HCD 303: Global Healthcare Systems
Key steps in the historical development of Germany healthcare system
-1871: Bismarck proposed a national social insurance system. -1883: The Sickness Insurance Act was passed -1990: The Berlin wall was torn down, signifying the reunification of East and West Germany
Capitation
-A payment model where hospitals and/or providers are paid on a per member, per month, regardless of the number of services provided. -This payment model provides the least financial risk for payers and the most financial risk for providers
Salary
-A payment model where physicians are paid biweekly based upon their expertise and experience. -The payment model that is utilized to pay specialists in the NHS. -Physicians are paid a predetermined salary based upon their level of expertise and experience.
EDRG's
-A type of Bundled payment that includes physician fees and follow the patient for an extended period of time beyond discharge. -Acts as a forcing function
Sir William Beveridge
-An author of the Social Insurance and Allied Health Services Report, A Civil-servant, Radio show host. -He worked in London's lower east side before, during & after WWII. -1942: He wrote & released the Beveridge Report (Official Name: Social Insurance & Allied Health Services). -Laid out the entire plan on how to develop and implement a fully federally-run healthcare system.
Key features of the Beveridge Model (Health Care Delivery)
-Centralized -Mostly Public
What are key characteristics of the healthcare system that established in East Germany?
-Centralized -Mostly public healthcare services
Key features of the Bismarck Model (INSURANCE program)
-Decentralized -Employer-Based -Private
Key features of the National Health Insurance Model (Health Care Delivery)
-Decentralized -Healthy mix of both public and private
What are key characteristics of the healthcare system that was established in West Germany?
-Decentralized -Mainly private healthcare services
Key features of the Bismarck Model (Health Care Delivery)
-Decentralized -Mostly Private
Risk factors for health disparities
-Disability -Race -Socio-Economic Status -Age -Gender -Geographic Location -Educational Level -Sexuality -Gender Identity
What type of nudging is evidenced in the "Healthy Kinzigtal" program?
-Economic -Educational -Environmental
3 Types of Nudging & examples of each
-Economic Nudges: Sin taxes, Employee health benefit plans, Social benefit plans. -Educational Nudges: Leverage opinion leaders and/or influential settings to promote health through education programs. -Environmental Nudges: Building walking paths, smoke free workplaces, and employee wellness programs.
List of countries that has implemented the Bismarck Model
-Europe: Germany, Belgium, Switzerland, France -Asia: Japan -Latin America: Primarily everywhere except for Cuba
List of countries that has implemented the Beveridge Model
-Europe: United Kingdom, Spain, Scandinavia -Asia: Hong Kong -Oceania: New Zealand -Latin America: Cuba
Medicaid changes through the ACA
-Expansion of Public Programs - specifically Medicaid (more eligibility to 138% of FPL) -Creation of health insurance exchanges -New regulation on health plans preventing insurers from denying coverage to people with pre-existing conditions -Requirement that Individuals must have health insurance (2014) -Penalties to employers that do not offer affordable coverage to their employees, with expectations for small employers
What programs does the Gesundes Kinzingtal Program offer?
-Gym Vouchers -Health promotion programs in schools/workplaces -Patient 'university' classes to help support prevention and self-management
Which of the following is NOT a dimension of population health management?
-Healthcare Delivery -Big data & population analysis -Patient engagement & empowerment -Case management & self-care -Digital health & AI -Prevention & public health -These are all dimensions of population health management
The 3 Goals of a healthcare system
-High quality -Low cost -Easy access
Key steps in the historical development of the UK healthcare system
-In 1911, parliament passed the very 1st form of what would become the National Health System (NHS) § In 1911, parliament passed the very 1st form of what would become the National Health System (NHS) · Parliament passed a very limited National Health Insurance Act o Covered workers (not dependents) for primary care, pharmaceuticals, and provided cash for short term disability or sickness · Few other private organizations offered voluntary coverage · Everyone else paid out pocket, through charity, or by big public hospitals -Problems at this time · Poor coordination between public and private hospitals · Access to specialists was uneven as many specialists gravitated towards private pay patients · Feud erupted among physicians over qualifications and who could work in hospitals -Throughout the 1920's and 1930's these issues sparked a heated and prolonged debate over healthcare reform -This reform debated took two forms · Option 1: Extend the 1911 act into comprehensive National Health Insurance · Option 2: Expand & universalize existing locally funded & run public health services
Orlando Health faced a barrier to effectively monitor and track the health of the population as a result of a fragmented, outdated patient health information system. As a result, they utilized AI to automate and digitize records, while simultaneously aggregating data. Why is aggregated data so important when managing population health? (select all that apply).
-It allows providers to access a much larger patient base when researching effective treatments, especially for rare diseases -It allows the health system to better identify high cost patients known as super-utilizers -It allows health systems to develop programs and direct resources towards segments of the population that are most in need
How do you measure the various goals?
-Life Expectancy -Quality of Care -Patient outcomes -Patient Safety -Patient Satisfaction -Cost of Care -Access to Care -Others
According to the article, "What Can the US and England Learn from Each Other's Health Care Reforms?," which of the following are common goals for both countries?
-Managing healthcare costs -Better integrating health services -Improving population health
List of countries that has implemented the National Health Insurance Model
-North America: Canada -Asia: Taiwan, South Korea
Which of the following is a measure of access within a healthcare system?
-Patient insurance status such as insured or uninsured -Patient insurance coverage -Geographical proximity to needed services -Physician to patient ratios
Who does Medicare cover?
-Patients with end-stage renal disease -Disabled -Elderly
The 4 Components of a healthcare system
-People -Parts -Interrelationships -Culture
Who does Medicaid cover?
-Pregnant Women -Elderly -Disabled -Low-Income
Which prevention programs costs the system money?
-Primary Prevention -Secondary Prevention
4 types of prevention, examples of each, and their overarching role in healthcare delivery
-Primary Prevention -Secondary Prevention -Tertiary Prevention -Quaternary Prevention
Key features of the National Health Insurance Model (INSURANCE program)
-Public -Tax-Based -Centralized
Match the department within the NHS to its primary role within the system:
-Public Health England--> Improves overall well-being and reduce health inequalities -NHS Business Services Authority--> Issues health insurance cards to citizens and act as the central HR department for all NHS employees -Care Quality Commission--> Regulates all medical, health, and social care service guidelines -Monitor--> Ensures that overall systematic performance is meeting standards, including quality, cost, and access measures, are being met throughout the UK
Which models are considered bundled payments?
-Reference Pricing -EDRG -DRG's
What 3 key aspects are needed to accurately define a health or healthcare disparity?
-Risk Factor -Comparison Population -Health or Healthcare Outcome
Key features of the Beveridge Model (INSURANCE program)
-Tax-Based -Centralized -Public
Which prevention programs save the system money?
-Tertiary Prevention -Quaternary Prevention
Aneurin Bevan
-The Minister of Health and an Elected Official. -Shared in Beveridge's vision. -Official Founder of the NHS when it was passes into law in July, 1948. -Had to make many compromises, especially with specialists. -Belief, "Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalized, but a misfortune, the cost of which should be shared by the community".
Lee Kwan Yew
-The Prime Minister who attended Cambridge University. -He believed that in order for Singapore to survive as an independent nation they had to turn themselves into a first world oasis in a third world region. -Developed the belief that a system that took care of ALL of its citizens needs would diminish the population's desire to succeed. · The people's desire to achieve and succeed must never be compromised by an overgenerous state.
Otto von Bismarck
-The first Chancellor of Germany
The Beveridge, Bismarck, and National Health Insurance models are all systematically very different. However, which of the following are commonalities that we see among all 3 models, that we also fail to have within the US healthcare system?
-The government maintains oversight of the system, allowing it to intervene when the system fails -Universal Coverage
What is population health the study of?
-They study of how diseases impact populations which can be defined by many parameters including geographically -The health outcomes of a group of individuals, including the distribution of such outcomes within the group
Per Diem
-This Payment model reimburses organizations and/or providers based upon the number of days treatment was given. -The cost of healthcare is established prior to treatment and paid to the hospital or provider based on the number of days treatment was given
Fee-for-service (FFS)
-This payment model provides the least financial risk for providers and the most financial risk for payers -All healthcare services, products, and prescription medications are unbundled and paid for separately.
Pay-For-Performance (P4P)
-This payment model was dubbed pay-for-process by physicians and played a significant role in what would ultimately become the opioid epidemic -Reimburses healthcare organizations and physicians who achieve, improve, or exceed their performance on specified quality and cost measures, as well as other benchmarks.
3 Public health enemies & prevalence in the US
-Tobacco Use -Obesity -Physical Inactivity
Which of the following are ECHO programs currently being run by ASU or scheduled to launch in Spring 2020?
-Veteran Community Care ECHO -Medication-Assisted Treatment ECHO -Behavioral Health Integration ECHO -End-stage liver disease ECHO
Why should we study health and healthcare disparities? (Select all that apply)
-We all benefit from having a stronger social compact/contract -Although some populations are impacted on a greater scale, the existence of disparities does impact all of us -Our population is extremely diverse, and becoming more-so with time, increasing the risk of populations being impacted greater
What regions/countries had the most significant influence over West Germany?
-Western Europe -United States
System
1. a set of connected things or parts forming a complex whole. 2. a set of principles or procedures according to which something is done; an organized scheme or method.
Approximately, what portion of the US population still smokes tobacco?
1/5
How much does the healthcare system actually impact the health of a population?
10%
When was the Affordable Care Act signed into law?
2010
How much do individual behaviors impact the health of a population?
40%
Percentage of health determined by behaviors & examples of those behaviors
40% of health determined by eating habits, exercise, tobacco use, etc.
According to the Kaiser Family Foundation, what estimated percentage of the population will people of color compromise in the year 2050?
54%
What percentage of our health is NOT attributed purely to genetics?
70%
How many unique care management and preventative programs were developed under the "Healthy Kenzigtal" initiative?
8
In Singapore, what is the level of subsidy that citizen's in the lowest income bracket qualify for?
80%
When was Medicare established?
A National Health Insurance Program that was established on June 30th 1965 by President Lyndon Johnson.
When was Medicaid established?
A State-Run Program w/federal assistance that was established on June 30th 1965 by President Lyndon Johnson.
Shared Vision
A common goal for more than one individual
Project ECHO
A continuing medical education model where teams of specialists train primary care providers to treat complex patients in need of specialty care services. The idea that if you tell your patients their care instructions enough, eventually they will understand it.
Sickness Funds
A form of health insurance; sum of money used to cover medical costs Health insurance plans
Health Disparities
A higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group.
What is a social compact/contract?
A mutually understanding among members of society to cooperate for social benefit, which may include sacrificing individual rights for community benefit
Globalization
A process of interaction and integration among people, companies, and government of different nations, a process driven by international trade and investment and aided by information technology.
Cultural Humility
A process of self-reflection and discovery in order to build honest and trustworthy relationships. It offers promise for researchers to understand and eliminate health disparities, a continual and disturbing problem necessitating attention and action on many levels.
What is a shared savings program?
A program where healthcare organizations and insurance companies share overall savings generated through effective implementation of high-value, patient centered care
Shared Reality
A reality that people have agreed to share
Copayment
A set dollar amount, set by the insurance company, that must be paid by the patient at the point of service
Co-Insurance
A set percentage of the total bill that must be paid by the patient at the point of service for the healthcare services
What is a common theme we see with regards to healthcare reform efforts throughout Singapore's history?
A strong emphasis on public health and preventive health efforts
The belief systems that were the foundation of Singapore's healthcare system
A system that took care of ALL of its citizens' needs would diminish the population's desire to succeed.
What is an integrated care system?
A type of system design where various stakeholders including providers and payers, are linked through conscious system design to work collaboratively towards improved patient care
What is one model of care that was originally developed in the United States that is being highly considered and adopted throughout the NHS in England?
Accountable Care Organizations (ACOs)
Universal Coverage
All citizens within a country have access to healthcare insurance, regardless of individual circumstance. Every OECD is able to get its citizens ___________coverage, except for the US.
Aspects of the US healthcare system that is represented in the Bismarck Model are...
Average Worker
Which of the following populations would NOT be considered a risk factor for health or healthcare disparities?
Being in the top 1% of income earners in the US
Which of the following payment models is NOT used to reimburse primary care physicians in the United Kingdom?
Bundled Payments
Which of the following is NOT a tax-based system for the means of accumulating healthcare funds?
Canada
Federal
Centralized government (A system in which power is divided between the national and state governments)
In the 1960's, what was the primary goal of the government in Singapore as it pertains to health and healthcare services?
Construction of public health services such as subsidized housing.
Which of the following statements is correct?
Cost sharing is a means by which to keep patients from over-utilizing healthcare services
Medicaid is...
Decentralized & Public
Regional
Decentralized government (Government run)
Healthcare Disparities
Differences between two or more groups in health insurance coverage, access to and use of care, and quality of care received.
Which dimension of population health management did Mercy Health in Ohio leverage to overcome issues with interoperability within their electronic health records?
Digital health & AI
What is the goal that Human and Health Services (HHS) has set out in their action plan with regards to health and healthcare disparities?
Eliminate racial and ethnic health disparities
What type of health insurance programs became popular immediately after WWII?
Employer-based insurance
Gesundes Kinzingtal Program
Established in 2006, so that: -A pre-determined amount of money is allotted for the care of these patients -Providers are reimbursed for any care that they provide -Any money left at the end of the term in the allotted population budget is split and shared among the providers and the sickness funds.
In the United Kingdom, they experience health disparities because of the role social determinants play in an individual's health, but they do not experience healthcare disparities because they have universal coverage and socialized medicine.
False
The National Health Service and the National Health Insurance model are the same thing and those two terms can be used as synonyms.
False
Attitudes/Beliefs
Focus on the ways that people evaluate and think about issues
Select the country that has a healthcare system that is decentralized in ALL aspects of their system (healthcare delivery & health insurance):
Germany
Which of the following is NOT a tax-based system for the means of accumulating healthcare funds?
Germany
Subsidy
Government Assistance
Nudges
Health interventions that make the healthy choice, the default choice. Interventions that influence or persuade people to make healthy choices. Interventions that rely less on conscious choice by individuals and more on influencing behaviors through environmental/societal norms are more likely to succeed.
According to the Kaiser Family Foundation (your reading material this week) what race/ethnic group is at the highest risk of being uninsured?
Hispanic
Bundled Payments (DRG)
Hospitals are reimbursed with a fixed feed regardless of the actual costs. Includes hospital expenses only. ACA required 30 day readmission penalty.
Access
How obtainable it is for someone to apply for healthcare
The belief systems that were the foundation of the UK's healthcare system
Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalized, but a misfortune, the cost of which should be shared by the community.
Pay for Performance (P4P) Incentive
Incentive: Adherence to process
Bundled Payment (DRG) Incentive
Incentive: Discharge appropriately
EDRG's Incentive
Incentive: Encouraging physician and hospital collaboration on improving both patient outcomes and cost.
Per Diem Incentive
Incentive: Increase length of stay
Capitation Incentive
Incentive: Keep the patient healthy and living their daily lives in their own home, out of hospitals, freedom to provide non-traditional healthcare services.
Reference Price Incentive
Incentive: Low expenses, and high quality of care
Fee-for-service (FFS) Incentive
Incentive: Overtreatment
Salary Incentive
Incentive: Provide the best treatment, regardless of ICD-code to the patient.
What did policymakers implement in Germany to shift the focus away from cost containment and towards enhancing efficiency in the early 2000's?
Introduced diagnosis-related groups as the primary basis by which sickness funds would reimburse hospitals
What impact did the invasion of the Nazi Germans have on the development of the UK's healthcare system?
It forced healthcare delivery service to organize into a centralized healthcare system
What is agency & why is it important when combating health disparities?
It is the capacity of individuals to act independently and have a voice in aspects impacting their lives. It is important in combating health disparities as it empowers citizens that have been traditionally marginalized.
The Glasgow Effect
It is the concept that neighborhood plays a very important role in our health and can change drastically, even within a small geographic area.
Healthcare Financing
It is the field in healthcare concerned with the overall cost of spending. It is the function of a system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively. It is the field in healthcare concerned with how physicians and hospital get paid.
What approach is key to understanding the needs of individuals and cohorts of people in order for population health management to be successful?
It must be data-driven to accurately reflect the immediate needs of the population
Gatekeeper
It's when a health plan dictates that a patient must get referred by their PCP to see a specialist
The National Health Insurance Model
Medical and healthcare services are provided through both public and private entities and paid for by a single government insurance plan.
The Out-of-Pocket Model
Medical and healthcare services are provided through both public and private entities and paid for through sickness funds.
Bismarck Model
Medical and hospital services are provided through both private and public services and paid for through sickness funds.
Aspects of the US healthcare system that is represented in the National Health Insurance Model are...
Medicare
Which of the following statements is true?
Medicare is a centralized program meaning it is organized at the federal level.
Marginalized/Underserved Community
Minority Populations
What is ONE lesson that the US can learn from recent reforms within the NHS?
Mixing financial incentives should be avoided and should stretch beyond just clinical care outcomes
In the early 2000's the Surgeon General release two reports that ultimately led to the creation of which organization?
National Center for Minority Health and Healthcare Disparities
In our country, that is currently experiencing strong political divides, what is an aspect of Singapore's healthcare model that might be appealing to those on the 'right' or more conservative in their political views?
One of the countries five main objectives is built in personal accountability and avoiding the over-reliance of a welfare state
In our country, that is currently experiencing strong political divides, what is an aspect of Singapore's healthcare model that might be appealing to those on the 'left' or more democratic political views?
One of the countries five objectives is universal coverage and there are systems in place to protect consumers from high costs when the system fails
Medicare (4 parts)
Part A (Part of the Original Medicare Bill) Inpatient Services -Inpatient Hospital Care -Inpatient stays at skilled nursing facilities -Hospice & home health services Part B (Part of the Original Medicare Bill) Physician Services -Doctor & Clinical Lab Services -Outpatient and preventative care -Screenings, surgical fees, &supplies -Physical & occupational therapy Part C (Introduced in 1997 by the Balanced Budget Act) -Also known as Medicare Advantage -Different way of getting part A & B coverage -Combines parts A & B into one plan and offered as: · HMO · PPO · PFFS · SNP Part D (Introduced in 2006, by the Medicare Prescription Drug, Improvement, & Modernization Act of 2003) -Prescription drug coverage
Which of the following is NOT a measure of the overall cost of a healthcare system?
Patient Income
Which of the following is NOT a measure of the overall quality of a healthcare system?
Patient Insurance Status
Which of the following is NOT a measure of overall access of a healthcare system?
Patient Satisfaction
Opt-in programs
Patient consent is required in order for patient health information to be stored and/or disclosed by the HIE
Opt-out programs
Patients may be automatically enrolled in the HIE but are given the opportunity to opt out of having their information stored and/or disclosed by the HIE
Select the response below that BEST illustrates a healthcare disparity:
Patients with disabilities experience cost as a barrier at a rate of 78% higher than their able-bodied counterparts
Uninsured/Underinsured
People either have no insurance or are underinsured/populations are underinsured.
Quaternary Prevention
Prevention efforts designed to ensure patients are not exposed to additional harm when seeking medical care, particularly in inpatient settings. Ex: Avoiding hospital-acquired infections for a patient undergoing heart surgery.
Secondary Prevention
Prevention efforts designed to keep individuals and populations from becoming at higher risk for illness/injury. Ex: Mammograms
Primary Prevention
Prevention efforts designed to keep individuals and populations from becoming at risk for illness/injury. Ex: Annual Physicals
Tertiary Prevention
Prevention efforts designed to keep individuals and populations from having acute episodes related to the poor management of chronic disease. Ex: Monitoring medical adherence for a patient with diabetes.
Safety Nets
Programs put in place to protect vulnerable populations from cost=sharing
Which of the following is NOT the goal of a healthcare system?
Provide care to only those who can afford it
Which of the following was NOT a healthcare system change introduced by the Affordable Care Act?
Provided universal health insurance coverage
Cost-Sharing
Provision of a health insurance policy that requires the policyholders to pay for a portion of their healthcare services.
According to the article, "Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition," what is the primary focus of healthcare reform in Germany today?
Quality Improvement
What is the difference between diagnosis-related groups (DRG) and reference pricing?
Reference pricing allows hospitals to charge whatever they choose, while DRGs does not
Where is the Out-of Pocket Model seen throughout the world?
Rural Regions: -South America -Africa -China -India
What regions/countries had the most significant influence over East Germany?
Russia
What regions/countries had the most significant influence over East Germany? (Select all that apply).
Russia
Societal Culture
Shared values, norms, identities, and interpretations that result from common experiences of members of an organization.
What is ONE underlying systematic design employed by ACO's aimed to improve quality and reduce healthcare costs?
Shifting the payment model away from fee-for-service to link savings to cure outcomes
Which of the following programs is NOT a public program?
Sickness funds in Germany
What is the primary means by which money is accumulated within the healthcare system in Germany?
Since the system in Germany is highly privatized money is accumulated by the sickness funds through payroll deduction
Medisave
Singapore's insurance program passed in 1984 that mandates citizens to contribute a certain percentage of their income tax to a tax free account.
Medishield
Singapore's insurance program passed in 1990 to protect citizens from catastrophic healthcare events.
Medifund
Singapore's safety net insurance program passed in 1993 to help low-income citizens cover their medical bills.
The belief systems that were the foundation of Germany's healthcare system
Social Solidarity- a government is obliged to provide a wide range of social benefits to all citizens including medical care and other forms of social welfare.
Beveridge Model
Socialized Medicine- Medical and hospital services that are provided by a government and paid for by taxes.
Which of the following countries introduced an innovative health system design where they reimbursed a private healthcare organization through public funds via non-risk-adjusted, capitation payments?
Spain
Sin taxes
Taxes that are placed on products that are known to be harmful to your health
Private Health Services/Insurance
Term used to describe when an organization is operated by a non-government body (Entity is owned by anyone BUT the government)
Public Health Services/Insurance
Term used to describe when an organization or program is operated by the government (at ANY level)
What happened on July 5th, 1948 in the UK?
The NHS was passed into law
In respect to the 3 organizations that we discussed in class that ranked various healthcare systems around the world, which of the following statements is correct:
The U.S. performed consistently poor on all 3 rankings - which are difficult to compare since they utilized different measures of success and analyzed varying numbers of countries overall.
How does the US perform on life expectancy?
The US life expectancy is poor. It is around 78.6 yrs
How does the US perform on quality, access, and cost?
The US performed the worst out of other countries. It is ranked last.
Cultural Competence
The ability to understand, communicate with and effectively interact with people across cultures. Being aware of one's own world view. Developing positive attitudes towards cultural differences. Gaining knowledge of different cultural practices and world views.
Reference Price
The amount now going to medical centers with high quality and low cost medical centers can charge more if patient chooses higher cost medical centers, patient pays the difference.
Premium
The amount paid monthly for a health insurance plan
What are the implications to the healthcare system in Germany when the Berlin wall is torn down?
The country adopts the health system of West Germany which is highly decentralized
What does mortality amenable to healthcare measure?
The deaths preventable within a healthcare system with timely and appropriate medical care
Quality
The health outcomes based on the quality of care that is provided
The Commonwealth Fund and the World Health Organization reports both used health equity as a measure in their rankings. What is health equity?
The inclusion of fairness in a system for providing health services and insurance coverage taking into consideration an persons individual circumstances
Health spending as a % of the GDP
The percent of money spent on healthcare every year, in relation to the total amount spent throughout all industries in the same year.
Cost
The price of a given service
Generalized Reciprocity
The principle belief in giving to someone/something knowing that you may not get an immediate returned benefit
Subsidiarity
The principle belief that matters of government responsibility should be handled at the lowest level of government that makes operational sense In other words.... The principle that organization both social and political issues should be handled at the most local or least centralized competent authority
Social Solidarity
The principle that the government has a responsibility to ensure all citizens have access to essential social services including healthcare In other words.... The belief that the government has an obligation to ensure all citizens have access to healthcare
Deductible
The set dollar amount that must be paid by the patient annually prior to the insurance company covering any medical expenses In other words... The amount that must be paid out-of-pocket annually, before insurance coverage kicks in
Organizational Culture
The set values, ideas, attitudes, and norms of behavior that is learned and shared among the members of an organization.
What are social determinants of health?
They are extenuating circumstances, outside the control of individuals, that have substantial impacts on health
What did Lee Kuan Yew believe had to occur if Singapore was going to survive as an independent nation?
They had to turn themselves into a first world oasis in a third world region
What populations listed below would NOT be covered by both Medicare and Medicaid (duel-eligible)
Those of low-income who are pregnant or had a child within the last year.
What was the initial focus of Singapore's healthcare system once they gained their independence?
To focus on public health services such as adequate housing and basic primary care services
Aspects of the US healthcare system that is represented in the Out-of-Pocket Model are...
Uninsured Population
Select the country that has a healthcare system that is centralized in ALL aspects of their system (healthcare delivery & health insurance):
United Kingdom
Centralized
Used to describe when healthcare is structured, organized and delivered at the federal level (single authority) In other words... Organization, regulations, and power is centralized at the federal level of government.
Decentralized
Used to describe when healthcare is structured, organized, and delivered at the regional or state level. In other words... Organization, regulations, and power is decentralized to the regional or state levels of government.
Aspects of the US healthcare system that is represented in the Beveridge Model are...
VA/Tricare: covers active active military, families, & veterans
US rankings in WHO report, Bloomberg Business report, & Commonwealth Fund report
WHO --> 37th Bloomberg --> 54th Commonwealth Fund --> 11th
Who holds responsibility for reducing health and healthcare disparities?
We all hold responsibility
What model does the United States use?
We have elements of all 4 models working in our healthcare system -Veterans Affairs/Tricare-->Beveridge model -Medicare-->National health insurance model -Average worker-->Bismarck model -10% with no access to health insurance-->Out-of-pocket model
Can healthcare disparities be compounded? In other words, does your risk increase if you qualify for more than one risk factor?
Yes, patient's who qualify for more than one risk factor would be at an exponentially greater risk for health and/or healthcare disparities.
Fill in the quote: "When it comes to health, your _________ _________ matters more than your genetic code."
Zip code
Why should we study healthcare systems around the world?
a. All of the above i. Get a gauge of where the US system performs overall, comparatively speaking ii. Determine what we can learn from other healthcare systems to improve our system here in the US iii. To gain an understanding of what types of system models are being used and how those models perform iv. Learn how other systems are structured, financed, and what barriers they are facing v. Learn about innovations in care delivery and their impacts on population health
Population Health Management
combination of information gathered to define problems and build awareness and the strategies to address needs
Key steps in the historical development of Singapore's healthcare systems
o Singapore gained independence from Britain in 1965 -At the time, it was a tiny, impoverished country with few assets and no natural resources -"Singapore's founding father, Lee Kuan Yew, knew that without Britain's military and financial support, this new country would succeed and endure ONLY if it could turn itself into a 'First World oasis in a Third World region." -Had a unique opportunity to learn from Western healthcare systems such as the U.K. and the US. -1960: Set up Housing Development Board (HDB) began investing in good, clean, affordable housing -1965: Singapore was a new nation but poor and impoverished. 55,000 Flats were also built. -1970: housing problems were solved -1980, the government first developed the various components of its healthcare system -1980: Sweeping reform in the 1980's: 1st Comprehensive National Health Plan introduced -1993: Released White Paper titled "Affordable Health Care" · Became blueprint for developing and refining Singapore's healthcare system
