MIDTERM- Comparative Health Politics
asses the value/quality of culture and healthcare
-culture: a set of values, beliefs, + practices that are shared by a specific group of people -typically passed down inter-generationally -within the context of health services, may influence the approach of of culture towards health care
Describe the Bismarck system or the "mutual insurance model."
-every working person contributes part of their income to a central fund; if someone becomes sick, they are able to claim part of the costs back from this mutual insurance fund -basic principles: free to choose your doctor, pay for your treatment and then get reimbursed for part of the expenses by your mutual insurance fund
Describe how the Beverage system/care in kind system works.
-healthcare provided + financed by the government through taxes -doctors/healthcare professionals became government employees; most hospitals and clinics became government owned -basic principles: designated medical service provider and patients receive free healthcare which is funded by healthcare
historic moments that have changed healthcare
-hospital sanitation improvement documentation -sanitary commissions on to promote clean conditions in hospitals -innovations such as pasteurization as well as the quarantine of contagious individual to control the spread -water sterilization -x-ray technology -education/clinical training of physicians -pharmaceuticals such as penicillin -healthcare financing -industry + mass production
describe the stakeholders in healthcare.
-patients, families, + communities (support system) -ministries of health, health providers, health service organizations -pharmaceutical companies -health financing bodies and other organizations
role of the world health organization in healthcare world wide
-specialized agency of the United Nations whose mission is to oversee health on a global level -current priorities: communicable disease, mitigation of the effects of non-communicable disease; sexual/reproductive health, development and aging; nutrition, food security, and healthy eating; occupational health; substance abuse; and finally, driving the development of reporting, publications, and networking
role of the EU in European healthcare
-the EU has no major role in healthcare - charter of fundamental rights of EU affirms that "a high level of human health protection shall be ensured in the definition and implementation of all union policies + activities" -directorate-general for health and consumers seeks to align national laws on the protection of people's health, on the consumer's rights, on the safety of food and other products -all EU countries offer citizens a free european health insurance card which provides coverage for emergency medical treatment when visiting other participating European countries
what is a health system?
-the combination of resources, organization, financing, and management that culminate in the delivery of health services to the population -all activities whose primary purpose is to promote, restore, and maintain health and includes the prevention of illness due to poverty
The Bismarck-Type social health insurance is characteristic of: a. south African healthcare b. German healthcare c. Italian healthcare d. none of the above
German healthcare
Which of the following countries has an excessively high doctor/patient ratio? a. Israel b. Italy c. Switzerland d. England
Italy
Nordics
What type of healthcare is provided? -Nordic healthcare systems are taxation based, and locally administrated with every citizen having equal access to services. All countries, however, require co-payments by patients for hospital care and medicines. How is healthcare funded? -citizens pay high taxes What are the strong points of the system? -81 year life expectancy -patient experiences measures involving patients of the actual treatment -prevention/health promotion excellency -good collaboration and cooperation among sectors + active localism What needs improvement? -copayments becoming more common -hospital charges in Sweden -need to be able to support more patients -one of the lowest infant mortality rates, one of the highest cancer survival rates, and lowest smoking/obesity rates -low health inequalities + good quality for long-term care
Indonesia
What type of healthcare is provided? -all citizens are now able to access a wide range of health services provided by public facilities, as well as services from a few private organisations that have opted to join the scheme as providers How is healthcare funded? -Those in formal employment pay a premium equivalent to 5% of their salary, with 4% payable by employers and 1% payable by employees. Informal workers, the self-employed and investors pay fixed monthly premiums What are the strong points of the system? -on the come-up; economic growth is good -cover is broad, but not deep What needs improvement? -0.3 doctors per 1,000 citizens -too many doctors practice in towns/cities roadblocks: size + remoteness of many areas + diet. of doctors, equipment, beds, + supplies -more than 28 million live under poverty line -infectious diseases -HIV/AIDS smoking -one of lowest countries in Asia for # of hospital beds
Hong Kong
What type of healthcare is provided? -dual-track; public and private -The private sector offers numerous options and luxurious perks, but comes at a very high price. The public sector, subsidised by the Hong Kong Government, is provided to eligible citizens at a very low fee. How is healthcare funded? What are the strong points of the system? -system of government-operated hospitals only costs the gov. about 3% -happy + productive workers What needs improvement? -expensive elderly care treatment -long waiting times -shortage of doctors/nurses -extreme lack of foreign doctors
Russia
What type of healthcare is provided? -every Russian citizen/resident entitled to free public healthcare under the Russian healthcare system, (OMI). How is healthcare funded? -Once you begin working in Russia, your employer will pay around 2-3 percent of your salary into a social tax, a percentage of which is paid into a national Russian healthcare fund. What are the strong points of the system? -private sector boom in Moscow What needs improvement? -bad economy -on paper, the system looks good, but in reality, the right to healthcare is blocked by bureaucratic systems of planning + regulation, reimbursement rates for providers that don't cover their costs, a scarcity of resources, + high levels of informal payments -overcapacity -dilapidated facilities + poorly trained doctors and longer wait times -a 1/3 of hospitals lack hot water and some don't even have a telephone -lack of trust in healthcare system -banks unwilling to lend money -corruption + low public trust
Germany
What type of healthcare is provided? -health insurance mandatory through SHI or private health insurance (SHI covers 85% of population) How is healthcare funded? -active participation/contribution from employers + staff (Bismarck system) -statutory sickness funds financed predominately through payroll taxes What are the strong points of the system? -world's lowest birth rate/ high life expectancy -for the most part, it delivers effective health care with low waiting times and high patient satisfaction What needs improvement? -most hospitals not allowed to see outpatients -complexity and decentralization of German system make change difficult -over 2,000 hospitals and 132 sickness funds make change difficult -obesity
Qatar
What type of healthcare is provided? -healthcare available to all Qataris and expatriates -free or highly subsidized (all Qataris receive free treatment; expats pay a small fee or buy a health card) -medicine highly subsidized -The healthcare system is available to all; whether you are a national, expatriate or a tourist. Qatar has a public health service that provides free or highly subsidised healthcare and, generally speaking, it is of an excellent standard. How is healthcare funded? -central funding What are the strong points of the system? -ambition in healthcare facilities/technology (smart beds in new facility) -investment in research and hospital facilities What needs improvement? -obesity (lack of exercise + poorly designed cities + fast food + conditioned comfort) -medical needs of foreign workers -need for a better primary care sector -poor coordination between hospitals and clinics -hospital dominance compared to ambulatory, primary, and community care
Mexico
What type of healthcare is provided? -healthcare guaranteed to all citizens by the government -Fully or partially subsidized regardless of work status -no universal healthcare quite yet though (working on it) -always been based on employment status; most salaried/formal-sector workers covered under 1 of 2 programs: 1. mexican social security institute (workers + families) 2. institute of social services/security for civil servants (gov. staff + families) How is healthcare funded? -1/2 government spending -1/2 out of pocket What are the strong points of the system? -telemedicine -consolidation -community health workers -healthcare tourism -low-cost innovation- telecom providers and retail pharmacies entering the market (CVS, for example) What needs improvement? -lack of unemployment -huge disparities in wealth and access to treatment -slow increase in life expectancy due to mainly violence/homicide -obesity
Netherlands
What type of healthcare is provided? -heavily influenced by Bismarck school of social insurance -social solidarity/competition; public and private sectors working together -all residents required to take out health insurance -consumers can buy complementary policies, but insurers aren't obliged to take them -mandatory universal health insurance with competition among private health insurers. How is healthcare funded? -financed with individuals' annual income-based contributions to the tax collector -In addition, all adults are required to pay premiums directly to the selected insurer, which sets its own community-rated premium. What are the strong points of the system? -consumer choice -dutch system is carefully designed with clear rules and responsibilities laid out for insurers, providers, and government -quality agencies What needs improvement? -growing financial pressure -variation across providers in cost/quality; esp. in maternity services -unsustainable hospitals in rural areas -tension between insurers and GPs -old-age care cost inflation
India
What type of healthcare is provided? -in principle: gov. health services available to all citizens in practice: poor access causes people to seek private care How is healthcare funded? -tax-financed public system + high out of pocket payments for private insurance What are the strong points of the system? -"right to health and right to life" -innovation/technology -combination of American assembly line methods and Japan management techniques to offer western levels of quality at a fraction of the cost -"apollo": largest telemedicine provider in india What needs improvement? - only around 300 million out of the 1.2 billion population has insurance -access to clean water/sanitation + malnourished children -overcapacity -large budget surpluses
Israel
What type of healthcare is provided? -national health insurance law ensures universal care -state responsible to provide health insurance for all residents -"health basket" covers a lot of treatment How is healthcare funded? -progressive health insurance premiums paid by each resident -employers' health tax payments -national insurance institute funds -ministry of health budget -consumer participation payments What are the strong points of the system? -technologically advanced/high quality system -modern hospitals with well-trained staff efficient health care delivery What needs improvement? -low number of hospital beds for acute care -long wait times for surgery -shorter than average hospital stays -fragmented long-term care (service gaps, inefficient incentives, + inadequate investment in prevention + rehabilitation
France
What type of healthcare is provided? -national program of social health insurance -3 principles: 1. personal payments 2. choice of doctor 3. clinical freedom How is healthcare funded? -employee/employer insurance contributions/earmarked taxes -private voluntary insurance and out of pocket payments What are the strong points of the system? -patient choice "medicine liberale" -protecting patient freedom to choose and a doctors freedom to practice + prescribe -expects same level of care in public + private sector; choice over competition What needs improvement? -weak economy + high unemployment -low pay of doctors -increasing co-payments of patients to see them -too few doctors -difficulty getting an appointment with a doctor who doesn't practice extra billing -not successful @ delivering coordination of the different types of care -fragmentation + lack of care pathway design -cost escalation -growing health inequalities
United States
What type of healthcare is provided? -no universal healthcare (still millions without) -Patients pay monthly health insurance fees to ensure that they will be covered when they need to go to the doctor, clinic or hospital. Insurance providers cover thousands of patients, so they are able to negotiate with health care providers for reduced fees and then pay for services. The Medicare or Medicaid insurance works the same way but on a bigger scale. Because they need to be able to negotiate, insurance providers generally have a network of doctors that they have agreements with, and patients are covered for visits to doctors within that network but may not be covered, or fully covered, for visits to doctors out of their network. Insurance providers will usually cover services considered necessary by doctors, but often will not cover services which are considered "elective." Insurance companies aim to keep their costs down while still covering necessary health care. -affordable care act How is healthcare funded? -government programs such as Medicare and Medicaid -private health insurance plans (usually through employer) -put-of-pocket What are the strong points of the system? -highest paid doctors -blue cross blue shield -ACO in the bronx ("montefiore"); tele monitoring, self education, + healthcare for poorer neighborhoods What needs improvement? -only spends 46% on health care, compared to the 70% OECD average. -"same old tune" -spending so much, national security could become a risk -many people get health insurance from their employer; rising premiums come out of wages and health care inflation has been cited as a main reason why pay wages have stagnated for decades -$765 billion goes to waste -steep administration costs -spends double the OECD avg. on prescription drugs
Malaysia
What type of healthcare is provided? -public/private model - dual-tiered system of healthcare services: a government-led and funded public sector, and a thriving private sector How is healthcare funded? -Public health services are heavily subsidized by the government. Primary care services at health clinics are delivered almost free of charge, whereby each patient is charged a nominal fee What are the strong points of the system? -medical tourism -foreign patients -government support for private hospitals abroad What needs improvement? -doesn't know if it can trust its government to managing, changing, + developing systems that use public $ effectively
Canada
What type of healthcare is provided? -regionally administered universal public insurance program How is healthcare funded? -Canada Health Transfer, provincial and territorial insurance plans must provide first-dollar coverage of medically necessary physician, diagnostic, and hospital services (including inpatient prescription drugs) for all eligible residents -67% of residents also have complementary coverage for noncovered benefits (e.g., private rooms in hospitals, drugs, dental care, optometry) What are the strong points of the system? -patient free choice of primary doctor -Canadian Patient safety Institute -Federally funded Canadian Foundation for Healthcare Improvement works with the provinces and territories to implement performance improvement initiatives, recently, for example, to reduce inappropriate prescribing for seniors in long-term care facilities -fundraising -telehealth -education -world-class research What needs improvement? -fragmentation -variation in access + availability of drugs + price paid by provinces -some say canada has 13 different health systems rather than 1 - in 2014 on average, Canadians had a 4 and 1/2 month wait for treatment after referral by a GP -disease is a big issue
China
What type of healthcare is provided? -universal -although there is insurance, patients still have to pay 1/2 - every citizen is entitled to receive basic health care services, with local governments—provinces, prefectures, cities, counties, and towns—responsible for providing them, with variations for local circumstances. How is healthcare funded? -central + local governments, publicly financed health insurance, private insurance, and social health donations What are the strong points of the system? -government commitment and people participation -treat public health as a public good What needs improvement? -mortality rates double in rural areas -poor access -inexperienced village doctors -bribes/unnecessary surgery -over-run hospitals -300 million smokers, pollution, cancer
Brazil
What type of healthcare is provided? -universal care -The constitution grants all Brazilian citizens the right to free medical assistance from public as well as private providers reimbursed by the government -basic + preventative healthcare provided by public domain -Private nonprofit and for-profit health care sector delivers the bulk of medical services, including government-subsidized inpatient care -"order and progress" motto How is healthcare funded? -services free at point of use and financed through general taxation -each level of government has to earmark a minimum portion of its revenues for health What are the strong points of the system? -One of the first and few countries outside the OECD to integrate the goal of universal health coverage in its legislation, recognizing health as a right of citizens and a responsibility of government -family health teams -foreign doctor force -international admiration for programs including immunization, tobacco control, AIDS, and free access to antiretroviral drugs -one of the world's highest vaccination rates/incentives for parents vaccinating their kids What needs improvement? -government only spends 48% on healthcare, compared to the 70% OECD avg. -primary care access -massive shortage of doctors, esp. in the slums
England
What type of healthcare is provided? -universal coverage How is healthcare funded? -general taxation supplemented by National Insurance contributions. -a smaller proportion of funding comes from national insurance ( a payroll tax) -copayments What are the strong points of the system? -NHS is considered the proudest achievement of modern society -good staff, technology, + quality of service -relationship between academic research and clinical practice What needs improvement? -poor integration between community and hospital -random and uncoordinated -bad communication between hospital, community, and primary care teams -system incapable of meeting ongoing needs
Italy
What type of healthcare is provided? -universal coverage; public healthcare free of charge at point of delivery -regionally based national health service (SSN) How is healthcare funded? -tax funding What are the strong points of the system? -"medical homes": patient-centered and team-based care in the community being developed in the North What needs improvement? -decentralized administration to regions -regions running deficits for political reasons and in some cases pushing up local taxes; blame game between national and local -too hospital centered and too much staff -lack of will and managerial skill to consolidate hospital facilities and develop a more progressive model of care based on ambulatory services and primary care -doctors resist change -aging population + worsening child health -public sector corruption; bribery -split between government responsibility for health financing and region responsibility for health expenditure
Japan
What type of healthcare is provided? -universal health coverage -mandatory enrollment in healthcare insurance program -30% co-payment for all enrollees (exception of children under 6, low income adults aged 70+ -majority of population also has private insurance for cash benefits in case of sickness How is healthcare funded? -general tax revenue + insurance contributions What are the strong points of the system? -ranked high for # of CT scanners/MRI units (preventative care) -bold reforms in long term care:"Kaigo Hoken"- mandatory long-term care insurance scheme to help older people lead more independent lives What needs improvement? -stigmas on mental health (causes of mental health illnesses considered to be things such as weakness of character) -"karoshi": death by overworking and suicide due to financial issues or health
South Korea
What type of healthcare is provided? -universal health insurance How is healthcare funded? -employer contributions + government subsidies which includes medical aid program for the poor -high out of pocket spending What are the strong points of the system? -improved healthcare through industrializations, improved water supply, sanitation, housing, + healthcare What needs improvement? -dominance of hospitals; 94% are privately owned -poorly designed payment system has encouraged large hospital operators to try and attract patients through hospital facility improvement -low pay for community doctors inhibits expansion of community services that are critical to prevention and rapid diagnosis
Singapore
What type of healthcare is provided? -universal healthcare but requires patients to pay a lot of the cost How is healthcare funded? 1. medisave- citizens set side money for family health expenses 2. medishield- low cost insurance scheme 3. medifund- safety net for those who can't afford their part of subsidized health expenses What are the strong points of the system? -one of the best health systems in the world and one of highest life expectancies -telehealth and telemedicine (virtual eye exams) What needs improvement? -dominance of private sector overs rare funding means not everyone has access
Australia
What type of healthcare is provided? -universal public health service provides free or subsidized access to care for citizens, residents w/ a permanent visa and certain new zealands -public + private sectors How is healthcare funded? -funded by the federal government mainly through indirect support to the states + health professions, subsidizing primary care providers through the medicare benefits scheme, pharmaceuticals benefit scheme, and providing funds for state services -state governments fund and deliver acute mental health care and psychiatric care in hospitals, community-based care, and residential care -public hospital care free to public patients What are the strong points of the system? -proactive community system with crisis/home treatment and early intervention -high life expectancy -good clinical outcomes What needs improvement? -weak integration between emergency, community, and private services -fragmented distribution of power -every thing is separate from employment to funding and financing -mix of federal/state funding and public/private sector makes services fragmented and complex
Switzerland
What type of healthcare is provided? -universal system, but administered by the individual cantons -federal health insurance act mandates that all swiss citizens are to be covered through private, non-for-profit health insurance; free to choose one of the 67 health insurance operators which cannot refuse to provide cover -combines public, subsidised private and totally private healthcare systems to create an extensive network of highly qualified doctors How is healthcare funded? -mandatory swiss health insurance premiums and out of pocket payments What are the strong points of the system? -happy, healthy, + educated citizens -low-waiting times -health conscious population -best equipped medical facilities and no waiting times What needs improvement? -very expensive healthcare system -fragmentation with 300 public and private hospitals serving 8 million
Portugal
What type of healthcare is provided? -universal/residence-based -public and private services How is healthcare funded? -general taxation What are the strong points of the system? -good hospital management -centralization -separation of provider, payer, + regulator- contributes to the good governance of the system What needs improvement? -old-fashioned management systems w/political micromanagement -loss of financial sovereignty has cost Portugal control of its own healthcare destiny -sometimes access is unattainable, esp. in more rural places
South Africa
What type of healthcare is provided? -varies from the most basic primary health care, offered free by the state, to highly specialised, hi-tech health services available in the both the public and private sector How is healthcare funded? -the bulk of health-sector funding comes from the South Africa's National Treasury. What are the strong points of the system? -strong economic growth lifting millions out of poverty, creating a middle class, and a more assertive population -mobile testing clinics to reach Africa's more remote areas -good private sector market, but only 16% of the peopulation can afford it What needs improvement? -sanitation, clean water, + communicable diseases -difference in spending on the private vs. the public sector -shortage of doctors in rural areas, even though half of the population live in these areas -57 year life expectancy -public hospital improvement -mining companies running their own hospitals -fragmentation in admin. management -AIDs -under-resourced
A major issue in Qatar is: a. A lack of Qatari-national health workers b. a high percentage of immigrants c. a lack of funds d. mismanagement of resources
a lack of Qatari-national health workers
one defect of health systems worldwide is: a. a lack of focus on the recipients of health services b. a lack of resources c. a lack of health workers d. none of the above
a lack of focus on the recipients of health services
A major issue in Italian healthcare is: a. corruption of the health system b. the split between the central government and the regions c. obesity in children d. all of the above
all of the above
Some of the greatest challenges to healthcare in South Africa a. clean water and sanitation b. fragmentation at almost every level of the public system c. AIDS and the transmission of the HIV virus d. All of the above
all of the above
culture, in the context of health behavior, refers to a. shared values, beliefs, + practices directly associated with a health-related behavior b. the adoption of a health education message by a group c. shared beliefs indirectly associated with a health behavior d. all of the above
all of the above
which of the following statements is most correct? a. research and development of technology distonguishes the health system in the US b. innovation distinguishes the health system in India c. choice of practitioner distinguished the health system in France d. all of the above
all of the above
defects of health systems
both rich and poor countries have have issues that create challenges that can include: -large populations of people without access to care because of inequitable arrangements for social protection -struggles with escalating costs due to inefficient use of resources -shortages of healthcare workers -health outcomes are unacceptably low across much of the developing world, and the persistence of deep inequities in health status is a problem from which no country of the world is exempt
membership in one of Israel's 4 HMOs is: a. compulsory, although citizens can choose which to join b. evaluated on a case by case basis and assigned automatically c. mandatory and determined by the government d. optional depending on income levels
compulsory, although citizens can choose which to join
which of the following groups tend to receive lower quality health care? a. europeans b. ethnic minorities c. senior citizens d. none of the above
ethnic minorities
in China: a. there is an over-abundance of health care workers b. the financial resources are available but there is a lack of leadership c. economic difficulty is the primary barrier to health d. the population is primarily youth
financial resources are available but there is a lack of leadership
in India: a. the government investment in healthcare is substantial b. health coverage is universal c. innovation in health services is lacking d. mismanagement of resources and corruption are among the most prominent barriers to access
mismanagement of resources and corruption are among the most prominent barriers to access
German hospitals do not provide: a. elderly care b. outpatient care c. accessible care d. none of the above
outpatient care
in countries that have universal health coverage, which of the following may create a barrier to access? a. pre-existing illness b. lack of insurance c. perceived inability to access health care d. there are no barriers with universal health coverage
perceived inability to access healthcare
in Australia: a. mental health is overlooked b. there are no disparities between indigenous and non-indigenous Australians c. private + public sectors both play important roles in health care d. the health system is progressive and in no need of reform
private + public sectors both play important roles in healthcare
the breakthrough method "seller, beter" for national quality improvement was introduced in: a. the united kingdom b. spain c. the Netherlands d. Italy
the Netherlands
one of the principal differences between Italy's SSN and the NHS in Britain is: a. the role of local health agencies b.the integration of private insurance in Britain c.the satisfaction rate of patients d. the decentralization of administration to the regions in Italy
the decentralization of administration to the regions in Italy
a strength of the British NHS is: a. high patient /hospital bed ration b. the efficiency and cost-effectiveness of care c. the elimination of co-payments d. all of the above
the efficiency and cost-effectiveness of care
in Japan: a. health care is used infrequently b. the government is able to control the costs c. universal health coverage does not exist d. the elderly have no access to healthcare
the government is able to control the costs
the first universal healthcare system was founded in a. the united kingdom b. england c. australia d. italy
the united kingdom
Describe universal healthcare.
universal healthcare vs universal health access physical accessibility -availability of good health services within reasonable reach of those who need them financial affordability -the ability to pay for services without financial hardship + is influenced by the wider health financing system and by household income acceptability -willingness to seek services -acceptability is low when patients perceive services to be ineffective or when social and cultural factors discourage them from seeking services
