Health Systems and Economics

What is Universal Health Coverage?

The ability of people to see a doctor for preventative care or when they are sick, and to pay for the care they receive.

What organizations are urging countries to achieve Universal Health Coverage by 2030?

The United Nations, World Health Organization, and World Bank.

What are the four systems of health care?

1) Universal coverage with single-payer system 2) Universal coverage with multi-payer system 3) Multi-payer system with no universal coverage 4) No national healthcare infrastructure.

What characterizes a Universal Coverage with Single-Payer System?

National healthcare is fully funded by the government; hospitals are publicly run.

What is one con of the Universal Coverage with Single-Payer System?

Doctors may prescribe medication without thorough diagnostics.

What is the coverage cost limit set by the law for medication in the UK?

No person can pay more than seven dollars for medication.

Universal Coverage

Funded by the government; hospitals are publicly run.

Which countries have a Universal Coverage with Multi-Payer System?

France, Germany, Japan.

In a Multi-Payer System with No Universal Coverage, what is a pro?

Advanced medical technology.

What is a con of a Multi-Payer System with No Universal Coverage?

Higher costs and no guarantee of coverage.

What are some insurance options available in the U.S.?

1) Private insurance through employer 2) Medicare 3) Medicaid 4) Veterans Health Administration.

What does 'In-Network' mean?

Providers that have a contract with the plan to provide care at a negotiated rate, resulting in lower consumer costs.

What is a Health Maintenance Organization (HMO)?

A plan that is secure but expensive, focuses on prevention and wellness, and does not cover out-of-network care.

What does a Health Maintenance Organization (HMO) mean?

A plan that is secure but expensive, focuses on prevention and wellness, and does not cover out-of-network care.

What characterizes a Preferred Provider Organization (PPO)?

It offers freedom but is risky, allowing both in-network and out-of-network providers without referrals for additional costs.

What is a premium in health insurance?

The amount the consumer regularly pays for the insurance regardless of usage.

What does 'cost sharing' refer to?

The amount the consumer pays versus how much the insurance covers, including deductibles, copays, and coinsurance.

What is a deductible?

The amount the consumer must pay out-of-pocket for services before the insurance plan starts to cover.

What is an Explanation of Benefits (EOB)?

Not a bill; it is a breakdown of healthcare costs showing how much insurance covers and what the consumer is responsible for.

What does 'allowed amount' mean?

The maximum amount a plan will pay for a service.

What might happen if a consumer goes out-of-network in a PPO?

The insurance may pay a certain amount and then require the consumer to cover the remaining cost.

What are the main types of health insurance plans?

The main types include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point of Service (POS) plans