Week 9: German, UK and US health care systems

Question 1

What model does Germany’s health care system follow?

Answer 1

Bismarckian model

Question 2

Bismarckian model

Answer 2

A social insurance funding system where individuals and employers contribute to a designated health insurance fund

Question 3

Components of Bismarckian model

Answer 3

Compulsory insurance w few exceptions
Multiple (non-profit) payers
Contributions geared to income

Question 4

How are German physicians paid for outpatient services?

Answer 4

On a fee-for-service basis by sickness funds

Question 5

How is the German health care system organized?

Answer 5

Multi-payer

Question 6

What other countries use the bismarckin model?

Answer 6

France and the Netherlands

Question 7

How much coverage is provided with the Bismarckian model?

Answer 7

90% coverage and the rest have private insurance

Question 8

What model does the United Kingdom health care system use?

Answer 8

Beveridge model

Question 9

Beveridge model

Answer 9

A national health service system that is run by the government

Question 10

How is the United Kingdom health care system organized?

Answer 10

Single payer

Question 11

How is the Beveridge model financed?

Answer 11

General revenues

Question 12

Exception to the single payer system of the United Kingdom model

Answer 12

General practitioners who are independent contractors with the national health service model to provide primary care on a capitation basis

Question 13

What other countries use the beveridge model?

Answer 13

Sweden and Italy

Question 14

Overview of the U.S health care system

Answer 14

Mix of public and private, for-profit and non-profit insurers and health care providers

Question 15

What is the dominant way in which health care is provided in the U.S.?

Answer 15

Private (67% of population)

Question 16

How much does public spending pay for health care spending in the US?

Answer 16

45%

Question 17

How many people lack health insurance in the US?

Answer 17

8.5%
Many people are underinsured

Question 18

How much of private insurance is provided by employers?

Answer 18

55%

Question 19

Private insurance

Answer 19

Often cover entire family
Majority offer choice of plan
Benefits vary
Employees contribute to premium
Involves managed care

Question 20

User fees involved in private insurance

Answer 20

Employees pay 28% of all costs
- deductibles
- co-pays

Question 21

What is not covered under private insurance plan?

Answer 21

Services and medical equipment

Question 22

Premium

Answer 22

Monthly payment to an insurance company for insurance coverage

Question 23

Managed care

Answer 23

Type of healthcare insurance plan that coordinates and manages healthcare services for its members to provide cost-effective and high-quality care
Involve contracts between insurance company and a network of healthcare providers.

Question 24

Highest coverage of care with managed care

Answer 24

When you choose from a list of “in network providers” for private insurance

Question 25

Deductibles

Answer 25

Annual amount of money an insured person has to spend out of pocket before their insurance coverage begins

Question 26

Co-pays

Answer 26

Fixed or percentage-based amount of money an insured person has to pay per appointment or procedure

Question 27

Medicare

Answer 27

US health insurance program administered by states and co funded by federal government Covers 18% of population

Question 28

Who is eligible to recieve Medicare?

Answer 28

People 65+ People with long term disabilities

Question 29

Part A of Medicare

Answer 29

Fee for service for hospital insurance

Question 30

Part B of Medicare

Answer 30

Fee for service program for non-hospital medical services

Question 31

Part C of Medicare

Answer 31

Covers additional services like mental health, drugs, dental and vision care

Question 32

Part D of Medicare

Answer 32

Alternative to part C that provides only prescription and drug coverage

Question 33

Who else does Medicare provide some coverage for?

Answer 33

Veterans' health administration Indian health service

Question 34

Medicaid

Answer 34

Provides health insurance to people with low incomes and is funded by federal and state governments; single payer Covers 18% of population Eligibility requirements vary

Question 35

Children's health insurance plan

Answer 35

Provides coverage for children up to age 19 who's parents are ineligible for Medicaid and cant afford private insurance Covers 9.6 million children

Question 36

What do some states include in the children health insurance plan?

Answer 36

Low-income pregnant women

Question 37

Patient protection and Affordable care act insurance regulations

Answer 37

Pre-existing conditions provision Ban on annual and lifetime coverage caps Cap on annual out of pocket costs Cover children on parents' policies until age 26

Question 38

What else was established with the affordable care act?

Answer 38

Individual mandate with premium subsidies Employer mandate Federal marketplace of individual insurance from private companies Establishment of a web site where people can learn about and sign up for health insurance New Centre for Medicare and Medicaid Innovation

Question 39

Individual mandate with premium subsidies

Answer 39

Requires that everyone has health insurance and those who can't afford it receive subsidies

Question 40

Purpose of safety nets

Answer 40

Alternative plans for people who cant afford insurance

Question 41

What are the different safety nets?

Answer 41

1. Federal qualified health centres 2. Charity care and safety-net programs in hospitals 3. Disproportionate care payments 4. Treating all patients

Question 42

1. Federal qualified health centres

Answer 42

Provides primary and preventative care to 27 million underserved individuals Fees based on income

Question 43

2. Charity care and safety-net programs

Answer 43

Public hospitals and local health departments receive charity care and safety-net programs

Question 44

3. Disproportionate care payments

Answer 44

Hospitals with a large number of publicly insured and uninsured receive disproportionate care payments

Question 45

4. Treating all patients

Answer 45

The federal law requires hospitals to treat all patients requiring emergency care regardless of ability to pay or insurance status

Question 46

Unsuccessful efforts at establishing universal health care coverage in the US

Answer 46

1930s: Roosevelt 1940s: Truman 1960s: Kennedy 1990s: Clinton

Question 47

Partially successful efforts to establish universal health care coverage in the US

Answer 47

1965: Johnson 1973: Nixon 1997: Clinton 2003: G.W. Bush 2010: Obama

Question 48

Johnson

Answer 48

Medicare parts A and B Medicaid

Question 49

Nixon

Answer 49

Medicare part C

Question 50

Clinton

Answer 50

Children's health insurance program

Question 51

G.W. Bush

Answer 51

Medicare part D

Question 52

Obama

Answer 52

Affordable care act

Question 53

Which country would you expect the most hassle when accessing health care after you lose your job?

Answer 53

United States

Question 54

Which countries health care system is the most similar to the affordable care act?

Answer 54

Germany

Question 55

What would make the US medicare program more similar to Canada's?

Answer 55

Change who is eligible to be covered

Question 56

Public system in the US

Answer 56

SINGLE PAYER Medicare Medicaid Children's health insurance program Veterans administrations Indian Health service

Question 57

Public spending and how much of population

Answer 57

Pays for 45% of all health care spending Covers 34% of population