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MHA 707 Exam 2 LSUS - Special Topics
Private sector in Canada - Answer>>30%, private health insurance and out of pocket payments Canada Population - Answer>>35.1M- 2/3 live on southern border and 84% within urban centers Age and Ethnicity in Canada - Answer>>-age 41. -white 87% -Indian 4.2% -other 5.2% Literacy in Canada and Government - Answer>>99% and parliamentary Life Expectancy in Canada - Answer>>male- 79.2 years female 84.5 years GDP - Answer>>-$1.785 trillion USD -HC 10.6% -per capita spending on HC $4, -public debt 71% GDP -canadians below poverty line 16.2% Size of Canada - Answer>>9.9 M sq. KM Health Care System - Answer>>NHI (canadian medicare) funds over 70% of all HC expenditures. Each province sets a budget and dictates what it will pay for health services - sets prices and also, a limit on overall spending
Canadian Medicare - Answer>>is a joint program between the federal government and the 13 provinces and territories of Canada. All citizens are covered by Canadian Medicare or some other federally-directed program. PHI in Canada - Answer>>is usually provided as a perquisite of employment or purchased by individuals in the marketplace. What % of premiums are paid through employers? - Answer>>90% of premiums for private health plans are paid through employers, unions, or other organizations under a group contract. The coverage provided by PHI pays for the services excluded under universal coverage, such as vision and dental care, prescription drugs, rehabilitation services and private hospital rooms. Where does the funding for Canadian Health System's budget come from? - Answer>>comes from general taxation with provinces leading the way on budgeting. Federal government matches the provincial spending in a dollar-for-dollar program via yearly block grants. Out of pocket contributions from citizens - Answer>>approach 15% of total health expenditures and generally focus on medications, dental and optical care. This is a growing fraction of expenditures. When does the government grant a tax credit up to 15% of net income to assist with expenses?
- Answer>>Once a citizen pays more than 3% of his/her net income for out-of-pocket expenses Some have said Canada has - Answer>>13 or more health systems how many people in 2006 worked in HC occupations? - Answer>>About 6% of Canada's workforce- 1 million people. In 2011, what was the ratio of nurses? - Answer>>there were 270,700 registered nurses in Canada (885 RNs for every 100,000 population). In addition, there were 277 LPNs per 100, people. (This places Canada above the average nurse per population ratio of G8 countries.)
Represents a paradigm shift away from acute care hospitals toward out-patient care (Canada) - Answer>>A significant portion of these closures were among smaller hospitals, particularly in rural areas. However, much of the decrease in hospital beds overall is mirrored throughout the OECD countries. The acute care hospital bed occupancy rate (canada) - Answer>>was 95% in 2017. Patient Satisfaction (Canada) - Answer>>with Canadian Medicare is high and has been so for many decades. In 2005, 84% of Canadians rated their satisfaction as "very satisfied" or "somewhat satisfied. More recently in 2010 - Answer>>62% of Canadians surveyed felt that "fundamental changes" or "a complete rebuild" of the health care system was necessary. These numbers were similar to respondent in the United States. In the UK, almost 62% surveyed felt that only "minor changes" to the healthcare system or necessary. Since the 1990s (Canada) - Answer>>there has been decreased federal support for the Canadian Medicare program which has resulted in a decline in healthcare infrastructure. The central issue is over physical access to healthcare services. Prolonged wait times, particularly for complex diagnostics and surgical procedure highlight Canada's difficulties. System performance (Canada) - Answer>>The average time for joint replacement surgery in Canada is about 6 months. There is also a physician shortage as well as a scarcity of support staff (particularly, radiologic technicians and rehabilitation therapists) in many provinces. Common cause of death in Canada? - Answer>>is cardiovascular disease. This was followed by lung cancer, stroke and dementia. Suicide and homicide are not in the top 10 causes of death for adults, nor are unintentional injuries/accidents. Alcohol/Drug abuse- This is a growing detriment to the overall health of people in all countries. In 2016, the OECD reported Opioid-related Deaths per 1 M population - Answer>>United States
UK - 41
Canada - 121 Sweden - 58 France - 3 Estonia - 80 Dependent drinking (Canada) - Answer>>United States - 7.1 % UK - 1.9% Canada - 4.1% Sweden - 5% France - 3% OECD average - 3.6% Canada- Availability of Care - Answer>>Wait times for diagnostics and surgical procedures are a continual source of problem as discussed above. If a service is "covered" but not available, when does it become constructively "not covered"? Availability is a crucial part of access. Overall Health Care Budget - Answer>>Canada currently spends around 10% of its GDP on healthcare. Although higher than most OECD countries, there is still room for more financial support if needed. Many Canadians are hoping for a broader range of services covered by Canadian Medicare, particularly pharmaceuticals, in the future. There are also growing calls for "privatization" of the healthcare system, similar to the United States. However, a recent survey showed that only about a third of Canadians are interested in this approach. Coordination of Care - Answer>>Just as in all healthcare systems, the coordination of care between primary care and specialty care needs improvement. Discharge planning from hospitals is the most commonly-cited area for concern. Health Disparities - Answer>>Growing health disparities between native populations and other Canadians, urban versus rural citizens and between the wealthier provinces and those with smaller budgets continue to be a source of concern.
France unemployment rate - Answer>>10.1% (2015) 12% of French citizens live under poverty level (US - 11%) Size of France - Answer>>551,695 Sq. kilometers (210,016 Sq. miles) It is 2 times larger than the UK, and the third largest country in Europe behind Russia and Ukraine. 19% of the population is considered rural. HC system in France - Answer>>NHI (National Health Insurance) and was established in 1945 as part of a broader social security system. This system replaced many insurance organizations that had developed over the prior century with a single network of coordinated insurance departments. The healthcare system (France) coverage grew from a workman's compensation program in 1945 into universal health care coverage in 2004, called - Answer>>SHI (statutory health insurance). Healthcare benefits accrued to all citizens. However, only the employed and their employers contributed money into the system via payroll taxes and insurance premiums. At the time universal coverage was enacted, - Answer>>providers were reimbursed via fee-for- service (FFS), retrospective reimbursements were allowed and patients were given unrestricted freedom to choose primary care and even specialty care providers. This system proved to be too costly so the government and private insurers enacted several cost sharing schemes including substantially lower reimbursements for dental, optical and prescription drugs and economic disincentives for not using a GP gatekeeper. Patients must now have a referral from a primary care "gatekeeper" before - Answer>>they can see a specialty physician unless they are willing to pay extra. The insurance system will only reimburse 60% of the cost of a specialty physician if there is no referral from a GP. What has been a preemptive strategy for the French over the last 4 decades? - Answer>>Curbing supply
Determined by Government (France) - Answer>>There is central control of hospital beds and provider fees for both hospitals and physicians. These measures have resulted in lower drug prices as well as hospital bed charges and physician fees for several years. The government has controlled medical fees by imposing ceilings on charges as well as setting global reimbursement targets for laboratories, hospitals and even nursing care. - Answer>>If these global targets are not met, corrective measures such as lowering the overall level of charges available in a region or service level, e.g., hospitals are put in place. The government can also claim refunds from practitioners (as a penalty) if cost-containment goals aren't met. France employers are required by law to provide? - Answer>>health insurance (SHI) for employees. The government provides health insurance for the unemployed and provides small subsidies for those who are employed but, have low-level jobs. 95% of French citizens also have voluntary health insurance (VHI) - Answer>>VHI comes from private insurance carriers and is often provided as a perquisite of employment. VHI covers what SHI excludes - predominately extra dental and vision coverage plus any balance billings from physicians. Balance billing in France represents? - Answer>>represents the difference between the SHI reimbursement rate (which is set by the government and the SHI insurance companies) and the actual charges made by the provider. Balance billing amounts can be substantial and are determined by the length of the post-graduate medical training of the doctor. VHI (France) represents - Answer>>15% of the total national health care expenditures in France. Presently, employees bear more than 50% of the premium costs of VHI. France Funding- Payroll - Answer>>53% of funding (Employers pay 80% of the payroll taxes while employees pay the remaining 20%.) France Funding- National Income Tax - Answer>>tax contributes 34% of total funding. Special taxes levied on tobacco and alcohol the pharmaceutical industry and the providers of WHI provide about 12% of total funding. State governments provide about 1% of total funding.
Although prices are set by the central authority, physicians are allowed to charge above the set rate (France) - Answer>>Last year, 25% of physicians charged above the national fee schedule regularly. This fact deteriorates the power of monopsony pricing that would otherwise be present in the French market place for healthcare. In 2018, there were __ nurses? - Answer>>700,000 nurses in France or about 11.5 nurses per 1,000 population. This compares with 14.5 per 1,000 pop in U.S. and 8.2 per 1,000 pop in UK. Delivery of Care in France - Answer>>The first point of contact for most patients in France is through a GP. There are economic incentives in place to encourage patients to allow the GP to function as the "gatekeeper" for all other care (specialists, hospitalization, therapy, etc.). there are no major penalties (France) - Answer>>for a citizen to access the healthcare system through a specialist or another GP, if desired. This freedom to choose a physician is very dear to the French. The majority of primary care services are delivered in physician's offices. Generally, all citizens are registered with a GP. In 2013 (France) - Answer>>there were 3,200 hospitals in France. Public hospitals account for 25% of beds. These public hospitals provide research and training of medical students and medical personnel. France- NP private hospitals - Answer>>hospitals account for 22% of beds while private for- profit hospitals account for 32% of hospitals in France (The private for-profit hospitals have seen the steepest decline in recent years). France- Public Hospitals - Answer>>receive a single per diem rate from the government that covers all services provided while private for-profit hospitals can bill for separate items. The number of hospital beds has decreased by 32,000 beds in recent years, leaving roughly 6.3 beds per 1,000 population, which is slightly above the European average. France- Rural Hospitals - Answer>>have closed because they cannot keep up with the latest technology and occupancy is low. However, much of the decrease in hospital beds overall is
mirrored in all OECD countries. This represents a paradigm shift away from acute care hospitals toward out-patient care. Hospital costs represent (France) - Answer>>38% of France's total health expenditures. The European average is 31%. The acute care hospital bed occupancy rate was 95% in 2017. Patient Satisfaction- France - Answer>>with the French health care system is high probably due to ease of access, freedom to choose a provider and no waiting lines. In 2004, 65% of the people surveyed were very positive about their health care, while only 6% consider HC a serious concern. The French system promotes - Answer>>(of provider and point of service) over cost and the system is usually more available to the average patient than in Canada or the UK. Access as measured by average wait-times for doctor appointments, high tech imaging and surgical procedures are very good in France. - Answer>>However, there can be large disparities among regions of the country, particularly those viewed as rural or underserved. These disparities also spill over into life expectancy and illness data. The most common cause of death in France is? - Answer>>cancer, particularly lung cancer (reflective of the high smoking rate among French adults, 31.7%; the smoking rate among U.S. adults is 23.9 %). Cardiovascular disease is the next leading cause of death in France followed by stroke and dementia. Suicide, homicide and unintentional injuries are lumped together (at 8% of total deaths) and barely make the list. Overall costs of providing health care (France) - Answer>>costs are straining national budgets Coordination of care (France) - Answer>>Just as in all healthcare systems, the coordination of care between primary care and specialty care needs improvement. Discharge planning from hospitals is the most commonly-cited area for concern.
Comparing drug prices between countries is incredibly complex, primarily because? - Answer>>of the intricate pricing schemes used by manufacturers with wholesalers, retailers and distributers through rebates, discounts and bundled pricing with other drugs in a "portfolio" offered to a specific provider or health care organization. In a 2013 analysis, researchers created a "retail price index" (RPI) for pharmaceuticals - Answer>>which attempted to merge RPI was 95 in Germany, 61 in France, 50 in Canada and 46 in the United Kingdom. In other words, U.S. retail prices for commonly prescribed drugs ranged from as low as 5 percent and up to as high as 117 percent more than prices for the same drugs in the other six major countries studied. Some of the reasons proposed by the authors - Answer>>were that many other countries employ centralized price negotiations with manufacturers, maintain strict national formularies, and utilize government research to assess cost-effectiveness for adding expensive drugs to the formulary and for determining price ceilings for prescription drugs.
. Although other factors may have a minor role, most experts believe that the majority of the spending difference in prescription medications relates to - Answer>>US drug prices in general. Similarly, Langreth, et al (2017) found that the prices of "blockbuster" new drugs were almost uniformly markedly higher in the United States, often multiples higher than the UK and Canada. What about the use of generic drugs which are generally cheaper? - Answer>>Counterintuitively, Kanavos, et al, (2013) found that the use of generics is highest in the US (along with UK) at 84%, followed by Germany (83%), Canada (70%), France (30%) and Switzerland (22%). Interestingly, generic prices appear to be significantly higher in the US than in other countries which may account for some of the extra cost overall. Other countries often get deep discounts on the same medications we pay top dollar for here in the US. Why? - Answer>>Because the medical systems in those countries set limits on what they will pay. The government-run health care systems have strict budgets and use this "lever" to keep prices down. Drug companies then face a dilemma - should they refuse to allow these other countries to have their medications at a significant discount - indeed, many of them are critical drugs
should they cost-shift the losses (or, lack of profits) to the American market? - Answer>>It is clear what that decision has been in the past! However, if drug companies were forced by law to limit prices in the US to a small margin above the lowest price they give another country, US drug costs would drop dramatically. Of course, the prices in many other countries would rise accordingly (some would rise dramatically), but this move seems intuitively fair to everyone. - Answer>>Poorer countries would have to adjust budgets upwards or make decisions about which medications they can afford to purchase. The downstream effects might be significant but, limiting drug companies to a 10 - 15% margin in the US above their "Most-Favored-Nation Price" internationally would lower Health Care costs here and force foreign healthcare systems to bare their fair share of the burden - or do without. It might be prudent to exclude vaccines from this pricing rule because they provide spillover benefits in this country through less influx of disease from outside our borders. Portfolio pricing - Answer>>This tactic stops market forces from working to cull out inferior products that would otherwise be eliminated by being priced too high or being unable to compete on value (a blending of quality and price). In 1999, the English NHS established the National Institute for Health and Care Excellence (NICE). - Answer>>NICE evaluates new technologies and treatments for the NHS to limit adoption to those that bring "value" to the system and also to facilitate uniform dissemination of those that are adopted. NICE makes decisions about relative benefits and cost-effectiveness compared to currently available therapies and seeks to maintain a coordinated approach to similar clinical situations (i.e., practice guidelines) and in complex situations such as end-of-life care and how far to go when traditional treatments fail. The reason that all 4 drugs, plus the older products, were still on the market four years later was because of? - Answer>>of price bundling by distributors which artificially propped up prices and sales for the less-desirable drugs. This is clearly NOT a true market! Some government oversight is needed to level the playing field and spur cooperation among rivals to save money - OUR money! the FDA, in conjunction with the NIH, CDC and select providers, could establish methods for - Answer>>analyzing and limiting unnecessary duplications in R & D for new medications and "better" medical devices
