Questions and Answers
Which of the following is a disadvantage of public healthcare systems?
Private healthcare systems guarantee healthcare for every citizen.
False
Name one country that uses a private healthcare system.
United States
The primary goal of national healthcare systems is to provide quality healthcare to the entire ___.
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Match the country with its healthcare system type:
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What is the amount paid by a patient for a healthcare service known as?
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A deductible is the percentage of costs of a healthcare service paid by the patient after other payments are made.
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What is the primary function of the Health Insurance Portability and Accountability Act (HIPAA)?
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The total amount paid out-of-pocket by a patient for medical bills in a year is often limited by the ________ of the insurance policy.
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Match the following insurance terms with their definitions:
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Study Notes
Healthcare Systems Overview
- Countries utilize private funding for healthcare, with no absolute right or wrong system.
- Monitoring and potential changes are necessary to ensure accessible healthcare for all citizens.
Public Healthcare Systems
- Primarily financed through taxes and social security.
- Advantages: Guarantees healthcare for all citizens, irrespective of their economic status.
- Disadvantages: Services may lack comprehensiveness, and tax burdens can be higher.
- Examples of public systems include Norway, France, the UK, and Canada.
Private Healthcare Systems
- Funded mainly by private insurance and out-of-pocket payments.
- Advantages: Comprehensive coverage, lower taxes, and potential economic growth.
- Disadvantage: Not all citizens have guaranteed access to healthcare.
- Notable examples are the United States and Switzerland.
Mixed Systems
- Few countries operate purely public or private systems; most create hybrid models.
- Example: Canada employs a mixed funding approach alongside the United States.
Goals of National Healthcare Systems
- Ensure quality healthcare for the entire population.
- Be responsive to citizens’ healthcare expectations.
- Provide financial security and equitable financing distribution.
Health Insurance Fundamentals
- Rising healthcare costs impact the economy but are burdensome for families.
- 1920s: The U.S. established health insurance to alleviate medical expense burdens.
- The Affordable Care Act of 2010 aimed to decrease the number of uninsured citizens.
Health Insurance Terms
- Premium: Payment amount for health insurance coverage.
- Deductible: Amount a patient pays before insurance kicks in.
- Co-payment: Fixed fee paid by the patient for specific services.
- Co-insurance: Percentage of costs a patient pays after meeting the deductible.
- Out-of-Pocket Expense: Medical bills paid directly by patients, often subject to annual limits.
- Cost-Sharing Reduction (CSR): Discounts on copayments and deductibles for eligible plans.
- Premium Tax Credit: Reduces monthly premiums based on income and household size.
- HIPAA: Protects patient health information and privacy.
Essential Health Benefits under ACA
- Must cover 10 key health services, including outpatient care, emergency services, and mental health treatment.
Types of Insurance
- Individual Insurance: A single person purchases their own policy.
- Group Insurance: Insurance obtained through an employer, sharing premium costs.
Indemnity Insurance
- Patients pay all medical costs upfront, reimbursed later by the insurance provider.
- May be financially burdensome for many individuals.
Managed Care
- Focuses on promoting good health and preventive medicine.
- Operates through networks of healthcare providers at reduced rates.
Managed Care Models
- Health Maintenance Organizations (HMOs): Require in-network visits and encourage preventive care.
- Preferred Provider Organizations (PPOs): More flexibility with network and non-network providers, but higher costs for non-network care.
- Exclusive Provider Organizations (EPOs): Coverage limited to in-network providers without referrals for specialists.
- Point of Service (POS): Requires a primary care physician and offers lower costs for in-network services.
Government Healthcare Plans
- Public health insurance programs are federally financed for eligible populations.
- Key programs include Medicaid, Medicare, TRICARE, and the Veterans’ Health Administration.
Medicaid
- A needs-based program designed for medically needy individuals and families.
- Covers services like hospital care, prenatal care, and prescription drugs.
- ACA expansion allows participating states to increase Medicaid eligibility.
Medicare
- An entitlement program for citizens aged 65 and over.
- Covers 80% of medical expenses post-deductible, with the insured responsible for 20%.
- Medigap insurance can supplement this 20% co-insurance cost.
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Description
This quiz explores the fundamentals of public healthcare systems, including funding mechanisms, advantages, and disadvantages. It emphasizes the importance of monitoring and potential changes needed to ensure quality healthcare for all citizens. Test your understanding of how different countries administer healthcare services.
