HLTA03 Week 6: International Comparisons

Why compare healthcare systems?

Learn alternative approaches and identify ways to improve healthcare.

Why is comparing healthcare systems difficult?

Countries differ in populations, policies, structures, and resources.

Which countries are commonly compared?

Developed, high-income countries with high Human Development Index (HDI) scores.

What is Gross National Income (GNI)?

Income earned by a country's residents and businesses, including income from abroad.

What does GNI per capita measure?

Average national income per person, including income earned from abroad.

What GNI per capita threshold defines high-income countries in these notes?

Above US$13,845 per year.

What three dimensions does the HDI measure?

Health, education, and standard of living.

What does the Commonwealth Fund provide?

Research and comparisons of healthcare systems across countries.

What does the OECD provide for healthcare comparisons?

Statistics on healthcare spending, outcomes, and system performance.

What does the WHO Global Health Observatory provide?

Global health statistics and indicators.

What is comparative health systems and policy research?

Research comparing how countries organize, finance, and deliver healthcare.

What four areas can comparative health research assess?

Health outcomes, equity, efficiency, and quality of care.

What is cross-country learning?

Countries learn from other countries' successes, failures, and policies.

What are health system typologies?

Classifications of health systems based on their structures, characteristics, or functions.

What defines the Beveridge model?

Mainly tax-funded healthcare; government is the primary provider. Example: UK.

What defines the Bismarck model?

Insurance-based funding, often involving employers and employees. Example: Germany.

What defines the National Health Insurance model?

A single-payer national insurance program with public or private providers. Example: Canada.

What defines the Out-of-Pocket model?

Individuals pay directly for care; comprehensive coverage may be limited. Example: US.

Centralized vs. decentralized governance?

Centralized: national control. Decentralized: regional or local governments have more autonomy.

What are the three service delivery models?

Public provision, private provision, and mixed provision.

What are the three healthcare coverage models?

Universal, selective, and limited coverage.

What is universal healthcare coverage?

Everyone in the covered population has access to healthcare services.

What was the goal of the Mirror, Mirror 2021 report?

Compare healthcare performance across 11 high-income countries.

Which three countries ranked highest overall in Mirror, Mirror 2021?

Norway (1st), Netherlands (2nd), and Australia (3rd).

What was Canada's overall rank in Mirror, Mirror 2021?

10th out of 11 countries.

What was the US overall rank in Mirror, Mirror 2021?

11th out of 11, despite spending the most.

What were Canada's care process, equity, and outcome ranks?

Care process: 4th; equity: 10th; health outcomes: 10th.

How much of GDP did the US spend on healthcare in 2019?

16.8% of GDP, the highest among the countries compared.

How much of GDP did Canada spend on healthcare in 2019?

10.8% of GDP.

What four lessons came from top-performing healthcare systems?

Universal coverage, strong primary care, less administration, and investment in social services.

What is Australia's healthcare system?

Universal public health insurance called Medicare, funded through taxation and a Medicare levy.

How is healthcare delivered in Australia?

Through public and private providers, with many Australians also holding private insurance.

What type of healthcare model does Australia use?

A hybrid Beveridge–Bismarck model with universal coverage and mixed public-private delivery.

What is the Pharmaceutical Benefits Scheme (PBS)?

An Australian program that subsidizes many prescription medications.

Why might Australia's healthcare system perform well?

Coordination of care and prescription drug subsidies may contribute to better performance.

Does private insurance alone explain Australia's healthcare performance?

No. Coordination, public coverage, and programs such as the PBS also matter.

Does the United States have universal health insurance?

No. Coverage comes from a mix of employer insurance, private insurance, Medicare, Medicaid, the VA, and out-of-pocket payments.

Why does healthcare access vary in the United States?

It depends on factors such as income, employment, age, state, and immigration status.

What are key problems with the US healthcare system?

High administrative costs, fragmented insurance, unequal access, and relatively low social spending.

How does Ontario's health insurance differ from the US system?

Ontario has OHIP, a main provincial public insurance plan for eligible residents.

What is Taiwan's National Health Insurance (NHI) system?

A universal, mandatory, single-payer health insurance system introduced in 1995.

How is Taiwan's NHI funded?

Through insurance premiums, including payroll-based contributions, and government subsidies.

How is healthcare delivered in Taiwan?

Through a mix of public and private providers.

What services does Taiwan's NHI cover?

Services include physician care, hospital care, dental care, pharmaceuticals, and traditional Chinese medicine.

What are some strengths of Taiwan's healthcare system?

Universal coverage, relatively low overall spending, and relatively short waits according to the lecture.

What are potential problems with Taiwan's NHI system?

Out-of-pocket payments can create financial barriers and inequities.

How does Taiwan's healthcare spending compare with Canada's in the lecture?

Taiwan spent about 7.3% of GDP, compared with Canada's 11.2%.

How does Taiwan's out-of-pocket healthcare spending compare with Canada's in the lecture?

Taiwan: 38.8%; Canada: 15.2%.

What is a two-tiered healthcare system?

A system with public healthcare for everyone and a private stream for those who can afford it.

What is one argument in favour of two-tiered healthcare?

Private healthcare could give patients another option and potentially reduce wait times.

Why might private healthcare fail to reduce public wait times?

Healthcare workers may move from the public system to private clinics, reducing public capacity.

What is "creaming off" in healthcare?

Private providers treat simpler, cheaper cases, leaving complex and costly cases to the public system.

How can two-tiered healthcare increase inequality?

Wealthier people gain greater access to faster private services, while others rely on the public system.

What is an upstream intervention in healthcare?

An intervention that addresses the underlying social and economic causes of poor health.

What are social determinants of health?

The social and economic conditions in which people are born, grow, live, work, and age.

What is an example of an upstream intervention?

Universal Basic Income (UBI), which could help address poverty and financial insecurity.

How could Universal Basic Income improve health?

By reducing financial stress and improving access to basic needs, potentially improving health and reducing healthcare use.