Health System Comparison: US vs. Germany - Describe the US system.
Mixed public and private system (for- & non-profit). Federal funding for Medicare, Medicaid, and other programs. Private insurance dominates, often provided by employers. Uninsured rate has decreased since the ACA.
Health System Comparison: US vs. Germany - Describe the German system.
Mandatory health insurance. Majority enrolled in statutory health insurance (SHI). Funded by wage contributions and supplementary income-dependent sums. Private insurance available for high earners.
What are the demographics of the US in terms of population, elderly, physicians, nurse, and hospital beds?
Population: 325.7M, Elderly (65+): 16%, Physicians: 2.6 per 1,000, Nurse: 11.7 per 1,000, Hospital beds: 2.8 per 1,000.
What are the demographics of Germany in terms of population, elderly, physicians, nurse, and hospital beds?
Population: 82.7M, Elderly (65+): 21.4%, Physicians: 4.3 per 1,000, Nurse: 12.9 per 1,000, Hospital beds: 8.0 per 1,000.
Define Spending Level and Spending Growth.
Spending Level: Amount of spending (low / high / middle). Spending Growth: How spending levels change over time (quickly / slowly).
Describe the spending growth in the US health system in 2022.
Federal government finances a third, Households 28%, Private Business 18%, State and local government 15%. Hospital care and physician services account for half. Prescription drug spending increased by 8.4%. Public health insurance covers 43%, private insurance covers 29%. Out-of-pocket spending increased by 6.6%.
What are the factors contributing to high healthcare spending in the US?
Low-value care overused. High-value care underused. Declining patient health. High patient demand. Rising drug prices.
Define Price, Cost, and Spending in healthcare.
Price: Amount paid per unit. Cost: Production cost of the service. Spending: Total money spent (Price x Quantity).
What are the inefficiencies in healthcare spending in the United States?
General inefficiencies include overpaying and excessive utilization of care. Overpayment burdens payers. Excessive utilization constitutes resource misallocation. Vaccination as an example of underutilization inefficiency.
What is the impact of technology on healthcare spending?
New technologies can be more or less expensive. Can lead to increased overall spending if used alongside existing treatments. Can drive increased utilization and spending due to improved longevity.
Explain the concept of 'cascade of care' in healthcare.
New technology can trigger a sequence of additional tests and treatments. Driven by anxiety, fear of malpractice, and patient requests.
Describe the strategies to solve spending issues in the US healthcare system.
High healthcare costs in the US due to advanced technologies and system complexities. Strategies include changing reimbursement methods and insurance structures.
Define Efficient Consumption in healthcare.
If patients consume more than the efficient quantity, the value of the care that exceeds the efficient quantity is less than its price. If patients consume less, there is care that patients value at more than its price that they are not using.
What is Moral Hazard in healthcare, and what are the solutions?
Overconsumption of healthcare services because insurance covers part of the cost. Solutions: Increase out-of-pocket costs, utilization management, change payment models, limit healthcare resources.
What factors influence patient decisions in healthcare?
Preferences, Income, Price of other goods, Demographics.
Define elasticity in the context of healthcare services.
Elasticity measures how the quantity demanded changes with price changes. Price elastic: Services that people are willing to forego if the price rises. Price inelastic: Essential services that people will still buy even if the price increases.
What are the parts and features of Medicare in the US?
Medicare is a federal health insurance for people over 65 or with certain disabilities. Parts: Part A (Inpatient care), Part B (Outpatient care), Medicare Advantage (Part C), Part D (Prescription drug coverage), Gap Plan.
What is the role of Medicaid in the US healthcare system?
Medicaid is a federal-state partnership providing health insurance with shared costs. States must cover basic services but can offer additional services and more generous eligibility.
What is Adverse Selection in health insurance, and what are the solutions?
Adverse Selection: Higher-risk individuals are more likely to buy insurance, leading to market imbalances. Solutions: Single Payer, Market-Based incentives.
Describe the different insurance plan features and their importance.
Cost sharing, premiums, deductibles, and spending triggers determine how much care a person will consume. Cost sharing includes copays, indemnity, and coinsurance.
What is the process of handling medical bills and insurance?
Chargemaster lists services and prices used to generate medical bills. Insurers negotiate allowed amounts with providers. Uninsured face full charges without negotiated discounts.
Explain the concept of Price Competition and Transparency in healthcare.
Limited in healthcare due to the importance of quality and expediency. Transparency helps patients shop for better prices but may not always improve outcomes.
What are the human behavior factors considered in healthcare economics?
Decision making, Utility, Rational choices, Economic vs. Accounting Costs, Perception and Information.
Describe the impact of Managed Care Organizations (MCOs) on healthcare.
MCOs aim to reduce costs while maintaining health outcomes. Strategies include eliminating wasteful spending, using incentives, and structures like HMO, PPO, POS.
What are the phases of drug approval in the US?
Phases: Preclinical and Phase 0, Phases I-III, New Drug Application (NDA), Post Market Observation.
Explain the concept of externalities in healthcare and give examples.
Costs or benefits from an activity that affect others not involved in the decision. Positive externalities: Vaccination, Negative externalities: Smoking.
What is the purpose of Tort Law and Medical Malpractice systems?
Provides restitution for harm caused by another's actions. Goals: Compensation and incentive to avoid malpractice. Includes economic, noneconomic, and punitive damages.
Describe health inequality sources and its impact.
Income, local environment, intergenerational persistence, urban-rural differences. Assessed using John Rawls’ veil of ignorance.
What are the international healthcare models, and which countries follow them?
Bismarck Model: Germany, Belgium, France, Japan. Beveridge Model: New Zealand, Spain, UK. Nationalized Health Insurance: Canada, South Korea. Fee-for-Service: Developing countries.
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