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Questions and Answers
In the OECD 2024 statistics, the US has a healthcare insurance coverage rate of 91.6%.
In the OECD 2024 statistics, the US has a healthcare insurance coverage rate of 91.6%.
True (A)
In the separated model of healthcare provision, actors have limited freedom of choice.
In the separated model of healthcare provision, actors have limited freedom of choice.
False (B)
Austria has a healthcare insurance coverage rate of 99.9%, matching that of the Netherlands.
Austria has a healthcare insurance coverage rate of 99.9%, matching that of the Netherlands.
True (A)
Organizational integration in healthcare is primarily concerned with the actual interaction among providers.
Organizational integration in healthcare is primarily concerned with the actual interaction among providers.
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The OECD average for healthcare insurance coverage is 97.9%.
The OECD average for healthcare insurance coverage is 97.9%.
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In the integrated model, insurers and providers operate as independent entities.
In the integrated model, insurers and providers operate as independent entities.
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In Australia, the healthcare system follows a separated model.
In Australia, the healthcare system follows a separated model.
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Vertical integration in healthcare is characterized by separate organizations for insurers and providers.
Vertical integration in healthcare is characterized by separate organizations for insurers and providers.
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Secondary care typically involves services provided by general practitioners.
Secondary care typically involves services provided by general practitioners.
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In horizontal integration, primary and secondary care are provided by different entities.
In horizontal integration, primary and secondary care are provided by different entities.
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Patient choice is limited to contracted providers in the separated model.
Patient choice is limited to contracted providers in the separated model.
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In some countries, GPs and specialists are part of the same organization under the integrated model.
In some countries, GPs and specialists are part of the same organization under the integrated model.
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Denmark is an example of a country that follows the separated model.
Denmark is an example of a country that follows the separated model.
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Exceptional expenses related to care for the disabled and long-term care in the Netherlands are covered by a compulsory national scheme known as WLZ.
Exceptional expenses related to care for the disabled and long-term care in the Netherlands are covered by a compulsory national scheme known as WLZ.
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All citizens in the Netherlands are exempt from needing a healthcare insurance policy.
All citizens in the Netherlands are exempt from needing a healthcare insurance policy.
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The Netherlands has around 40 insurance providers that compete in the market for essential healthcare.
The Netherlands has around 40 insurance providers that compete in the market for essential healthcare.
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Military personnel in the Netherlands are included in the mandatory basic insurance scheme.
Military personnel in the Netherlands are included in the mandatory basic insurance scheme.
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Complementary care such as dental and alternative medicine is covered under a compulsory insurance policy in the Netherlands.
Complementary care such as dental and alternative medicine is covered under a compulsory insurance policy in the Netherlands.
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Around 80% of the Dutch population has a complementary insurance policy.
Around 80% of the Dutch population has a complementary insurance policy.
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0.1% of the population in the Netherlands is regularly unable to pay health insurance premiums.
0.1% of the population in the Netherlands is regularly unable to pay health insurance premiums.
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Private health insurance in the Netherlands only serves as supplemental coverage to the mandatory insurance.
Private health insurance in the Netherlands only serves as supplemental coverage to the mandatory insurance.
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Insurers are allowed to profit from basic care in Switzerland.
Insurers are allowed to profit from basic care in Switzerland.
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The maximum annual deductible for Swiss health insurance is CHF 2,500.
The maximum annual deductible for Swiss health insurance is CHF 2,500.
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In Switzerland, health insurance rates must be identical within each company, regardless of sex or state of health.
In Switzerland, health insurance rates must be identical within each company, regardless of sex or state of health.
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Children in Switzerland pay CHF 1,450 on average for health insurance coverage.
Children in Switzerland pay CHF 1,450 on average for health insurance coverage.
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Out-of-pocket payments account for 30% of total health expenditure in Switzerland.
Out-of-pocket payments account for 30% of total health expenditure in Switzerland.
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Public hospitals in Switzerland are usually owned and run by private entities.
Public hospitals in Switzerland are usually owned and run by private entities.
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The risk-equalization system in Switzerland transfers funds from insurers with fewer women and elderly to those with a greater number.
The risk-equalization system in Switzerland transfers funds from insurers with fewer women and elderly to those with a greater number.
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Most hospital doctors in Switzerland work on a fee-for-service basis.
Most hospital doctors in Switzerland work on a fee-for-service basis.
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Italy adopted the National Health Service model after World War II.
Italy adopted the National Health Service model after World War II.
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Countries with fewer veto players can implement healthcare reforms more swiftly.
Countries with fewer veto players can implement healthcare reforms more swiftly.
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Conservative governments predominantly adopt NHS healthcare schemes.
Conservative governments predominantly adopt NHS healthcare schemes.
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The Italian healthcare system has only utilized the NHS model since its inception.
The Italian healthcare system has only utilized the NHS model since its inception.
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Germany's healthcare model can be classified as SHI/MRI.
Germany's healthcare model can be classified as SHI/MRI.
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The concentration of power index in New Zealand is -2.78.
The concentration of power index in New Zealand is -2.78.
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Switzerland has the highest index of veto players listed.
Switzerland has the highest index of veto players listed.
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The Italian National Health Service is primarily financed through private donations.
The Italian National Health Service is primarily financed through private donations.
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The 1990 reform of the UK healthcare system was based on the principle of the 'external market'.
The 1990 reform of the UK healthcare system was based on the principle of the 'external market'.
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Patients in England were granted the right to choose from any hospital provider starting in 2008.
Patients in England were granted the right to choose from any hospital provider starting in 2008.
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In Spain, only the 'historical' regions had their health competencies transferred until 2002.
In Spain, only the 'historical' regions had their health competencies transferred until 2002.
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The Dutch healthcare system requires citizens to purchase an insurance policy covering a standard, basic benefits package.
The Dutch healthcare system requires citizens to purchase an insurance policy covering a standard, basic benefits package.
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The star rating system in England was designed to limit patient choice.
The star rating system in England was designed to limit patient choice.
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Decentralization in Spain's healthcare system occurred in a uniform manner across all regions.
Decentralization in Spain's healthcare system occurred in a uniform manner across all regions.
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In the Netherlands, insurers can refuse applicants for insurance coverage.
In the Netherlands, insurers can refuse applicants for insurance coverage.
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In the UK, the concept of 'money following the patient' was a feature of the internal market.
In the UK, the concept of 'money following the patient' was a feature of the internal market.
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Study Notes
Healthcare Models
- Three primary healthcare models exist: voluntary health insurance, social health insurance, and national health service. These models differ in their funding mechanisms and the organization of healthcare service delivery.
Voluntary Health Insurance (VHI)
- Individuals freely choose whether or not to purchase insurance from private companies.
- Insurance policies can be tailored to individual needs, with premiums based on income, health conditions, and risk tolerance.
- Providers are independent from insurance companies, and insurers simply reimburse providers for services.
- Individuals have significant freedom to choose their healthcare providers.
Social Health Insurance (SHI)
- Governments may mandate health insurance for certain occupational groups.
- Multiple sickness funds manage the scheme, collecting contributions from workers based on territory or occupation.
- These not-for-profit sickness funds manage the funds and reimburse healthcare costs.
- Healthcare providers are distinct entities, allowing individuals choice among providers.
National Health Service (NHS)
- Funding through general taxation is the core of NHS models.
- The state oversees healthcare provision and resource management.
- The NHS guarantees healthcare to the entire population.
- Healthcare services are generally publicly owned, including hospitals and, often, medical practitioners.
Funding Models
- Simple market: healthcare providers and users directly interact without third-party mediation. Providers set prices, and users pay directly.
- Voluntary insurance: Individuals choose to participate in private health insurance programs, competing with one another. Premiums can be risk-rated.
- Targeted programs: Funded by general taxation, these programs provide healthcare to vulnerable groups, such as low-income individuals, the elderly, and specific occupational/professional groups.
- Social health insurance: Required coverage for certain groups; various sickness funds manage contributions and reimbursements, based on territorial or occupational factors.
- Mandatory residence insurance: Residents are required to purchase private health insurance from competing providers.
- Universalist model: Funded by general taxation, the system guarantees healthcare to all residents, with no direct link between payments and coverage.
- Medical Savings Accounts (MSAs): Individual accounts receiving regular payments from workers, which are used to reimburse medical costs. Not typically fully autonomous.
US Public Programs
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Medicare: Covers Americans over 65 and younger with long-term disabilities. Means-tested and not exhaustive in population coverage and services.
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Medicaid: Covers low-income individuals; mean tested and not exhaustive in population coverage and services. Funding shared between states and the federal government
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CHIP: Provides insurance to children of low-income families who exceed Medicaid income thresholds.
Healthcare Systems in Specific Countries
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Germany: The system is based on social health insurance and is compulsory for most employed citizens.
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Canada: The system is a form of universal healthcare (single-payer) and funded mainly by general taxation, but with private providers for some services.
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Switzerland: Mandated coverage and relies on a risk equalization system that subsidizes health insurance for individuals. This is accomplished through mandatory, community-rated insurance and public subsidies.
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France: This system is a blend of public and private insurance and includes a large private voluntary health insurance market
Healthcare Provision
- Separated Model: Actors (insurers, doctors) have significant autonomy and choice in practice.
- Integrated model: Insurers and providers are part of a larger organization that coordinates care among multiple healthcare professionals, and restricts choices for the insured.
- Various methods of care coordination (like Gatekeeping) exist within both separated and integrated models of provision
Patient Choice and Access
- Complete freedom of choice: Wide ranging of providers or types of care for consumers.
- Limited choice: Limited types of providers or types of care for consumers. This is often in cases where care requires close coordination with the insurer, such as gatekeepers.
Healthcare Costs
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Cost-sharing is utilized to reduce excessive use of healthcare services.
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Co-payments, co-insurance and deductibles are common strategies in certain countries (US, Germany).
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Healthcare spending can vary substantially across countries; the US, however, is significantly higher than the OECD average.
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Description
This quiz explores the 2024 healthcare insurance coverage rates in various countries according to OECD statistics. It addresses different healthcare provision models, their organizational structures, and the implications for patient choice. Test your knowledge about the integrated and separated healthcare models as well as specific country coverage rates.
