation

7

Financing Aspect Questions

Who pays for health care services? How is it routed?

8

What are the 2 types of Financing

Private Sources, Public Sources

9

Private Sources

1) Individual Out of Pocket
2) Insurance: individual and employment based

10

2 types of delivery

1) Private Organizations and Providers
2) Government Organizations and Providers

11

3 options for allocation

1) On basis of market competition
2) on basis of central plan
3) on basis of quality

12

Allocation: Market competition

multiple auto-buyers and competitors for business. Physician income based on number of patients

13

Allocation: Central Plan

negotiated plan: agreement with how much they will be paid, negotiation between government and physicians

14

Allocation: quality

problematic because what counts as quality

15

Conditions of a pure competitive market (free market)

1.Freedom to enter and leave the market, 2.adequate info on price and quality, 3.many buyers and sellers,4. freedom for prices to go up and down

16

Limitations to freedom to enter and leave the market

Licensing laws = sellers (physicians) prevent entry, buyers (patients) do not know when they will "enter" the market, cannot choose to not purchase health care

17

Limitations to information on price and quality

Quality is asymmetric and imperfect

18

2 Limitations to number of sellers and buyers in free market

not enough sellers = monopolies, not enough buyers = organized larger third party (monopsonies)

19

limitations to price range in free market

prices are not free to go up and down because of imbalance between buyers and sellers

20

monopsony

market situation where there is only one buyer

21

where do pure markets exist?

no where

22

4 types of health models

Mutual Aid Model, State Model, Professional Model, Corporatist Model

23

Mutual Aid Model

" to support fellow members and their families when ill"

24

Who is responisble in Mutual Aid Model

Individual.

25

Power in Mutual Aid Model

local

26

Financing of Mutual Aid Model

Voluntary, organized insurance for health care. there is a collective sense that you're not going to do something that will increase your risk

27

advantages of Mutual Aid Model

more emphasis on public health, needs are determined by community

28

disadvantages of Mutual Aid Model

voluntary

29

State Model

to strengthen via a healthy vigorous populations

30

individual in State Model

conceived as a responsibility of the state

31

power in State Model

of the state, not authoritarian

32

financing in State Model

mandatory, taxes

33

Professional model idea

to give access to people who can pay, less emphasis on universal

34

Professional model allows

inequality

35

Professional model: individual

choice to participate in the health care systems

36

advantages of Professional model

great innovation

37

corporatist model

refers to different interest groups, corporations in terms of groups of people

38

basis of corporatist model

negotiation on how the health care system will look and operate

39

example of corporatist model

contemporary germany

40

what kind of model is canada

state bilateral monopoly

41

what does light say about different health care systems

we should think about the fact that there are different values behind these health care systems. technical comparisons are important but the value that allows the tech is too.

42

Argument of Hacker

concerned that government spending is starting to cut in to important systems like education but politicians don't want to increase taxes in case they get voted out

43

Competition under Light:

comparative sociocultural point of view, “competition” is a dominant myth or ideology in modern society that is used to explain and justify how economic activity is organized

44

compelling promise of competition is that

maximize individual gain will increase the wealth and power of the society as a whole

45

Light: beneficial competition only occurs if

a number of conditions or restrictions are in place.

46

4 Key factors in the evolution of health care systems

political system, strength go the working class, strength of medical profession, history

47

key moments in the historical evolution of health care systems

great depression, world war 2, rise of neoliberalism

48

1945 Tommy Douglas Saskatchewan (4)

Free care for pensioners and poor people, swift current insurance plan, 1947 hospital insurance plan, 1961 provincial medicare program

49

CHA discourages

private financing of "medically necessary" services

50

how many provinces prohibit third party insurance for services covered by provincial plans

six

51

in alberta, a physician may "opt out" of a public plan and charge what they wish but...

private insurance for publicly insured services is prohibited, and public sector coverage denied for patients revoking insured services from opted out physicians

52

3 key features of Healthcare System

Financing: predominantly publicly financed "singer payer
Delivery: predominately privately delivered
Allocation: mix of market and planning: physicians paid on a fee-for-service basis

53

4 advantages of single payer

less paperwork and fewer administrate costs, prevents risk rating, may prevent neglect of public system, choice in providers

54

a sociological perspective on health care policy points out that

policy decisions about financing, delivery and allocation are social decisions and that the shape of a health care system reflect underlying values and social structures

55

a sociology perspective examines

the socially-informed assumptions underneath policy requirements, the local consequences of policy decisions

56

what are the 3 period of health care since ww2

1945-65: era of professional dominance
1966-65: era of federal involvement
1983-present: era of managerial control and market mechanisms

57

3 characteristics of The Era of Professional Dominance

most americans gained insurance through employment, struggle over whether to implement a national health insurance plan, provider-driven system

58

2 characteristics of era of fed involvement in usa

passage of medicare and medicaid in 1965, beginning of "buyers backlash" in 1970s

59

era of managerial control (now)

govt share continues to grow and implements payment caps for hospitals, most covered through employment based insurance

60

Regressive or Progressive? Individuals out of pocket

regressive

61

insurance: Regressive or Progressive?

regressive

62

government taxation (general) Regressive or Progressive? ?

progressive

63

sales and social security taxes: Regressive or Progressive? ?

regressive

64

Hacker argues that health care policies have been dominated by growth of

health care costs

65

neoliberal ideology

suggests that governments have exceeded what they should participate in the market

66

Marg Thatcher idea

governments should be smaller and let the market handle services

67

Fraser Institute advocates

greater role of market mechanisms. claims canadians are worse off

68

Hacker writes that thatcher and fraser institute discourse were

rhetoric in dismantling role of government in health care

69

governments that adhere to neoloberalist did not...

produce much changes to health care systems

70

Health care systems change on grounds that

never intended through politics.

71

the British National Health Service (NHS) is what kind of model

state model

72

NHS financing

primarily public, through taxation (progressive)

73

NHS is more generous while

paying less

74

NHS delivery

consultants are salaried public employees

75

Allocation NHS

General Practitioners are paid through a combination of capitation and fee for service: idea of trying to reduce cost per patient. healthier patients = cheaper

76

What was the 4 ways of restructuring the NHS

Purcher-Provider Split, New Managerialism, Empowering the Consumer, Welfare Pluralism

77

Purcher-Provider Split

given a budget to buy services that their patients need

78

Purcher-Provider Split gets rid of

the asymmetry problem

79

Purcher-Provider Split attemps to create

situation with more competition, hooping to increase quality and reduce costs

80

New managerialism

bring business quality to health care system

81

Welfare Pluralism

increase private services and financing

82

oldest national health system

german

83

Germany is what kind of model

coporatist: state is the umpire. Major interest groups are self governing

84

in germany, cost control became dominant concern in what time period

1990s

85

what percent of germans are covered by mandatory, employment based sickness fund

90%

86

in germany, almost all services are

covered

87

is there gatekeeping in german HC

no

88

what is gate keeping

a hc prof usually a primary care physician who is the patients first contact with the health care system

89

two findings of Roos et al

1) the utilization of health care services is related to health status 2) even though the system is free in canada, Manitobans of lower income do not overuse services

90

Roos et al found that those of lower SES tend to

be of poorer health, therefore hospital costs are higher for them

91

Roos et al found that physician costs are

not higher for those of lower SES

92

implications of Roos et Al

linking payments to utilization will only discourage the poor form getting care they likely need