Health systems
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Health systems - Marcador
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Health systems - Detalles
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| What are the three main models of healthcare insurance? | Voluntary Health Insurance (VHI): Optional, private, often supplements public insurance. Social Health Insurance (SHI): Mandatory contributions through payroll taxes; tied to employment. National Health Insurance (NHI): Government-funded, universal coverage through taxation. |
| What are the key challenges of Voluntary Health Insurance (VHI)? | Limited access for low-income populations, inequity, and high administrative costs. |
| What is the primary advantage of National Health Insurance (NHI)? | Provides universal coverage and minimizes out-of-pocket expenses. |
| What is the funding difference between the Bismarck and Beveridge models? | Bismarck: Funded by employer and employee contributions. Beveridge: Funded entirely through general taxation. |
| What is the focus of the Beveridge model? | Equity and access to free healthcare at the point of use. |
| What are the three main payment methods for doctors? | Fee-for-Service: Payment based on quantity and type of services. Capitation: Fixed payment per patient, regardless of services used. Salary: Fixed amount for a pre-agreed working schedule. |
| What is a major weakness of Fee-for-Service payment? | Risk of overutilization and focus on quantity over quality. |
| What are the seven financing models in healthcare? | Direct Market Model Voluntary Insurance Social Health Insurance (SHI) Targeted Programs Mandatory Residence Insurance (MRI) Universalist Model Medical Savings Accounts (MSAs) |
| What is the key benefit of Social Health Insurance (SHI)? | Promotes equity through income-related contributions and risk pooling. |
| What is "risk selection" or "cherry-picking"? | Insurers attracting low-risk individuals while deterring high-risk applicants. |
| What is "open enrollment"? | A requirement that insurers accept all applicants without rejecting coverage. |
| What is gatekeeping in healthcare? | General Practitioners (GPs) regulate access to specialists and ensure appropriate care. |
| What is the difference between vertical and horizontal integration in healthcare? | Vertical Integration: Combines different levels of care (e.g., hospitals acquiring primary care clinics). Horizontal Integration: Merges providers at the same level of care (e.g., hospitals merging with other hospitals). |
| What are the five major trends in healthcare reforms? | Increased competition. Greater integration of financing and services. Decentralization. Strengthened patient rights and choice. Broader insurance coverage. |
| What healthcare reform introduced mandatory insurance for all residents in the Netherlands? | The 2006 Mandatory Residence Insurance (MRI) reform. |
| What is the "0-7-90-90" rule in Sweden? | The "0-7-90-90" rule focuses on relationship building: respond within 0 days, follow up in 7 days, reconnect every 90 days, and keep interactions to 90 seconds. Ensures instant contact, timely GP visits, specialist consultations, and treatment within set timeframes Patients unable to receive timely care were offered alternatives in other countries or private facilities. |
| How did France address universal coverage in 1996-1999? | Introduced the Juppé Plan, shifting financing to income-based taxes and using the "carnet de santé." |
| What are the six type of roles the state can have in healthcare systems? | Laissez-Faire: Minimal intervention. Stimulator: Incentives/disincentives in the market. Regulator: Ensures quality and affordability. Protective Role: Covers vulnerable populations. Financier: Funds healthcare through taxes. Producer: State directly owns and operates healthcare facilities. |
| How do cultural values shape the structure and priorities of healthcare systems? | Communitarian Cultures (e.g., Germany, Japan): These cultures value collective well-being and social responsibility, leading to Social Health Insurance (SHI) systems where funding comes from shared contributions and everyone is ensured access to healthcare. Egalitarian Cultures (e.g., UK, Sweden): These cultures prioritize equality and universal access, favoring National Health Services (NHS) that are publicly funded to provide healthcare to all as a right. Individualistic Cultures (e.g., U.S.): With a focus on personal choice and responsibility, these cultures often rely on Voluntary Health Insurance (VHI), where individuals purchase insurance privately, reflecting a market-driven approach to healthcare. |
| Why are doctors often resistant to NHI models? | NHI limits physician autonomy and earnings, while doctors prefer the independence of SHI or VHI system |
| How do interest groups influence healthcare policy? | Groups like insurers, pharmaceutical companies, and doctors lobby to shape policies, often blocking reforms. |
| What is the Direct Market Model in healthcare financing? | Patients pay providers directly, with no insurance or risk pooling, leading to full out-of-pocket expenses. |
| What is Voluntary Health Insurance (VHI)? | Insurance purchased voluntarily, often private, used to supplement public coverage or cover excluded services. |
| What is Social Health Insurance (SHI)? | A mandatory system funded through payroll taxes, tied to employment, often managed by sickness funds. |
| What is Mandatory Residence Insurance (MRI)? | Compulsory insurance for all residents, provided through regulated private insurers (e.g., Netherlands, Switzerland). Not income-based but relies on flat premiums with income-based subsidies for low earners |
| What is the Universalist Model? | A government-run single-payer system, funded by general taxes, ensuring universal healthcare for all citizens. |
| What are Medical Savings Accounts (MSAs)? | : Individual accounts funded through mandatory or voluntary savings, used to pay for healthcare expenses |
| What is the key difference between SHI and MRI? | SHI is tied to employment and funded through payroll contributions, while MRI is universal and not tied to employment. |
| How does the Beveridge Model differ from the Bismarck Model? | Beveridge: Funded through taxes, universal coverage, public providers. Bismarck: Funded by employer/employee contributions, near-universal coverage, private providers. |
| What distinguishes VHI from Universalist systems? | VHI is optional and private, often leaving gaps in equity, while Universalist systems are compulsory and government-funded for all. |
| What is a major challenge of the Direct Market Model? | High out-of-pocket costs exclude low-income individuals and discourage access to necessary care. |
| What are the challenges of SHI systems? | Coverage gaps for unemployed/informal workers, administrative complexity, and variability in benefits. |
| Why is the Universalist Model prone to underfunding? | It depends heavily on efficient tax collection and budget allocations, which can face constraints. |
| What are the weaknesses of MSAs? | Limited risk pooling, insufficient funds for catastrophic expenses, and high reliance on financial literacy. |
| What were the five major trends in global healthcare reforms? | Stimulating competition in healthcare. Promoting integration in financing and service delivery. Decentralizing healthcare decision-making. Strengthening patient rights and freedom of choice. Expanding insurance coverage for equity. |
| What were the main features of the 2006 Dutch healthcare reform? | Introduced Mandatory Residence Insurance (MRI), promoted competition among private insurers, and implemented community-rated premiums with risk adjustment. |
| What was the goal of Sweden's "0-7-90-90" rule in 2005? | To reduce waiting times by ensuring instant contact, timely GP visits, specialist consultations, and treatment. |
| How did France achieve universal coverage in 1996-1999? | The Juppé Plan shifted financing to income-based taxes, introduced the "carnet de santé," and targeted excluded populations. |
| What were the key reforms introduced under the 2010 Affordable Care Act (ACA) in the U.S.? | Medicaid expansion. Insurance mandates with penalties (later repealed). Creation of insurance marketplaces. Protections for pre-existing conditions. Coverage for young adults up to age 26. |
| What are the main challenges faced by SHI systems like Germany's? | Rising costs, managing multiple sickness funds, and ensuring equity in private insurance premiums. |
| Why is gatekeeping both an advantage and a challenge? | Advantage: Improves coordination and ensures appropriate care. Challenge: Limits patient choice and can cause delays in specialist access. |
| What are the main equity concerns in VHI systems? | Only those who can afford premiums benefit, leading to significant disparities in access and coverage. |
| How do interest groups challenge healthcare reforms? | Groups like doctors, insurers, and pharma lobby against changes that limit autonomy, reduce profits, or increase regulation. |
| What are the key features of the NHS/ Uk national health insurance? | Universal coverage, free at the point of use. Government ownership of most hospitals. Prescription co-payments with exemptions for vulnerable groups. |
| What are Germany’s key healthcare features? | Coverage through nonprofit, non-governmental sickness funds: private substitutive insurance is an option for high-income earners and self-employed individuals. Freedom to choose providers. Risk adjustment to ensure equity among sickness funds. |
| What challenges does Germany face in its SHI system? | Administrative complexity, rising costs, and disparities in private insurance premiums. |
| What major reform did the Netherlands implement in 2006? | Mandatory Residence Insurance (MRI), requiring all residents to purchase private insurance. |
| What are the key features of the Dutch healthcare system? | Baseds on Mandatory Residence Insurance (MRI) introduced in 2006, replacing the prior dual SHI-private system. • Healthcare is segmented into three tiers: 1. Exceptional care (long-term care): Covered by a public insurance scheme (WLZ) 2. Essential care (primary and hospital care): Covered by mandatory private insurance with government-defined benefits. 3. Complementary care (dental care for adults): Covered by voluntary private insurance. Private nonprofit insurers complete to offer the mandatory package under strict regulation, including community rating and risk adjustment. Patients pay flat premiums, which are not income-based, but low-income earners receive income-based subsidies to ensure affordability. |
| What challenges does the Dutch system face? | Balancing competition with equity and managing high premiums and co-payments. |
| What is unique about the U.S. healthcare system? | It combines private insurance (mostly employer-sponsored) and public programs (Medicare, Medicaid, CHIP). |
| What is the key features of France’s healthcare system? | Has dual financing system with: Social Health Insurance (SHI): Workers and their dependents are covered through mandatory contributions to sickness funds, with additional targeted programs for nonworkers + Complementary Private Insurance: Covers out-of-pocket costs or services not included in the SHI scheme. Widely used (90% of the population has it) Healthcare services are delivered by private providers, reimbursed by nonprofit sickness funds. Patients enjoy freedom of choice for providers, such as doctors and hospital |
| How is healthcare delivered in Italy? | Through the National Health Service (SSN), funded by general taxation and decentralized to regions. |
| What are the key features of U.S. healthcare? | No universal coverage; 8% remain uninsured. Public programs cover specific groups (e.g., seniors, low-income). ACA reforms expanded Medicaid and introduced insurance marketplaces. |
| What are the key features of France’s healthcare system? | Universal coverage achieved through targeted programs (CMU), provided health insurance to individuals who were not covered by the standard French social security system due to unemployment, lack of work history, or other reasons. Patients enjoy provider choice. High reliance on co-insurance (20-30% of costs). |
| What are the key features of Italy’s SSN? | Universal coverage. Regional management leads to variations in quality. GPs act as gatekeepers. |
| What challenges does Italy’s system face? | Regional disparities, rising costs, and a growing reliance on private care. |
| What makes Switzerland’s healthcare system unique? | It combines universal coverage with competition among private insurers under Mandatory Residence Insurance (MRI). Insurance is divided into three groups: basic health insurance, mandatory accident insurance and complementary insurance |
| What are the key features of Swiss healthcare? | Universal Coverage: Standardized Benefits: Insurers provide identical basic care packages defined by the government. Insurance Types: * Basic Insurance, Accident Insurance and Complementary Insurance Community Rating: Premiums are equal within demographic groups, regardless of health status. Cost Sharing: Annual deductibles (CHF 300–2,500) with 10% co-insurance above the deductible, capped at CHF 700 annually. Out-of-pocket costs make up 23% of total health expenditure. Subsidies: Income-based subsidies for ~30% of residents to help with premiums. Providers: Healthcare is delivered by a mix of public and private providers; no gatekeeping |
| What are Switzerland’s main challenges? | High premiums and costs, heavy reliance on out-of-pocket payments, and administrative complexity. |
| How does Singapore’s system work? | Individuals save 8-10% of their salary in personal accounts to pay for healthcare expense. The funds are used for specific healthcare expenses, such as hospitalization, day surgeries, outpatient procedures and long-term care. Medisave can be used for the account holder or immediate family Medishield Life, is a universal mandatory health insurance covering catastrophic healthcare costs. It is funded by annual premium Medifund is a government-fiannced safety net program designed to assist the poor in meeting healthcare costs not covered by Medisave or Medshield Life |
| What challenges does Singapore’s system face? | Limited risk pooling, rising costs, and high out-of-pocket spending. |
| What are Singapore’s key healthcare features? | Medisave for routine expenses. Medishield Life for catastrophic coverage. Medifund for the indigent. |
| Which country introduced competition with fund-holding GPs in 1990? | The UK, under Thatcher’s government. |
| What were the main goals of global healthcare reforms in the 80s and 90s? | Extend insurance coverage. Increase competition. Promote integration of services. Strengthen patient rights. Decentralize decision-making. |
| What healthcare reforms did Germany introduce in 2007? | Mandatory insurance, standardized SHI contribution rates, and competition among sickness funds. |
| What reforms were introduced by the ACA in the U.S. in 2010? | Medicaid expansion, insurance marketplaces, and protections for pre-existing conditions. |
| What was the impact of the 1990 healthcare reform in the UK under Thatcher? | Introduced an internal market, separating suppliers and purchasers. Increased efficiency through competition among hospitals and fund-holding GPs. Gave local health authorities budgets for purchasing services. |
| What was the impact of the 2001-2005 reforms in the UK under Blair? | Strengthened patient rights by introducing provider choice. Implemented a star rating system for transparency. Marked a shift towards a more patient-centric healthcare approach. |
| What was the impact of the 2006 healthcare reform in the Netherlands? | Ensured universal coverage with mandatory private insurance. Increased competition among insurers, driving efficiency and innovation. Risk-adjusted redistribution promoted equity, but high premiums remained a challenge. |
| What was the impact of the 2005 "0-7-90-90" reform in Sweden? | Improved patient experience by reducing waiting times. Ensured timely access to GPs, specialists, and treatment. Enhanced focus on patient satisfaction and system responsiveness. |
| What was the impact of the 1996-1999 Juppé Plan in France? | Achieved near-universal coverage through targeted programs. Shifted financing from payroll contributions to income-based taxes. Introduced the "carnet de santé" for better information management( personal health record booklet for each individual/journal) and assigned family doctors as gatekeeps for secondary care |
| What was the impact of the 2007 healthcare reform in Germany? | Established universal insurance obligation, ensuring comprehensive coverage. Standardized SHI contribution rates for fairness and simplicity. Promoted competition among sickness funds, improving efficiency and choice. |
| What was the impact of the 1999 healthcare reform in South Korea? | Consolidated over 350 insurance societies into a single-payer system. Streamlined administration and ensured uniform contribution rates and benefits. Reduced fragmentation, creating a more equitable system. |
| What was the impact of the 2010 Affordable Care Act (ACA) in the U.S.? | Reduced the uninsured rate from 13.3% to 8%. Expanded Medicaid and made insurance more accessible through marketplaces. Improved access to preventive care and standardized essential health benefits. |
| What was the impact of the 1992-1993 decentralization reform in Italy? | Transferred healthcare management to regions, increasing local accountability. Allowed regions to tailor services but led to significant regional disparities in quality and access. |
| What was the impact of the 1996 introduction of Mandatory Residence Insurance (MRI) in Switzerland? | Achieved universal coverage with competitive private insurers. Balanced equity with efficiency through community-rated premiums and subsidies. High healthcare costs and premiums remain challenges. |
| What was the impact of the introduction of Medisave in Singapore in 1984? | Encouraged personal responsibility for healthcare spending. Reduced reliance on public funding by promoting individual savings. High out-of-pocket costs and limited risk pooling remain concerns. |
| What are some strengths of Canada’s healthcare system? | Universal access, equity through progressive taxation, low administrative costs, and high standards for core medical services. |
| What challenges does Canada’s healthcare system face? | Long wait times for specialist care, gaps in coverage for dental and vision services, regional disparities, and sustainability concerns due to rising costs. |
| What is the role of provinces and territories in Canada’s healthcare system? | Provinces and territories are responsible for administering Medicare, planning health services, and managing their own insurance plans with partial federal funding. |
| What type of healthcare model does Canada follow? | Canada follows the National Health Insurance (NHI) model, combining public funding with private delivery of services. |
| What were the advantages and disadvantages of the UK’s 1990 healthcare reform introducing the internal market and fund-holding GPs? | Advantages: Increased efficiency through competition among providers. Enhanced accountability by separating suppliers and purchasers, enabling "money follows the patient." Greater autonomy for hospitals, which became independent trusts. Disadvantages: Increased administrative complexity due to the fragmentation of responsibilities. Unequal implementation led to regional disparities in service quality. |
| What were the advantages and disadvantages of the UK’s 2001-2005 reform emphasizing patient rights, choice, and the star rating system? | Advantages: Strengthened patient rights and provided more choices for care, including access to private hospitals. The star rating system improved transparency, allowing patients to make informed decisions. Encouraged providers to improve quality of care to achieve higher ratings. Disadvantages: Persistent regional disparities in access and quality. High administrative costs for maintaining transparency and managing performance assessments. |
| What were the advantages and disadvantages of the Netherlands’ 2006 reform introducing mandatory health insurance and risk-adjusted redistribution? | Advantages: Ensured universal coverage by requiring all residents to purchase insurance. Risk-adjusted redistribution and community-rated premiums reduced the risk of inequities. Encouraged competition among insurers, promoting efficiency and innovation. Disadvantages: High premiums and out-of-pocket costs placed a burden on low-income households. Complex administrative systems for risk adjustment and redistribution increased bureaucratic costs. |
| What were the advantages and disadvantages of Sweden’s 2005 reform implementing the "0-7-90-90" waiting time guarantee? | Advantages: Reduced waiting times for consultations and treatments, improving patient satisfaction. Ensured access to timely care, even allowing treatment in other regions or private facilities if local services were unavailable. Disadvantages: Heavy reliance on private providers for backup care increased costs. Added pressure on county councils to meet guarantees, creating disparities in performance across regions. |
| What were the advantages and disadvantages of France’s 1996-1999 reforms introducing Universal Health Coverage and the carnet de santé? | Advantages: Universal Health Coverage expanded access to all residents, reducing health inequities. The carnet de santé improved coordination of care and avoided redundant or contradictory prescriptions. Introduced gatekeeping by family doctors, optimizing resource use for secondary care. Disadvantages: Increased tax burdens to fund expanded coverage. Administrative complexity in managing new tools and coverage mechanisms. |
| What were the advantages and disadvantages of Germany’s 2007 reform mandating universal insurance and standardizing SHI contributions? | Advantages: Achieved universal coverage for all residents, improving equity. Standardized SHI contributions ensured more fair distribution of resources across sickness funds. Promoted competition among sickness funds, increasing efficiency and patient satisfaction. Disadvantages: Rising healthcare costs continued to strain the system. The persistence of numerous sickness funds increased administrative complexity and operational inefficiencies. |
| What were the advantages and disadvantages of Spain’s 2002 healthcare reform transferring full healthcare competencies to 10 additional autonomous communities? | Advantages: Allowed regional governments to tailor healthcare policies to local needs, improving responsiveness and flexibility. Encouraged innovation at the regional level to address specific healthcare challenges. Disadvantages: Created regional disparities in healthcare quality and access due to unequal administrative and financial capacity among communities. Coordination between national and regional systems became more complex, leading to inefficiencies. |
| What are the key features of a separeted model and a intergrated model and can you say examples of models with the models? | Separated model: Actors enjoy a high degree of autonomy, pluralism(more authorities), contractual relation and ample freedom of choice. Example: SHI, MRI, universalist(australia and canada) Integrated model: Actors belong to the same organization, stable and biunique relationship(one leader assigned to a specific task), hierachy and limited freedom of choice. Example: Universalist(sweden, canada, finland, uk) |
| What are the key differences between the separated and integrated models of healthcare in terms of: 1. Vertical integration 2. Horizontal integration 3. Gatekeeping 4. Patient choice 5. GP practices? | Separated Model: 1. Vertical Integration: Insurers and providers belong to the same organization. 2. Horizontal Integration: GPs and specialists belong to the same organization. 3. Gatekeeping: Mandatory. 4. Patient Choice: Limited to contracted providers. 5. GPs: Group practice. Integrated Model: 1. Vertical Integration: Insurers and providers are independent entities. 2. Horizontal Integration: Primary and secondary care is provided by separate entities. 3. Gatekeeping: Discretionary. 4. Patient Choice: Choice among all providers. 5. GPs: Solo practice. |
| What is the difference between vertical and horizontal intergration | Vertical: Intergrating different levels of care delivery. Goal is coordinated care and cost reduction across the care continuum. Impact on patients is improved continuity of care Horizontal: Consolidating similar healthcare providers at the same level. Goal is to expand market share and achieving economies of scale. Impact on patients is potentially greater acess to care and specialized services |
| What is the difference between National Health Insurance, National Health Services and Universalist model? | The answer is on picture |
| What are the key features of Sweden’s healthcare system? . | Sweden operates under a National Health Service (NHS) model, funded through general taxation collected by municipalities and county councils. Healthcare is decentralized, with 21 regional councils managing delivery and local municipalities handling elder care. General Practitioners (GPs) act as gatekeepers to specialist and hospital care. Public providers dominate, but private providers can deliver publicly funded care. Patients have freedom of choice in selecting primary care providers and can access specialists via referrals. |
| What are the main strengths and challenges of Sweden’s healthcare system? | Strengths: * Universal access ensures equity and solidarity. * Decentralized governance allows services to be tailored to local needs. * Strong cost control through tax-funded financing. * Patient guarantees (e.g., 0-7-90-90 rule) reduce waiting times and improve satisfaction. Challenges: * Regional differences in service quality and waiting times. * Rising costs of elder care and healthcare due to an aging population. * Growing demand for specialist care puts pressure on primary care coordination. |
| How has Sweden’s healthcare system evolved historically? | 1953: Sweden implemented a universal healthcare system funded through taxation. 1970s: Decentralization reforms gave regional councils responsibility for healthcare delivery. 1990s: Privatization reforms allowed private providers to compete for public contracts. 2005: Sweden introduced the 0-7-90-90 guarantee to reduce waiting times for GPs, specialists, and treatment. |