Public Health Programs and Insurance Models

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Questions and Answers

Which groups are primarily targeted by public health programs?

High-income professionals and civil servants

Healthy adults under 30

Low-income individuals, the elderly, minors, and refugees (correct)

Individuals with private health insurance

What distinguishes targeted programs from other financing models?

Targeted programs are exclusive to the military and civil servants

Funding comes only from the state and no community contributions

Beneficiaries and funders do not necessarily overlap (correct)

Beneficiaries are the same as those who finance the programs

Which program covers individuals over the age of 65 and younger individuals with long-term disabilities?

Medicare (correct)

Social Health Insurance

Medicaid

Chip

What is the primary funding source for Social Health Insurance (SHI) programs?

Contributions from salary paid by workers Signup and view all the answers

How are health insurance funds managed under the Social Health Insurance model?

By quasi-public, non-profit organizations under government regulation Signup and view all the answers

Which of the following statements about Medicaid is true?

It is a mean-tested program for low-income persons Signup and view all the answers

How are contributions to health insurance funds calculated in the SHI model?

Based on earned income only Signup and view all the answers

Who are considered 'weak' groups in the context of public health programs?

Individuals affected by serious illnesses and prisoners Signup and view all the answers

What distinguishes voluntary health insurance (VHI) from other models?

Citizens can customize their insurance policies based on personal choice. Signup and view all the answers

Which model of healthcare organization is characterized by government-mandated insurance policies for specific occupational groups?

Social Health Insurance Signup and view all the answers

What role do sickness funds play in the Social Health Insurance (SHI) model?

They collect insurance contributions from workers on a non-profit basis. Signup and view all the answers

Which of the following is true about the National Health Service model?

It is characterized by comprehensive health coverage funded by taxes. Signup and view all the answers

Which historical figure is associated with the establishment of Social Health Insurance in Germany?

Otto von Bismarck Signup and view all the answers

What is a key characteristic of providers in the voluntary health insurance model?

They are independent entities that are reimbursed by insurance. Signup and view all the answers

How has the scope of mandatory insurance coverage changed in countries adopting Social Health Insurance?

It has progressively included more occupational and social groups. Signup and view all the answers

In the context of health care models, what is referred to as a potential disadvantage of voluntary health insurance?

Possibility of unequal access based on income and risk preference. Signup and view all the answers

Which health care model is most aligned with an individualistic culture?

VHI Signup and view all the answers

What type of political culture do Germany, Netherlands, and Japan share regarding health systems?

Communitarian culture Signup and view all the answers

Which of the following countries implemented the SHI model under a conservative government?

Austria Signup and view all the answers

What year did the UK establish its NHS model?

1946 Signup and view all the answers

Which government was responsible for introducing universal healthcare in Australia?

Whitlam (Labour) Signup and view all the answers

What is the ideological orientation of the government that implemented the SHI model in Italy?

Authoritarian Signup and view all the answers

Which of the following countries implemented its universal healthcare model during a Communist regime?

Hungary Signup and view all the answers

What commonality can be seen in the health care models of countries with a social democratic orientation?

Adoption of NHS models Signup and view all the answers

What type of insurance is primarily obtained through employment in Canada?

Private health insurance Signup and view all the answers

Which of the following services is typically not covered under Canada’s Medicare basic package?

Vision care Signup and view all the answers

How are hospital-based physicians in Canada typically compensated?

Fee-for-service Signup and view all the answers

In Switzerland, what is the obligation for each individual regarding health insurance?

To purchase a health insurance policy Signup and view all the answers

What is a common payment method for general practitioners in Canada?

Fee-for-service Signup and view all the answers

What percentage of residents in Switzerland benefit from public subsidies for mandatory insurance?

30% Signup and view all the answers

Which of the following statements regarding mandatory health insurance in Switzerland is true?

All applicants must be accepted by insurers. Signup and view all the answers

What is a common trend happening in Canada regarding primary care?

Formation of inter-professional primary care teams Signup and view all the answers

What is a key characteristic of the integrated model in healthcare systems?

Insurers and providers belong to the same organization Signup and view all the answers

Which healthcare system allows for more patient choice among providers?

Separated model Signup and view all the answers

In the separated model, which of the following is true regarding primary and secondary care?

Primary and secondary care are provided by separate entities Signup and view all the answers

Which integration model is characterized by GPs and specialists belonging to the same organization?

Horizontal integration model Signup and view all the answers

What distinguishes secondary care from primary care?

It requires more sophisticated equipment Signup and view all the answers

Which countries are primarily associated with the separated model of healthcare?

Australia and Canada Signup and view all the answers

In the context of healthcare systems, what does 'vertical integration' refer to?

Combining both primary and secondary care under one entity Signup and view all the answers

How is patient care structured in an integrated model?

Through a coordinated effort of GPs and specialists Signup and view all the answers

What penalty is imposed on individuals who do not purchase an approved insurance policy starting in 2014?

$695 for individuals, $2,085 for families Signup and view all the answers

Which of the following statements about health insurance exchanges is correct?

They allow comparison of policies and premiums. Signup and view all the answers

What regulation is placed on insurers regarding premiums for applicants?

Insurers must offer the same premium to all applicants of the same age and location. Signup and view all the answers

As of 2024, what percentage of the population was expected to utilize health insurance exchanges?

4% Signup and view all the answers

What is the eligibility threshold for Medicaid expansion in 2014?

Families earning up to 138% of the poverty level Signup and view all the answers

In what year were individual mandate penalties abolished?

2019 Signup and view all the answers

What percentage of premium dollars must insurers spend on healthcare according to the PPACA?

85% Signup and view all the answers

Which form of funding accounts for the majority of the German health insurance system?

Contributions to statutory health insurance Signup and view all the answers

Study Notes

Healthcare Models

Three basic models exist for healthcare organization: voluntary health insurance, social health insurance, and national health service
These models differ in their funding mechanisms and the way healthcare services are organized

Voluntary Health Insurance (VHI)

Individuals freely choose whether to purchase health insurance from a private company
Choices are influenced by income, health, and risk tolerance
Healthcare providers are independent from insurance companies
Insurance companies reimburse providers

The government mandates health insurance for specified occupational groups
Separate, non-profit sickness funds manage contributions
Funding is based on territory or occupation
Healthcare providers remain independent entities

National Health Service (NHS)

Healthcare is financed through general taxation
The state manages healthcare resources
Healthcare is guaranteed to all citizens
Healthcare is primarily publicly owned, with physicians as public employees

Funding Models

Simple market
Voluntary insurance
Targeted programs
Social health insurance
Mandatory residence insurance
Universalist model
Medical Savings Accounts (MSAs)

Simple Market

Healthcare providers and users interact directly
Users pay providers directly, with no third-party involvement

Voluntary Insurance

Individuals elect whether to purchase private health insurance
Insurers are competitive and may be for-profit or non-profit
Premiums may be risk-rated or community-rated

Targeted Programs

These programs are funded by general taxation meant for specific populations
Vulnerable populations are the beneficiaries: low-income, elderly, minors, those with chronic illnesses, prisoners, refugees

States mandate participation for specific worker groups
Health insurance funds (quasi-public/non-profit) handle worker contributions
Medical expenses are partly reimbursed in exchange for contributions
Contributions use earned income only

Mandatory Residence Insurance

The state demands that all residents acquire private health insurance
Multiple, competing insurers handle essential health services
The state may offer subsidies to low-income citizens
The state regulates the insurance market

Universalist Model

Healthcare funded via general taxation, not worker contributions or premiums
A single payer acts as the insurer
All citizens have access to necessary medical treatments

United States Public Programs

Medicare: for Americans over 65+ with long-term disabilities; mean-tested
Medicaid: for low-income individuals; mean-tested
CHIP: for children of low-income families (with income exceeding Medicaid ceilings)
Other programs exist for veterans, federal employees, Native Americans, and those with chronic illnesses like HIV/AIDS

Five Major Reform Trends

Stimulating greater competition in the healthcare market
Promoting integration of financing and delivery of healthcare services
Decentralization of healthcare systems
Strengthening patients' rights and freedom of choice
Extending insurance coverage for more individuals

UK Health System Reforms

1990:* Thatcher government reforms introduce an "internal market" model. Local authorities receive budgets to purchase services from many providers.
2001-2005:* Blair administration enhances patient choice, allowing more options for hospitals (including private ones) and provider accountability through a "star rating" system.

Spain Health System Reforms (2002):

Important health competencies moved from national to regional governance.

Netherlands Health System Reforms (2006)

All residents must have health insurance
Insurers must accept all applicants, and premiums are community-rated
There's a national fund for income-based contributions
Low-income families have access to subsidies

Sweden Health System Reforms (2005)

National Treatment Guarantee established, promising quicker access to care.
A specific rule ('0-7-90-90' rule) was implemented to guarantee faster access to consultations and specialists

France Health System Reforms (1996-1999)

Introduced "carnet de santé" to combat contradictory prescriptions.
Established "médecins traitants" (family doctors) as gatekeepers for specialized care

Germany Health System Reforms (2007)

Insurance now mandatory for all residents
A Central Reallocation Pool is introduced to manage SHI contributions. This improves efficiency and avoids discriminatory premiums

South Korea Health System Reforms (1999)

All sickness funds consolidated into a single national health insurance scheme

Payment Methods for Doctors and Healthcare Providers

Fee-for-service (FFS): doctors are paid for each service performed
Capitation: doctors receive a fixed amount for each patient assigned to them
Salary: doctors are paid a fixed amount for a specific timetable

The politics of Health Care

Ideological orientation of governments impacts the creation and implementation of health care models. Conservatives often favor SHI
Political institutions influence how quickly and easily health care reforms are enacted. Systems with fewer veto players are most efficient.

Healthcare Models in Three Countries

Germany: Social Insurance Model (SHI)
Canada: Single-payer, National Health Service (NHS)
Switzerland: Mandatory health insurance based on a risk-equalization system

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Description

Test your knowledge on the various groups targeted by public health programs and the distinctions between different health insurance models, including Social Health Insurance and Voluntary Health Insurance. Explore key concepts like Medicaid and the roles of sickness funds in the healthcare system.