health insurance and comparison of health insurance system in the world
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Lecture Fourteen. Health Insurance and Comparison of Health Insurance System in the World. Learning Objectives. Identify a person’s health risks in his or her life Explain the two concepts of health care system and health insurance system - PowerPoint PPT PresentationTRANSCRIPT
Health Insurance and Comparison of
Health Insurance System in the World
Lecture Fourteen
Learning Objectives
Identify a person’s health risks in his or her life Explain the two concepts of health care system and health insurance systemExplain the classification of health insurance programsCompare different health insurance system in the world
Main Contents
Health risks in a person’s lifeHealth care system and health insurance system The health insurance system and reforms in the U.S.The health insurance system reforms in EuropeHealth insurance system in Canada Health insurance system in France Health insurance system in GermanyHealth insurance system in Japan Health insurance system in China
What’s the problem with our health?
Health is wealth. Good health is a universal objective of human beings. In people’s life, however, there are different kinds of health risk. Such as:
Illness
premature death
injury
what’s the costs of poor health in the USA?
Case 1: Tom, 36, is a self-employed hair-dresser who has got a brain tumor that required immediate surgery, his surgeon’s fees, hospital expenses, and other medical bills totaled $125,000. Tom has not health insurance. In addition, he was out of work for more than one year and did not have any social health insurance . In short, because of lack of health insurance, Tom was exposed to serious financial burden as result of the unexpected surgery.
Tom’s experiences shows:
Bad health results in two major financial problems:
Payment of medical bills (expenses for medical services)
The loss of income ( a person will loose his or her income when he or she is unable to work due to an injury or illness)
Health insurance plays great roles in managing personal financial risk resulted from poor health.
Different countries has different health insurance system
Health Care System
Health Insurance System
Two concepts
Figure 1: Health Care System Government
Health InsuranceHealth Resources
Health Care ServicePublic Health
Person
Health insurance System in U.S.
Health insurance programs are provided by different organizations in the U.S., which are classified into three types:
Social health insurance programs provided by governments MHOs, PPOs, etc. provided by non-profit making associations Commercial health insurance provided by private insurers
The social health insurance programs in U.S.
The US is the most typical country where health insurance is provided by commercial insurers. However, still there are two major types of social health insurance programs. That’s:
Medicare Medicaid
The social health insurance programs in the U.S.
Medicare (医疗照顾制度 ) ： The insured:
1n 1965, the U.S. Congress created Medicare. it provides health insurance for the persons aged 65 or older, as well as those under age 65 who have been receiving Social Securities disability benefits for at least two years.
The social health insurance programs in the U.S.
Medicare (医疗照顾制度 ) ：
Coverage:Inpatient hospital care: a maximum of
90days’ care for any individual period of illness with deductibles
The patient must bear a deductible of
$879 for the first 60days, and $219 a day for each day between 60 and 90 days.
The social health insurance programs in the U.S.
Skilled nursing home care
Home health care
Hospice care.
The social health insurance programs in the U.S.
Medicaid (医疗救济制度 )
The insured: Provide health insurance for the low income persons. The programs are financed by both state and federal government tax revenues. It was established in 1965.
Coverage: The coverage is similar to Medicare. But the benefits vary somewhat among the states.
Health insurance provided by non-profit making organizations
Blue Cross Association( 蓝十字协会 ) Blue Shield Association ( 蓝盾协会 ) Health Maintenance Organization ( 健康维
护组织） Point-of-Service Plans( 定点服务计划） Preferred Provider Organizations( 优先医
疗服务提供者组织）
what’s the costs of poor health in the USA?
Case 1: Jim Carson, aged 22, is a recent college graduate who is looking for a job. One problem that Jim is encountering in his job search is that he has had asthma since childhood and sometimes suffering severe problems. Thus, he must be especially careful about the type of job he takes and the environment in which he will work. Jim also fears that when he finds and accepts a job, his new employer’s health insurance plan might exclude him. Jim’s parents are urging him to buy an individual health insurance policy as soon.
Commercial health insurance in the US
There are over 1800 private insurers proving health insurance in the US. The coverage of health insurance policies are various as follows (see figure2: health insurance classifications):
Long-term Plans
Health Insurance
Health Expenses Coverage Disability Income Coverage
Short-termPlans
MiscellaneousCoverage
Major Medical Insurance
Basic Health Insurance
Hospital Insurance
Surgical Insurance
Regular Medical Expenses Insurance Others
Long-term Care Insurance
Dental Insurance
Confronted problems of health insurance system in the U.S.
Unequal access to health care: still 35-45 million people have no any health insurance, especially Hispanics, immigrants, etc.
Rising health care expenditures: total health care spending has increased substantially over time. Over 14.8% of GPD is invested in health, the highest in the world.
44%
37%
44%
29%
29%白人非南美洲移民
黑人非南美洲移民南美洲移民
亚洲移民
土著人
200%FPL＜
/根据民族 种族及收入人群划分的未保险 2005率 年
16%
11%21%
12%8%白人非南美洲移民
黑人非南美洲移民
南美洲移民
亚洲移民
土著人
≥200%FPL
Confronted problems of health insurance system in the U.S.
Unsatisfied service quality: low coverage and insufficient health services, especially for aging populations.
Long waiting line: lower efficiency.
Urging for universal coverage
Health care system reforms
In 1993, President Bill Clinton proposed a comprehensive health care system reforms. The emphasis is placed on the expansion of health insurance for those uncovered, requiring all the employers to provide insurance to their employees
However, the proposals by Clinton were defeated by the business community.
Health care systemreforms
In 2003, Congress passed legislation signed by President W. Bush, authorizing to create Health Savings Accounts (HSAs) . There are many argues. The opponents’ voice is much louder than the supporter.
Two types of health insurance system
1. National health services (Denmark, Sweden, UK, Italy, Greece, Spain and Portugal)
Funded by general taxation
Universal coverage
Guaranteed by public organizations such as health authorities
Public ownership of health care facilities
Health insurance system in Europe
2. Social insurance systems (France, Germany and Austria)
Funded by payroll contributions
Private facilities
Physicians paid according to services provided
Coverage segmented
Guaranteed by sickness funds organized according to region, occupation or workplace
Health insurance system in Europe
As U.K., Canada is social health insurance system funded by general taxation Universal coverage Guaranteed by public organizations such as health authorities Public ownership of health care facilities
Current Canadian Health insurance system
Restrict access to specialists Longer waiting times for non-emergency surgeriesClosing and merging of hospitals loss of beds
Restriction of equipment--have to be approved by provincial government
Current Canadian Health insurance system
New Plans
Allow private insurance??
Not allow direct-to-consumer pharmaceutical ads
Move for fee-for-service to managed care??
Current Canadian Health insurance system
Employer pays 3X individual contribution
Contribute to higher unemployment in lean times
Universal health care widely accepted but takes 40% of worker’s pay
French Health insurance system
French Health Care System
New law to devote more resources to elderly
Local government cover full costs until death
Recoup costs from patients estate
1880s national health insurance lawsOccupational guilds basis of insurance--sickness funds membership according to location or occupation rather than choice contributions based on income (with single persons subsidizing families) rather than risk Members managed the funds1883 employees contributed 2/3 and employers 1/3 of costs governed by board of employees and employers government set minimum benefit level by statute--sick pay, medical expenses and hospital treatmentmembership compulsory if income below a set level (3x avg wage)
German Health insurance system
1913 separate funds white-collar from blue-collar
1980s started to implement cost controls
1989 1,100 different funds blue collar below certain wage--no choice of funds white collar could join substitute fund above certain income did not have to join
German Health insurance system
First to have universal coverage 1948
“socialized medicine” or budgeted
UK offer access to a system of care not insurance for care
UK integrated system--no cost-shifting between state and federal--covers all costs--hospitals, physicians , clinics
Criticism led to reform in 1989--put interests and wishes of the patients first--not more money but new forms of management and competition within the National Health service
Health Insurance system in U.K.
Reform
1989 1. tried to introduce National Health Insurance and privatization
2. Introduced general managers at all levels, not work--no change to original system, managers little information to work with
Health Insurance system in U.K.
UK current crisis How to fund
increased taxes
shift public spending
expand the private sector
Government managed Health InsuranceFund for employees of company not self insuredPay 8.2% of payroll—1/2 from employee and ½
from employer
Other Occupations covered—seaman and day laborers
Japan
National Health Insurance
for occupations not covered by employer based—farmers, small business owners, retired from employer based funds, doctors.
State pays 32-52% of cost
Japan
Health insurance system in China
Dualistic health care systems :
Since establishment of PRC, based on its economic systems, China has established different health care systems in urban and rural areas
Wide differences are existing in health care financing and service delivering systems between the urban and rural areas
The pre-reform health care system in China
In the urban areas In the rural areas
Government Insurance
Program (GIP)
Labor Insurance Program
(LIP)
Cooperative
Medical System
(CMS)
The first reform period
In the urban areas GIP and LIP turned to
partially out-of -pocket (OOP) payment schemes
Co-payment (20% vs 80%), strengthening the individual accountability
In the rural areas CMS collapsed in most
areas The majority of people
lost health insurance The majority of people
paying medical costs out-of-pocket money
The second reform period (late 1990s – present)
Health care financing system reform in urban areas
Health care financing system reform in rural areas
In the urban areas
In 1998, UEBHIS was launched nationwide
In the rural areas
In 2002, launched the New Rural Cooperative Medical Scheme (RCMS)
The pilot programs of the New RCMS has been expanding rapidly nationwide
The New RCMS is expected to cover 80% of the rural population in 2008, and the entire rural population by 2010
Large disparities in health
Disparities in health status
Disparities in access to healthcare
Disparities in health status Under-5 year mortality by regions, 2000
Similar patterns exist for maternal mortality 9.6, 111 and 399 in Shanghai, Guizhou and Tibet, respectively
Disparities in health status Maternal mortality rate by regions
Disparities in access to healthcare Failure to treat illness due to financial problems
Source: NHSS, 1998, 2003
32
3632
39
0
10
20
30
40
50
Urban Rural
1998 2003
Health problems create poverty
30 to 50 percent of the poor report illness and injury being the main reason of poverty
Over 2/3 of China’s population needs to fully rely on their savings to pay for health services
How people cure diseases and keep healty?
Self-care and self-medication
Physical exercises
What explains it?
Access to health insurance is not equitable
Government health spending is not equitable
Health spending is not efficient
The system for cost control and safety is weak
What can be done?
New social economic development objectives
Promoting equitable access to basic health care at affordable cost
Promoting equitable access to basic health at affordable cost
Establish an equitable and universalized health insurance system
Enhance the essential public health functions
Raise efficiency and quality in health service system
Summary
In people’s life, however, there are different kinds of health risk. Such as Illness, premature death ,injury.
Bad health results in two major financial problems.
Health insurance plays great roles in managing personal financial risk resulted from poor health
Health insurance system is different from country to country.
Summary
U.S. is the most typical country where health insurance is provided by commercial insurers. However, still there are two major types of social health insurance programs
Germany, France and some other European countries are social insurance system, while U.K, Canada and some others are national health insurance system.
China has established different health care systems in urban and rural areas 。
Each health insurance system has its advantage and disadvantage.
Review questions
Explain the basic characteristics of a major medical policy.
what’s the major characteristics of the U.S. health care system? Are there any experience that China can learn?
What are the confronted problems for Chinese health insurance system ?
Identify the major tendency of health care system reforms in the world.
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