Podcast
Questions and Answers
What percentage of the population is insured by the Ministry of Health?
What percentage of the population is insured by the Ministry of Health?
What is the age limit for children to be insured under the civil health insurance?
What is the age limit for children to be insured under the civil health insurance?
What is Universal Health Coverage (UHC)?
What is Universal Health Coverage (UHC)?
What percentage of the population is insured by private health insurance?
What percentage of the population is insured by private health insurance?
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Who is eligible for civil health insurance?
Who is eligible for civil health insurance?
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What is a benefit of being an organ donor?
What is a benefit of being an organ donor?
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What type of cost sharing requires the insured person to pay a fixed amount of money when a medical service is received?
What type of cost sharing requires the insured person to pay a fixed amount of money when a medical service is received?
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Which type of medical cost sharing is typically applied to more significant or expensive healthcare services?
Which type of medical cost sharing is typically applied to more significant or expensive healthcare services?
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Which of the following is not one of the ten essential health benefit categories according to the text?
Which of the following is not one of the ten essential health benefit categories according to the text?
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What is the term for the monthly cost for insurance coverage?
What is the term for the monthly cost for insurance coverage?
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What is the term for the total amount the insured person pays out-of-pocket before insurance will pay for services?
What is the term for the total amount the insured person pays out-of-pocket before insurance will pay for services?
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Which type of cost sharing allows for predictability for the insured, as they know in advance how much they will need to pay for certain services?
Which type of cost sharing allows for predictability for the insured, as they know in advance how much they will need to pay for certain services?
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What type of insurance is typically provided by an employer or organization to its employees or members?
What type of insurance is typically provided by an employer or organization to its employees or members?
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What is the main purpose of social insurance programs?
What is the main purpose of social insurance programs?
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Which of the following is NOT a reason why nations consider social insurance?
Which of the following is NOT a reason why nations consider social insurance?
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What type of insurance is typically funded through payroll taxes or other mandatory contributions from workers, employers, or both?
What type of insurance is typically funded through payroll taxes or other mandatory contributions from workers, employers, or both?
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What is a key feature of social insurance programs?
What is a key feature of social insurance programs?
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Which type of insurance aims to provide coverage to a broad segment of the population, often including all workers in formal employment?
Which type of insurance aims to provide coverage to a broad segment of the population, often including all workers in formal employment?
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What is the primary role of financing policy in health care?
What is the primary role of financing policy in health care?
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Why should doctors be concerned about health care financing?
Why should doctors be concerned about health care financing?
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What is one way in which governments pay for health care?
What is one way in which governments pay for health care?
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What is an example of a private health care financing mechanism?
What is an example of a private health care financing mechanism?
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What is a consequence of rising health care costs for doctors?
What is a consequence of rising health care costs for doctors?
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What is another term for government health care financing through taxes?
What is another term for government health care financing through taxes?
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What is a common characteristic of individuals who are more likely to seek health insurance coverage?
What is a common characteristic of individuals who are more likely to seek health insurance coverage?
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What type of health care provider arrangement allows members to receive care from any licensed healthcare provider?
What type of health care provider arrangement allows members to receive care from any licensed healthcare provider?
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What is the primary benefit of purchasing health insurance from the insured's perspective?
What is the primary benefit of purchasing health insurance from the insured's perspective?
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What is a factor that can influence an individual's willingness to purchase comprehensive health insurance coverage?
What is a factor that can influence an individual's willingness to purchase comprehensive health insurance coverage?
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What type of arrangement allows members to choose from a mix of in-network and out-of-network providers?
What type of arrangement allows members to choose from a mix of in-network and out-of-network providers?
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What is a consequence of an individual's perceived value of insurance relative to its cost?
What is a consequence of an individual's perceived value of insurance relative to its cost?
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Study Notes
Health Policy and Financing Policy
- Financing policy serves as a critical tool for achieving health policy objectives, including improving access, enhancing quality, promoting equity, and ensuring sustainability of healthcare systems.
Importance of Healthcare Financing for Doctors
- Rising healthcare costs lead to government cost control measures, insurance company scrutiny of doctors' actions, and loss of clinical autonomy.
- Doctors should be concerned with healthcare financing because it affects their practice and patient care.
How to Pay for Healthcare
- Out-of-pocket payment by patient and family
- Employer payment (e.g., reimbursement, social security corporation)
- Private insurance scheme
- Charity
- Government funding (e.g., taxes, National Health Insurance scheme)
- Medical Savings Accounts (e.g., Singapore's Medisave)
- Foreign aid (important in poor countries)
Health Insurance in Jordan
- Ministry of Health (MOH) is the largest insurer, covering 55.2% of the population
- Royal Military Services (RMS) covers 39.5%
- Private insurance covers 10.4%
- Others (UNRWA, UNHCR, and outside Jordan) cover 3.6%
- University hospitals cover 2.2%
Civil Health Insurance in Jordan
- Covers civil servants, dependents, children under six, adults above sixty, poor segments of society, and remote areas
- Also covers one family member of an organ donor, blood donors, and pregnant women without incurring financial costs
Universal Health Coverage (UHC)
- Ensures access to quality essential health services without financial hardship
- Encompasses promotion, prevention, treatment, rehabilitation, and palliative care
- Aims to achieve equity in access and financial protection for all
Basic Insurance Terms
- Coverage limits: maximum amount of coverage for certain services or treatments
- Premiums: monthly cost for insurance coverage
- Copayment: fixed amount paid out-of-pocket for medical services
- Deductible: total amount paid out-of-pocket before insurance coverage
- Coinsurance: percentage of costs paid out-of-pocket for services
Essential Health Benefit Categories
- Ambulatory services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
Group Insurance
- Provided by an employer or organization to its employees or members
- Coverage extends to all eligible members under a single master policy
- Premiums are calculated based on the group's overall risk profile
Social Insurance
- Government-sponsored programs that provide benefits based on contributions
- Funded through payroll taxes or mandatory contributions
- Aims to provide equitable access to healthcare
Features of Social Insurance
- Mandatory participation to ensure a broad base of contributors
- Contributions based on income levels
- Universal coverage to provide access to a broad segment of the population
- Preventive and wellness services, chronic disease management, and pediatric services
How Insurance Works
- A contract between insured and insurer
- Insured pays premiums and transfers financial risk
- Insurer pays financial losses suffered by the insured in case of unforeseen events
Healthcare Provider Arrangements
- Exclusive Provider arrangement: limited to a specific network of healthcare providers
- Any Provider arrangement: flexibility to seek care from any licensed healthcare provider
- Mixture of Providers: hybrid model with a mix of in-network and out-of-network providers
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Description
Learn about how health insurance works through contracts where the insured pays a premium and transfers financial risk to the insurer. Explore different types of health care provider arrangements like Exclusive Provider arrangements.
