US and Internation Healthcare Systems

How much does the US spend on Healthcare per person?

Around 13,000 to 14,000

What are the factors Quality of Healthcare is based on?

• Care Process

• Access

• Administrative Efficiency

• Equity

• Healthcare Outcomes

What is the United States average life expectancy compared to other countries?

#48 with an average of 79.61 years

How does health spending in the US compare to other countriess?

The US spends about 2x as much per person on healthcare compared to other wealthy countries

What are some characteristics of healthcare in the US?

• Fragmented System - Not straight forward and highly individualized

  • Sometimes you have no insurance and other times you have 2

  • Different policies, laws, and guidelines

What are some of the ways to get insurance in the US?

• Age

• Income

• Disease state

• Residence

• Pregnancy status (Medicaid eligibility is different for pregnant women compared to men and non-pregnant women)

• Family structure

What is National Health Insurance (NHI)?

• A system of health insurance that insures a national population against the costs of health care.

• The government participates in or enforces participation in the country’s healthcare scheme (Universal Healthcare)

• The government administers the health insurance for the country. The healthcare system stays the same, but the financing changes.

Who is eligible for National Health Insurance (NHI)?

Citizens and permanent residents

An example country that uses NHI

Canada

What is Socialized Medicine or National Health Services (NHS)?

• The government participates in the country’s healthcare scheme

• The government employs healthcare practitioners, own healthcare facilities, and administers the healthcare systems

• The public system dominates healthcare provision, private health care and complementary treatments are available for those willing to pay

Who is eligible for NHS?

Citizens and permanent residents

Example NHS country

England

What is SSI Healthcare?

• Universal healthcare administered by the government

• Most services are covered free of charge

• Private (non-governmental) healthcare is available for non-essential services That are not covered by the government health insurance

What are limitations to SSI health care?

• Dental care

• Copayments for Rx drugs

Who is eligible for SSI?

Citizens and residents with Social Security Institution

Example country using SSI healthcare

Turkey

What is Decentralized National Health Programs - statutory health insurance

• Healthcare that is financed through government mandated contributions by employers and employees

• Healthcare is delivered by the private sector

• Not for profit companies collect the funds and distribute to hospitals and physicians

Examples companies using decentralized national health programs

• Germany

• Japan

What is Socialist Medicine?

• Health care system is under complete control of a socialist/communist government which allows very little choice

Example countries using socialist medicine

• China

• Russia

• Cuba

What type of healthcare does the US use?

• Pluralistic

When did Canada adopt their healthcare system?

• 1957 with the Hospital Insurance and Diagnostic Service Act

  • Provided inpatient hospital care insurance for all Canadians

  • 50% from the central government and 50% from the province

What are the 5 principles of Canada’s Medical Care Act of 1966?

• Portability of benefits between provinces

  • Higher spending provinces received more federal money, but that represented a lower proportion of their expenditures

• Comprehensive (hospital and physician)

• Universal (all citizens are equal)

• Accessibility (access is assured)

• Public administration (public organization accountable to the provincial government to run the plan

What is the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act of 1977?

• Federal government no longer paying 50% of medical insurance coverage

  • Tax transferred to provinces

• Larger cost burden on provincies

• Physicians began to balance bill patients

What is The Canada Health Act of 1984?

• It combined previous health laws and outlawed balanced billing

  • Led to universal coverage of all insured services

What services were provided after the Canada Health Act of 1984?

• Hospital services

• Physician services

• Surgical-dental services

What are advantages of Canada’s NHI?

• Each province develops its own plan as long as it meetrs the requirements set by the federal government

• Every Canadian has access

• Costs less than US

• Health status of Canadians has improved

  • Increased longevity, decreased infant mortality

• Improved MD distribution

• NHI is popular with Canadians

What are disadvantages of Canada’s NHI?

• Hospitals work on a budget that cannot be exceeded

• Hospitals run at capacity and there is a waiting list for non-emergency care

• Physicians are paid based on a list of fee for services set by province/feds negotiated by medical association. There is no limit on physician services or demand for care

• Many services are not convered

What is covered under Canada’s NHI?

• Physician care

• Inpatient hospital care including room/meals, nursing services, diagnostic procedures, medications

• Private insurance is available to cover vision, dental, cosmetic surgeries, and outpatient medications

What does The Patented Medicine Prices Review Board (PMPRB) do?

• Regulates drug prices in Canada

• May withdraw a patent on a drug that is priced too high

• May withdraw a patent on one other drug in the manufacturer’s line as a penalty

• Results in LOW Rx prices

What incentives to Canadian drug manufacturers have?

• They have no incentives

• Some have moved to countries like the US to develop new drugs

What did the National Health Services Act of 1946 do in the UK?

• Universal comprehensive service

• Financing through general taxation

• Nationalization of the nation’s hospitals

How is the NHS funded?

Publicly

• Primary Care Trusts (PCTs) - Contracts to groups of providers responsible for patient care, not completely unlike US ACOs

• Primary Care Pharmacists - Hybrid between community and hospital pharmacists; They work within PCTs in a clinical and administrative role, providing care and med reviews while managing budgets

What were some initial problems with NHS?

• It did not decrease healthcare costs

• Physicians did not want to practice in nationalized hospitals

• Private insurance made a comeback

What is the current structure of NHS?

• Reforms of the 1990s

• NHS is now under a National Health Service Executive (NHSE)

  • 8 regional offices responsible for roughly 80 health authorities

  • These control Family Health Service Authorities who provide management over primary care

How are specialists paid?

• Hospital based physicians (specialists) are salaried

• Senior medical staff members are permitted some private practice (up to 10% of their gross income)

Advantages of NHS

• Increase in healthcare costs is less than US

• Better distribution of physicians and healthcare resources

• Health status of British has improved

• NHS is popular with British people

Disadvantages of the NHS

• Long waiting time for nonemergency care

• Less technology used

• Salaries are low for healthcare professionals

• Little consumer input

• NHS is subject to political change

Pharmacy in the UK

• UK is the 5th largest producer of medication in the world (GSK)

• Prescriptions drugs are covered under NHS via a formulary, prescribing is closely monitored

• 70% of Rxs are generic

• Prices are negotiated by NHS and manufacturers