Health Systems: Global
Studied by 0 people
Learn
Practice Test
Spaced Repetition
Match
Flashcards1/71
There's no tags or description
Looks like no tags are added yet.
Name | Mastery | Learn | Test | Matching | Spaced |
|---|
No study sessions yet.
72 Terms
What is capitation in physician payment?
A set payment per patient per time period.
What is risk adjustment in capitation?
Higher payments for patients with higher expected needs.
What is fee-for-service?
Payment to providers for each service delivered.
What is per diagnosis payment?
Bundled payment based on a diagnosis, e.g., pregnancy or pneumonia.
What is a Diagnosis-Related Group (DRG)?
Set Medicare payment for expected care based on diagnosis.
What is salary-based physician payment?
Fixed annual amount regardless of services or volume.
What are key metrics for evaluating a health care system?
Access, cost, satisfaction, quality, and equity.
What is a regional care model?
System with local primary care, regional hospitals, and national tertiary care centers.
What is single payer health care?
One public payer (often government) pays all health care costs.
What are advantages of single payer systems?
Lower admin costs, price negotiation, and universal coverage.
What type of system does Germany use?
Mixed social insurance and public assistance.
What are sickness funds in Germany?
Employer-based insurance funds retained if unemployed.
Can Germans purchase private insurance?
Yes, for extra services or preferential access.
Are sickness funds allowed to use experience rating?
No, only community rating.
How are contributions to German sickness funds collected?
Through a central government-run fund.
How are German physicians and hospitals paid?
Physicians have billing caps; hospitals receive set rates.
Do primary care providers in Germany work in hospitals?
No, they work in outpatient settings.
How is a 42-year-old employed person covered in Germany?
Employer-based sickness fund with shared premium (~15% of income).
How is a 27-year-old unemployed person covered in Germany?
Ex-employer’s fund, employee portion paid by government.
How is a 70-year-old retired person covered in Germany?
Funded by pension (40%) and active workers’ contributions (60%).
How is a 5-year-old child covered in Germany?
Covered under parent’s fund; receives Kindergeld child benefit.
What type of health care system does Canada have?
Universal, tax-financed, single payer system.
Who is the payer in Canada’s health system?
Provincial governments.
Is employment required to get health care in Canada?
No.
Can private insurance pay for covered public services in Canada?
No, it is prohibited.
How are Canadian hospitals funded?
Global budgets (not per service).
How are most Canadian physicians paid?
Fee-for-service at negotiated rates.
What other payment models are emerging in Canada?
Capitation and pay-for-performance.
How are drug prices and new technologies managed in Canada?
Government regulates prices and purchases.
How do Canadian primary care providers interact with hospitals?
They admit patients.
What is a concern in Canada’s system?
Long wait times and quality concerns.
How is a 42-year-old employed person covered in Canada?
Tax-financed provincial health plan.
How is a 27-year-old unemployed person covered in Canada?
Tax-financed provincial health plan.
How is a 70-year-old retired person covered in Canada?
Tax-financed provincial health plan.
How is a 5-year-old child covered in Canada?
Tax-financed provincial health plan.
What is the UK’s national health care system called?
National Health Service (NHS).
How is the NHS funded?
General taxation.
Can people purchase private insurance in the UK?
Yes, for faster access to the same services.
What role do GPs play in the UK system?
Gatekeepers to specialist care.
How are UK GPs paid?
Capitation + carve-out fee-for-service for prevention.
How are UK specialists paid?
Salaried, some also do private fee-for-service.
Where do GPs work in the UK?
In the community, not hospitals.
What is pay-for-performance (P4P) in the UK?
Payment tied to quality, access, safety, and experience.
What is a key feature of UK cost control?
NHS budgeting, capitation, and limits on specialists and services.
How is a 42-year-old employed person covered in the UK?
NHS, may buy private insurance.
How is a 27-year-old unemployed person covered in the UK?
NHS, possibly exempt from contributions.
How is a 70-year-old retired person covered in the UK?
NHS, may pay more for long-term care.
How is a 5-year-old child covered in the UK?
NHS, no contributions required.
What kind of health care system does Japan have?
Universal public insurance with employer-based and national plans.
What is “society-managed” insurance in Japan?
Large employer-based plans for employees and dependents.
What is citizens’ health insurance in Japan?
Government-managed plan for small business workers, self-employed, and retirees.
How is health insurance for older adults funded in Japan?
Through premiums and taxes.
Can Japanese patients see specialists directly?
Yes, no gatekeeping required.
What is unique about physicians in Japan?
They dispense medications and profit from them.
How does Japan control health care costs?
Government-regulated fee schedules.
What are concerns about Japan’s system?
Aging population and sustainability of financing.
How often do Japanese people visit physicians?
Frequently—physicians may see up to 60 patients/day.
What is Japan’s average life expectancy?
~85 years (one of the highest globally).
How is a 42-year-old employed person covered in Japan?
Employer-based or government-managed insurance with shared premiums.
How is a 27-year-old unemployed person covered in Japan?
Citizens’ health insurance.
How is a 70-year-old retired person covered in Japan?
Citizens’ health insurance or Long Life Medical Program if 75+.
How is a 5-year-old child covered in Japan?
Through a parent’s insurance plan.
What contributes to higher health care costs in the US?
Higher prices for nearly all services and medications.
What percent of US health care spending is administrative?
Estimated 15–30%.
What are administrative cost drivers in the US?
Multiple insurers, complex billing, prior authorizations, credentialing.
How do under- and un-insurance raise costs?
Lead to delayed care, sicker patients, and higher acute care needs.
How do social programs affect US health care costs?
Less investment in social supports (e.g., child care, paid leave) worsens health outcomes.
What role does technology play in US costs?
High use of expensive technology, especially at end of life.
Why can’t the US negotiate lower prices?
Limited ability to negotiate with drug and equipment companies.
How does malpractice contribute to costs?
Defensive medicine and malpractice insurance drive spending.
What demographic trend affects US costs?
An aging population requiring more care.
How does primary care underinvestment affect cost?
Less prevention and more expensive downstream care.