Week 9 - Health Care Policy in Other Wealthy Countries Flashcards

1
Q

Bismarkian models

A
  • Social insurance model
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2
Q

Social insurance model

A
  • Multiple entities pay for health care
  • Compulsory insurance with few exceptions
  • Contributions geared to income
  • Non-profit organizations that pay for health care
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3
Q

What countries follow a social insurance model

A
  • Germany
  • France
  • Netherlands
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4
Q

Beveridge models

A
  • National health service model
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5
Q

National health service model

A
  • Single payer
  • Nationalization of hospitals and staff
  • Financed by general revenues
  • General practitioner capitation
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6
Q

What countries follow a national health service model

A
  • UK
  • Sweden
  • Italy
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7
Q

Is the US public or private system dominant

A
  • Private
  • 67% of the population
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8
Q

How many people in the US lack health insurance

A
  • 8.7%
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9
Q

What percentage of private insurance is covered by employers

A
  • 55%
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10
Q

What is included in private insurance covered by employers

A
  • Entire family coverage
  • Offer choice of plan
  • Benefits vary widely
  • Employees typically contribute to premium
  • Often involves managed care
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11
Q

What percentage of private insurance is covered by employees

A
  • 28%
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12
Q

How is private insurance paid by employees

A
  • Deductibles
  • Co-pays
  • Services and medical equipment not covered in plan
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13
Q

Types of public insurance in the US

A
  • Medicare
  • Medicaid
  • Children’s health insurance plan
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14
Q

Medicare eligibility

A
  • People 65+
  • People with long term disabilities
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15
Q

How many parts of medicare are there

A
  • A-D
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16
Q

Medicare part A and B

A
  • Fee for service
17
Q

Medicare part C

A
  • Established in 1973, optional supplement to A&B which covers additional services like mental health, prescription drugs and dental and vision care.
  • Requires enrolees to enter into a medicare advantage, a type of managed care
18
Q

Medicare part D

A
  • Established in 2003, alternative to part C only providing prescription and drug coverage
19
Q

What extra services does medicare provide

A
  • Veterans health administration
  • Indian health service
  • Medicaid
  • Children’s health insurance plan
20
Q

What percentage of the population does medicare cover

A
  • 18%
21
Q

Medicaid eligibility

A
  • Provides health insurance for people with low incomes and is funded by the federal and states governments
  • Eligibility, coverage, funding and cost sharing vary widely
22
Q

Children’s health insurance plan

A
  • Those ineligible for medicaid by don’t have or cant afford private insurance
  • Up to age 19

Some states include low-income pregnant women

23
Q

How many children does the children’s health insurance plan cover

A
  • 9.6 million children
24
Q

When was patient protection and affordable care act created

A
  • 2010
25
Q

Affordable care act insurance regulations

A
  • Pre-existing conditions provision
  • Ban on annual and lifetime coverage caps
  • Cap on annual out-of-pocket costs
  • Cover children on parents policy until age 26
26
Q

Additional features of affordable care act

A
  • Individual mandate with premium subsidies
  • Employer mandate
  • Federal marketplace of individual insurance from private companies
  • New centre for medicare and medicaid innovation
27
Q

“Safety nets”

A
  • Federally qualified health centres
  • Primary and preventive care to 27 million underserved
  • Fees based on income
28
Q

Examples of safety nets

A
  • Charity care and safety-net programs in public hospitals and local health departments
29
Q

Unsuccessful efforts to establish universal health care in the US

A

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

30
Q

Partially successful efforts to establish universal health care in the US

A

1956 - Johnson (Medicare parts A and B; medicaid)
1973 - Nixon (Medicare part C)
1997 - Clinton (Children’s Health Insurance Program)
2003 - GW Brush (medicare part D)