US. Health exam 3 nations, literacy, conflict, digit. Flashcards
(73 cards)
Germany
Mandatory sickness funds
Predominantly private
Government-mandated, employment-based private insurance
7.3% is employer responsibility; 7.3% withheld from pay; equals 14.6% for each employee
2009-government run health fund distributes health funds based on risk adjustment
Not allowed to exclude, or raise rates according to age or medical condition
Remain in fund if ill, retired, lose job
Higher income can select private insurance
Germany: Medical Care
Appointments with Primary Care is common
Allowed to make appointments with specialists without a referral
Over 40% of physicians are generalists
Little coordination between hospitalists and generalists
Appointments, labs, prescriptions, hospitalization=No bill to the patient
Germany: Payment Structure
Primary physician Bills regional Association of Physicians
- 1986- began to cap spending- Rationing
- Physicians are reviewed quarterly, with each quarter affecting the following quarter
Hospitalists bill via Episode- Based funding or Bundle payment
Germany: Cost Control
Concerted Action
- Guideline Fees
- Hospital Rates
- Pharmaceuticals
Controls physician fees, capping physician fees
Throughout time still Germany has Gross Domestic Product (GDP) that has been rising since 1990
Canada: Overview
Health insurance: show provincial government card
Hospital Insurance Act: Hospital coverage but no MD coverage
Universal medical insurance 1966
Tax financed, public, single-payer health care system
Funded with provincial and federal tax revenues
Not attached to employment at all
Everyone contributes through taxes-everyone benefits
No bill if part of provincial health service
Private insurance allowed for gaps: some pharmaceutical coverage or private hospital rooms
Canada: Medical Care
Family physician referral to specialist
Specialists get paid best if referred
Longer waiting for elective procedures
Less services per capita than US for example: MRIs and surgery
Despite everyone being covered, inequities still happen
US (days) vs. Canada (weeks): Long Waits
canada waits longer
Canada: Payers/Payment
Physician bills provincial government (and the government pays using the taxes!)
Paid in full according to fee schedule
Physicians must agree with payment, cannot bill patient
Blended models
Fee-for-service
Capitation
Hospital services slow-not enough money to pay extra
Hospitals do not need to prepare itemized bills
Approval process for capital projects of hospitals
Regulation of pharmaceutical prices
Canada: Cost Control
Canada vs. US
- Less administrative costs
- Less expensive high tech costs
- Lower pharmaceutical prices
Caps on payment (Similar to Germany)
Changes in 2010 due to lack of confidence
United Kingdom: Overview
Being on the “soil” entitled to receive tax supported medical care through NHS –National Health Service
Private health insurance can compete with NHS
11% buy private health insurance
Private insurance can pay for care of private hospitals not NHS facilities
United Kingdom: Medical Care
NHS – need referral to specialist
Must have general practitioner
GP is primary care, local hospital is secondary care, regional/national hospitals is tertiary care
GPs not in hospitals, but with social services
Home care is highly developed in UK
United Kingdom: Payer/Payment
Capitation for MD
Preventive care fee for service
Home visits, nights and weekends, fee for service
Consultants=Specialists
Quality is awarded
United Kingdom: Cost Control
Queues lengthened
Capitation and salary for physicians
Limited consultant slots- controls supply of personnel and facilities
Fewer surgeons
Fewer meds
Fewer x-rays
More skeptical of new technology than US
Japan: Overview
Large companies- required to operate self-insured plan for employees and dependents
Smaller companies-single national health insurance plan
Self-employed workers and Retirees- National Health
Insurance or Citizen’s Health Insurance
Government workers- society managed insurance
All have standard comprehensive coverage
Mix of employment-based insurance, social insurance, universal insurance
Japan: Medical Care
No pre-authorizations
No restrictions
Less hospitalizations
Less surgery
Longer hospital stays
Japan: Payer/Payments
Fee-for service was the basis
2003 hospitals paid per diagnosis, physicians still paid fee-for-service
Government strictly regulates physician fees, hospital payments, medication pricing, number of expensive services
Physicians have high volume of seeing patients
Average physician visits: 13 per capita in Japan versus 4 per capita in US
Physicians may see 60 patients in a day
Physicians can dispense medications and profit from medications dispensed
Some patients see physicians just for refills
Japan: Cost Control
GDP increasing 7.7% in 2000 to 10.3% in 2012
Healthcare system relies greatly on employer taxes
Low birth rate and longer life expectancy is problematic for this structure
Japan estimated 65 and older population is projected to increase from 12% 1990 to 39% in 2050
US 65 and older population also growing but not as quickly from 13% in 1990 to 21% in 2050
Costs are contained with strict fee schedules but may not be able to sustain with older facilities and potential underfunding of the healthcare system
the U.S is a world outlier when it comes to spending
spends a lot on health care
the U.S is the only high inncome country that does not guarantee health coverage
the U.S spends 3 to 4 times more on health care than south korea, new zealand and japan
the U.S has among the lowest rates of physicians visits and practicing physicians
hospital stays are shortest in the netherlands and the U.S
the U.S has amongst the lowest number of hospital beds
the US spends more on admin. costs but less on long term healthcare than other wealthy countries
Secondary Features of National Health Insurance Plans
Benefit Package: What is covered or what is NOT covered? Just emergency care or is prevention care covered? Are prescriptions covered? Think about discrepancies such as women’s health?
Patient Cost Sharing: What is covered or what is NOT covered? How much are copayments, coinsurance, premiums, deductibles? Is there a maximum out of pocket? ACA has high cost sharing is a criticism of the system. Single-payer models tend to have low cost sharing.
Effects on existing health care coverage: National health care needs to look at all current health care options and understand effects on each type of coverage for example Medicare, Medicaid.
Cost Containment: Many models exist, including patient cost sharing, limiting percentage of health care premiums that can be retained for overhead and profit, review of medical loss ratio, or the amount of claims being paid for actual health services.
Reform Health Care Delivery: Expanding roles of nurses, pharmacists, and other health care providers, development of Accountable Care Organizations, financial incentives for rewarding higher value care.
