Podcast
Questions and Answers
Match the countries with their type of practice:
Match the countries with their type of practice:
Australia = Solo practice France = Highly separated systems Finland = Group practice Germany = Separated systems
Match the integration index with the corresponding country:
Match the integration index with the corresponding country:
5 = Portugal 4.5 = New Zealand 3.5 = Israel 2 = Australia
Match the country with their financing type:
Match the country with their financing type:
Norway = Universalist Austria = Separated Japan = Separated Denmark = Integrated
Match the provided systems with their countries:
Match the provided systems with their countries:
Match the following countries with their health service classification:
Match the following countries with their health service classification:
Match the following countries with their healthcare insurance coverage percentage:
Match the following countries with their healthcare insurance coverage percentage:
Match the following healthcare programs with their primary beneficiaries:
Match the following healthcare programs with their primary beneficiaries:
Match the following healthcare coverage types with their funding sources:
Match the following healthcare coverage types with their funding sources:
Match the following health insurance characteristics with their definitions:
Match the following health insurance characteristics with their definitions:
Match the following countries with their healthcare insurance coverage status:
Match the following countries with their healthcare insurance coverage status:
Match the following terms related to healthcare finance with their descriptions:
Match the following terms related to healthcare finance with their descriptions:
Match the following healthcare percentages with their corresponding countries:
Match the following healthcare percentages with their corresponding countries:
Match the following percentages with the respective Medicare coverage statistics:
Match the following percentages with the respective Medicare coverage statistics:
Match the following provisions of the PPACA with their descriptions:
Match the following provisions of the PPACA with their descriptions:
Match the following penalties and exemptions under the PPACA:
Match the following penalties and exemptions under the PPACA:
Match the following features of insurance regulations under the PPACA:
Match the following features of insurance regulations under the PPACA:
Match the following healthcare systems to their characteristics:
Match the following healthcare systems to their characteristics:
Match the following years to their significant PPACA events:
Match the following years to their significant PPACA events:
Match the following aspects of Medicare restructuring:
Match the following aspects of Medicare restructuring:
Match the following statistics regarding Medicaid expansion:
Match the following statistics regarding Medicaid expansion:
Match the following terms with their meaning in the context of healthcare:
Match the following terms with their meaning in the context of healthcare:
Match the type of payment system with the corresponding country:
Match the type of payment system with the corresponding country:
Match the country with its payment method for primary care physicians:
Match the country with its payment method for primary care physicians:
Match the country with its payment method for hospital doctors:
Match the country with its payment method for hospital doctors:
Match the payment type with its characteristics:
Match the payment type with its characteristics:
Match the healthcare programs with their descriptions:
Match the healthcare programs with their descriptions:
Match the country with the type of health service system used:
Match the country with the type of health service system used:
Match the healthcare segmentation principles with their definitions:
Match the healthcare segmentation principles with their definitions:
Match the healthcare payment model with its definition:
Match the healthcare payment model with its definition:
Match the following countries with their primary care physician payment types:
Match the following countries with their primary care physician payment types:
Match the U.S. public programs with their target groups:
Match the U.S. public programs with their target groups:
Match the country with its healthcare remuneration:
Match the country with its healthcare remuneration:
Match the healthcare sectors in the Netherlands with their focus areas:
Match the healthcare sectors in the Netherlands with their focus areas:
Match the healthcare terms with their meanings:
Match the healthcare terms with their meanings:
Match the demographic factors influencing segmentation with their descriptions:
Match the demographic factors influencing segmentation with their descriptions:
Match the terms related to health insurance with their explanations:
Match the terms related to health insurance with their explanations:
Match the characteristics of hybrid healthcare systems with their significance:
Match the characteristics of hybrid healthcare systems with their significance:
Match the health care features in Switzerland with their descriptions:
Match the health care features in Switzerland with their descriptions:
Match the payment methods for physicians with their descriptions:
Match the payment methods for physicians with their descriptions:
Match the advantages and disadvantages of Fee-for-service (FFS) with the relevant statements:
Match the advantages and disadvantages of Fee-for-service (FFS) with the relevant statements:
Match the characteristics of Capitation with their effects:
Match the characteristics of Capitation with their effects:
Match the types of health care coverage with their features:
Match the types of health care coverage with their features:
Match the impact of physician payment methods with their results:
Match the impact of physician payment methods with their results:
Match the payment method with its main advantage and disadvantage:
Match the payment method with its main advantage and disadvantage:
Match the terms related to Swiss health care with their definitions:
Match the terms related to Swiss health care with their definitions:
Flashcards
Hybrid healthcare system
Hybrid healthcare system
A system for organizing and financing healthcare that uses a combination of different models, such as private insurance, government programs, and direct payment.
Segmentation of healthcare services
Segmentation of healthcare services
Dividing healthcare services into different packages based on their importance or necessity. For example, essential procedures are covered by basic insurance, while supplementary procedures may require additional costs.
Segmentation of the population
Segmentation of the population
Dividing the population into different groups and assigning them different insurance schemes based on factors like age, income, or employment status.
MediShield Life
MediShield Life
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Medifund
Medifund
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Medicare
Medicare
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Medicaid
Medicaid
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Healthcare segmentation in the Netherlands
Healthcare segmentation in the Netherlands
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Universalist Integrated Systems
Universalist Integrated Systems
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Universalist Separated Systems
Universalist Separated Systems
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Moderately Separated Systems
Moderately Separated Systems
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Highly Integrated Systems
Highly Integrated Systems
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Highly Separated Systems
Highly Separated Systems
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What characterizes the US healthcare system?
What characterizes the US healthcare system?
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What is Medicare?
What is Medicare?
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What is the extent of Medicare coverage?
What is the extent of Medicare coverage?
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What is Medicaid?
What is Medicaid?
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Does the US have universal healthcare?
Does the US have universal healthcare?
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Who does Medicare cover?
Who does Medicare cover?
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What other health insurance options exist in the US?
What other health insurance options exist in the US?
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What is an example of a more centralized healthcare system in the US?
What is an example of a more centralized healthcare system in the US?
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The Patient Protection and Affordable Care Act (PPACA)
The Patient Protection and Affordable Care Act (PPACA)
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Individual mandate (Obamacare)
Individual mandate (Obamacare)
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Health insurance exchanges (Obamacare)
Health insurance exchanges (Obamacare)
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Federal subsidies (Obamacare)
Federal subsidies (Obamacare)
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Regulation of insurance companies (Obamacare)
Regulation of insurance companies (Obamacare)
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Medicaid expansion (Obamacare)
Medicaid expansion (Obamacare)
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German Social Health Insurance
German Social Health Insurance
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Out-of-pocket payments (Germany)
Out-of-pocket payments (Germany)
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Capitation
Capitation
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Fee-for-service (FFS)
Fee-for-service (FFS)
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Salary
Salary
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Free Choice of Physician
Free Choice of Physician
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Fee-for-service (FFS)
Fee-for-service (FFS)
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HMOs
HMOs
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Capitation
Capitation
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Salary System in Healthcare
Salary System in Healthcare
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Extra-Billing (EB)
Extra-Billing (EB)
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Pay-for-Performance
Pay-for-Performance
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Private Practice (PP)
Private Practice (PP)
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Primary Care Physician (PCP)
Primary Care Physician (PCP)
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Hospital Doctor Compensation
Hospital Doctor Compensation
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Study Notes
Healthcare Organization Models
- Three basic models exist for healthcare organization in industrialized countries: voluntary health insurance, social health insurance, and national health service.
- Each model differs in its funding mechanisms and how healthcare services are organized.
Voluntary Health Insurance (VHI)
- Citizens choose whether to purchase private health insurance from a private insurance company.
- Insurance policies are customizable depending on individual needs, income, or health conditions.
- Healthcare providers are usually independent from insurance companies; insurers only reimburse providers.
- Policyholders have significant freedom in choosing healthcare providers.
Social Health Insurance (SHI)
- The government mandates health insurance for certain occupational groups.
- Multiple sickness funds (not-for-profit organizations) collect contributions from workers based on their employment.
- Workers receive total or partial reimbursement for incurred medical expenses.
- Contributions are calculated based on earned income, not overall income.
- The classic model assigns workers to specific funds according to their profession.
- More recently, some countries allow workers to choose their health insurance fund.
National Health Service (NHS)
- National health services receive funding through general taxation.
- The state manages resources needed to fund healthcare provision.
- NHS guarantees healthcare access to the entire population.
- Healthcare treatment is considered essential and a fundamental right.
- Most hospitals and physicians are publicly owned/employed.
Funding Models
- Simple market: Providers directly interact with users, who pay directly for services. No third-party involvement.
- Voluntary insurance: Individuals choose whether or not to purchase private insurance.
- Targeted programs: Programs funded by general taxes aimed at specific populations experiencing high health risks (e.g., low-income individuals, elderly, and minors).
- Social health insurance: The government mandates certain groups to purchase health insurance. Multiple sickness funds collect contributions from each category of workers.
- Mandatory residence insurance: The state requires all residents to have private health insurance. Different insurers compete to provide essential health coverage.
- Universalist model: Government funds healthcare through general taxation, offering healthcare to everyone.
- Medical Savings Accounts (MSAs): Individual deposit accounts where workers set aside funds for healthcare costs. These funds are usually tax-free.
US Public Programs
- Medicare: Covers Americans over age 65 and younger people with long-term disabilities. It's a mean-tested program for low-income people.
- Medicaid: Covers low-income people.
- CHIP: Covers children of low-income families whose earnings exceed Medicaid limitations.
- Other public schemes: cover war veterans, military personnel, federal government employees, Native Americans, prisoners, and other vulnerable groups.
Healthcare Systems in Three Countries
- Germany: First country to implement SHI in 1883. Funding is mostly through contributions from workers; 8% general taxation.
- Canada: Has a single-payer public insurance program (Medicare). About 70% of health spending is funded via taxation.
- Switzerland: Each resident is required to have health insurance. Insurance rates are identical within each company for people in the same age and region.
Healthcare Provision
- Two rival models: separated and integrated.
- Separated: High autonomy among actors, pluralism, contractual relations, and significant choice;
- Integrated: High coordination within the same organization, stable relations, hierarchy, and limited choice.
- Organizational integration: Formal contracts and agreements that bind healthcare providers.
- Clinical integration: Coordinating efforts among various healthcare providers treating the same patient.
- Primary care: Treats most common health issues.
- Secondary care: Specialized treatment delivered by medical experts.
- Gatekeeping: System requiring referral from a general practitioner (e.g., family doctor) to access specialists.
- Patient freedom of choice: Complete freedom of choice to select any provider (public or private); Limited choice to contracted providers.
- Solo practice: General practitioners are independent and work alone.
- Group practice: General practitioners work together.
The Importance of Institutional Rules & Political Context
- Majoritarian Model: Political power concentrated in the executive branch.
- Consensual Model: Political power dispersed among multiple actors.
- Veto Players: Actors who can block government initiatives.
The Obama Healthcare Reform
- Individual mandate/play or pay: Individuals required to purchase insurance or pay a penalty.
- Health insurance exchanges: State-regulated marketplaces allowing individuals to compare policies.
- Federal subsidies: Low-income individuals and families receive federal subsidies to help purchase insurance.
- Regulations for insurance companies: Prevent discriminatory pricing and policies related to pre-existing conditions.
- Medicaid expansion: Increased Medicaid coverage to more low-income and disabled people.
- Other public programs: The government maintains existing programs covering military healthcare, children, and/or people with specific diseases.
The Uninsured
- Large number of individuals in the USA remain uninsured.
- Many factors can lead to this: not meeting eligibility requirements, lacking employment, or high healthcare costs.
Healthcare Payment Methods
- Fee-for-service (FFS): Providers are paid for each service rendered.
- Capitation: Providers are paid a set amount per person assigned.
- Salary: Providers are paid a fixed amount regardless of patients or services.
- Extra-billing: Providers charge patients beyond what insurers reimburse.
- Private practice (PP): Physicians maintain practices separate from government and group organizations.
Health Insurance in the US
- Overall, public health programs are required to address a range of issues such as the insured, the uninsured, costs, and provider and insurance company behavior.
Comparing National Health Services in Northern and Southern Europe
- Total health expenditure per capita, and public versus private expenditure
- Hospital bed counts (public/private)
- Public Health System satisfaction rates
Other Noteworthy Points
- Healthcare systems aren't exclusive to one model. A "hybrid" system blends different elements from various models.
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Description
Test your knowledge on global healthcare systems with this matching quiz. Match countries with their healthcare practices, financing types, insurance coverage, and more. Perfect for students of public health or those interested in healthcare policy.