Chapter 4 - Chapter 4 Health care systems organizational...

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Chapter 4 11/11/13 Health care systems: organizational arrangements and processes through which a society makes choices concerning the production, consumption, and distribution of health care services Who makes the choices? o Centralized government: a single individual or an appointed or elected committee o Decentralized: individual consumers and health care providers through interaction in the marketplace Model of a health care system: o Three players: Patients or consumers o Sponsors: act as intermediaries or brokes Employers or government Structure coverage, manage enrollment, contract and negotiate risk-sharing arrangements… The contributions… o Three elements: Financing Reimbursement Production or delivery Canada—National Health Insurance o Compulsory—everyone in Canada is covered by this one insurance plan Called Medicare, but closer to Medicaid o Maintained by each province (varies a little by province) o First-dollar coverage Means no deductible or copayment for most services o No limit on lifetime benefits You can’t run out of dollars o Taxes from each province, some federal government cost-sharing o Private insurance coverage for services covered by NHI is illegal o The third party payer is that one insurance provider o Canada has very minimal out-of-pocket Germany—Socialized Health Insurance o A little bit of what we should expect with our Affordable Care Act o Government mandated—everyone must have health insurance (it does not have to be
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  • Fall '15
  • Health care provider

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