Medicare Financing and Delivery Systems

Medicare Financing and Service Delivery

• Medicare operates as a single-payer system with a decentralized model for service delivery.
• This model diverges from the more centralized national health services like the UK's National Health Service.
• Physicians primarily operate as independent contractors, billing public insurance plans through fee-for-service or other payment methods.
• There are limited accountability relationships between healthcare providers and health authorities, hospitals, or governments, despite their work within regional or provincial health authority boundaries and publicly financed hospitals.
• This structure's origins can be traced back to Saskatchewan, where physicians staged a 23-day province-wide strike to preserve their autonomy and ability to bill patients or private insurance plans instead of the government.
• The strike culminated in the Saskatoon Agreement, which established physicians as publicly paid but self-employed professionals with minimal involvement in system-wide governance.

Medicare Financing and Service Delivery

• Medicare is a single-payer financing system for healthcare in the United States.
• The US system is decentralized, with service delivery managed separately from financing.
• Unlike the UK's centralized National Health Service (NHS), financing and service provision in Medicare are distinct.
• Doctors in the US are primarily independent contractors, billing public insurance plans under a fee-for-service or other contractual arrangements.
• These doctors operate within the framework of regional or provincial health authorities, and work in hospitals predominantly funded by the public.
• However, there's a limited level of accountability between physicians and health authorities, hospitals, or the government.
• This decentralized structure originated in Saskatchewan, Canada, where doctors staged a 23-day province-wide strike to ensure their ability to bill patients or private insurance plans.
• The strike resulted in the Saskatoon Agreement, a compromise that allowed doctors to integrate into the single-payer system as publicly paid but self-employed professionals with minimal involvement in system-wide governance.