eco question
shazuanzhe
Healthpoliciesaroundtheworld1.pptx
Health policies around the world
Expenditures Across OECD Countries
U.S. medical spending is highest in the world
Why?
What are the possible explanations?
Table 14.5 Health Systems Quality and Access Indicators
Canadian National Health Insurance: Medicare
Canada’s population distribution challenges health care delivery
Canada’s national health insurance system delivers high-quality medical care to all at about half of the per capita cost of U.S. health care
Canadian National Health Insurance: Medicare
Features:
Universal coverage
Health plans be publicly administered
Accessible
Comprehensive first-dollar coverage of all medically necessary services (no out-of-pocket)
Most Canadians have supplemental insurance that covers dental, vision and prescription drugs
Canadian National Health Insurance: Medicare
Financing of health care spending, 2013:
67.3% public sector
14.3% private insurance
13.6% patient out-of-pocket expenses
Wait lists for some medical services
Germany: history of sickness funds
Began in the 1800s with three guiding principles:
social solidarity
subsidiarity
corporatism
Germany: sickness funds Today
Universal coverage
All required to have health insurance
Those earning below threshold €53,550 (in 2014, about $60,000) must join a sickness fund; those earning above may get private insurance
About 15% (mostly civil servants) have comprehensive private insurance paid by their employers (giving better access)
Premiums for workers in sickness funds based on income, not age, dependents
Germany: Sickness Funds Today
Private insurance covers more, creates competition, spurs use of technology, ensures that care gap between public & private small
Germans receive high quality hospital & ambulatory care, prescription drugs, dental care, & disability income benefits; but public health services & psychiatric services minimal
Since 1977, 40 laws to control costs; copayments added; per capita spending fell
Switzerland
Swiss model has avoided link between health insurance coverage and employment, relying instead on personal responsibility
Insurance sold per individual; group & family plans do not exist
Health care spending 11% of GDP, 2nd only to U.S; medical resources highest in Europe
Permanent residents must purchase health insurance; if refuse, assigned to a plan
Over 30% purchase supplemental policy
Switzerland
Insurance provided by 67 private insurers operating on a not-for-profit basis; each canton governs own, & financed through taxes
Individuals pay community-rated premiums
Policies have 6 different deductibles
Two types of managed care plans, one like staff-model HMO, the other a GP network
Hospitals paid on a DRG basis
Switzerland
Three markets in Swiss health care: physicians compete for patients, insurers compete for customers, & insurers compete for primary care physicians
Swiss system is a reasonable alternative to government-run insurance plans in Europe:
Individual mandate to purchase private insurance with benefits defined by government
Coverage automatic at birth and guaranteed renewable, covering all pre-existing conditions
All expected to contribute something to purchase, and subsidized when cannot afford
A possible model for U.S. reform?
United Kingdom: National Health Service
Single-payer concept & limited supervision of providers kept administrative costs low, but from start, NHS underfunded and dominated by medical community
Health care delivery politicized; led to a series of crises (one every 3 years) between government & medical practitioners
A goal of NHS to eliminate inequalities, increase facilities in underserved regions, and restrict expansion in over-served regions, but these changes have met limited success
United Kingdom: National Health Service
Every citizen registered with a GP (general practitioner) ; GP is family doctor to patient, gatekeeper to specialists and hospitals
Anyone requiring “elective” procedure (not life-threatening) put on waiting list
2014, 2.99 million on hospital wait lists (5% of population)
Those who can buy private insurance do (12%)
Number of hospital beds has declined from 480,000 (1948) to <146,000 (2013)
1993, Thatcher reforms, instill market, but incentives weak; competition did not work
United Kingdom: National Health Service
Health organizations became independent NHS trusts; many GPs became fundholders
By 1995, health care provided through NHS trusts; a two-tiered system developed
1997: NHS reorganized for 5th time in 25 years
Blair reforms to remove market; placed GPs in primary care trusts (PCTs), each receiving a fully capitated budget to provide all health services for a defined population
10 year plan included promise of more hospitals, physicians, cleaner facilities, etc
United Kingdom: National Health Service
Health inequalities have widened since NHS; even so, public supports equal access by 2 to 1
2010 – Tory coalition plans to reform NHS, 6th time; 5 year plan to rebuild administrative structure of NHS:
Phase out primary care trusts by 2013
Money set aside for primary care will go to newly created GP consortia to purchase care like HMO
Plan short on details; will require much legislation
Risk of creating a tax funded system where small number of GP consortia control ½ of NHS budget
Public Satisfaction with Health Care Delivery Systems
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