Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Financing Health Care, Part 1 Lecture c This material (Comp 1 Unit 4) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Financing Health Care, Part 1Learning Objectives - 1 • Describe the history and role of the health insurance industry in financing health care in the United States, and federal laws that have influenced the development of the industry. (Lecture a) • Explain the importance of the health care industry in the U.S. economy and the role of financial management in health care. (Lecture b)

3. Financing Health Care, Part 1Learning Objectives - 2 • Describe models of health care financing in the U.S. and in selected other countries. (Lecture c) • Explain the differences among various types of private health insurance and describe the organization and structure of network-based managed care health insurance programs. (Lecture d)

4. Financing Health Care, Part 1Learning Objectives - 3 • Describe the various roles played by government as policy maker, payor, provider, and regulator of health care. (Lecture d) • Describe the organization and function of Medicare and Medicaid. (Lecture e)

5. Health Care in Other Countries • Benefits/drawbacks of two public (tax-funded) health care plans • Compare a multi-payor health care system with a single-payor system • The role of private health insurance in each system

6. Types of Health Care Systems • Mixed Delivery System • Primarily private health care organizations and providers • Government operated system • Affordable Care Act (ACA) • Veterans Health Administration • Military Health System • Indian Health Service

7. Single vs. Multi-Payor Systems • United Kingdom • Public payor • Public funded • Provides basic services • Private payor • Employer plans • Canada • Single public payor in each province or territory • Limited or no private payor

8. Public Health Care in the United Kingdom and Canada • United Kingdom:National Health Service • Department of Health funds 5 regional health care plans throughout the country • Canada: MEDICARE • Provincial/Territorial Single Payor • Medicare funds provinces and territories, which run their own health plans

9. Five Single-Payor Systemsin the United Kingdom • The U.K. Department of Health: • Funds the National Health Service (NHS) • Ten regional health authorities • Primary Care Trusts (PCTs) • Salary • Fee-for-service • Capitation

10. How the NHS Began • 1946 National Health Service Act passed • Authorized NHS • Began covering medical services July 1948 • Goal - Provide free health care for all citizens • Ambitious and controversial project • Health minister Aneurin Bevan • 90% of British doctors joined

11. NHS Governance & Responsibilities • The Department of Health • Administers and provides funds • Responsible for NHS • Public • Parliament • Improving public health • Environmental health hazards • Medication safety • National policies • Health education

12. NHS Expenditures and Funding • Expenditures • Per capita spending (2013) $3,595 • Financing • National taxes (76%) • Payroll taxes (18%) • Other sources (6%) • NHS patients • Private patients • Other

13. What the NHS Provides • Universal coverage for all U.K. residents • Primary care, specialists, hospital care, long-term care, and preventive care • Mental health, rehabilitation, dental, and eye care

14. NHS Patient Fees • Services free until the early 1950s • 2007 out-of-pocket average cost • U.K. $343 in U.S. dollars • U.S. $890 in U.S. dollars • Help keep health care affordable: • Fixed rate for prescriptions • Fee exemptions • Caps on cost of dental procedures

15. U.K. Private Health Insurance • 12% of population • Employer sponsored • Self-pay for private insurance • Provides more choices and shorter wait lists • NHS or private hospitals • NHS working to reduce wait times • Hospital specialist : 18 weeks or less

16. Post-2010 NHS Reform • Health services determined locally, not centrally • Groups of local general practitioners, specialists, nurses, and consumer advocates • Requirements: • Provide urgent and emergency care • Address health and social needs of all users • Protect patients’ interests, quality, and efficiency through outcomes

17. The Canadian Health Care System (MEDICARE) • Similar to the NHS • Taxpayer-funded • Universal coverage • Different from the NHS • Nationwide and regional funding • Federal government cannot run regional health care plans • Limitations on private health insurance

18. Financing Canada’s Health Care • Canada Health Act 1984 • Increased access • Lowered individual costs • Defined medically necessary services • Financing • Federal income tax distributed to provinces and territories • Province/territory fund a portion

19. Hospital & Provider Dichotomy • Hospitals • Most hospitals public institutions • Providers • Most providers in private practice • Paid fee-for-service

20. Five Principles ofthe Canada Health Act • Public administration • Comprehensiveness • Universality • Portability • Accessibility

21. Public Administration and Comprehensiveness • First two principles explain how plans are administered • Public administration: • Publicly administered • Non-profit organizations • Accountable to the public • Comprehensiveness: • Must provide all medically necessary services • Each province or territory decides what is medically necessary

22. Universality, Portability,and Accessibility • The last three principles protect patient rights • Universality • Right to health care • Portability • Provides coverage between regions or travels outside of Canada • Accessibility • Provided regardless of health, age, or income

23. MEDICARE Coverage in Canada • Medically necessary services • Medical and surgical care • Preventive care • Hospitalization due to illness or injury • Medical Equipment • Dental surgery • Extended health care services • No requirement for coverage • Many areas provide some coverage • Average $580 per year out-of-pocket

24. The Role of Private Insurance • Private insurance • Available through employers or purchase • Supplement for non-covered Medicare services • Prohibited from paying for medically necessary services • Private insurance payments • 30% of Canada’s total health care expenditures

25. Limiting Private Insurance • Effects include: • Does not improve access to basic services already covered by MEDICARE • Increases the public cost of universal coverage • Some want to expand the role of private insurance to solve these problems • Others want to continue restriction to ensure equal access for all

26. Public Health Benefitsof the Canadian System • Statistics show Canadians benefit from good health care • Life expectancy • 80 years as of 2005 • Among highest in industrialized nations • Infant mortality cut in half from 1979 to 2005

27. Financing Health Care, Part 1 Summary – 1 – Lecture c • Health plans in the United Kingdom and Canada reflect different national priorities • Both have tax-funded universal coverage • United Kingdom NHS • Centrally administered and funded • Services at government operated facilities • Providers employees of NHS • Private insurance allows for additional access and choice

28. Financing Health Care, Part 1 Summary – 2 – Lecture c • Canada MEDICARE • Services at government facilities by private providers • Private health insurance limited to provide equal access • Challenge of wait times • UK permits private insurance • Canada does not

29. Financing Health Care, Part 1References – 1 – Lecture c References British Broadcasting Corporation. Birth of the National Health Service: the early history of the NHS. http://www.bbc.co.uk/archive/nhs. Accessed January 23, 2017. British Broadcasting Corporation. The NHS at 50: making Britain better. http://news.bbc.co.uk/2/hi/events/nhs_at_50/special_report/119803.stm. July 1, 1998. Accessed January 23, 2017. Canadian Health Care. www.canadian-healthcare.org. Accessed January 23, 2017. Citizens Advice Bureau [United Kingdom]. National insurance—contributions and benefits. http://www.adviceguide.org.uk/index/life/benefits/national_insurance_contributions_and_benefits.htm. Accessed January 23, 2017. Citizenship and Immigration Canada. Health care in Canada. http://www.cic.gc.ca/english/newcomers/after-health.asp. Accessed January 23, 2017.

30. Financing Health Care, Part 1References – 2 – Lecture c References Commonwealth Fund. 2015 International profiles of health care systems. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf. Accessed January 23, 2017. Department of Health [United Kingdom]. History of the department. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Aboutus/HowDHworks/DH_074813. Updated May 23, 2007. Accessed January 23, 2017. Department of Health [United Kingdom ]. About us. https://www.gov.uk/government/organisations/department-of-health/about. Accessed January 23, 2017. Health Canada. About Health Canada: activities and responsibilities. http://www.hc-sc.gc.ca/ahc-asc/activit/index-eng.php. Updated May 3, 2008. Accessed January 23, 2017. Madore O. The Canada Health Act: overview and options. Library of Parliament, Parliamentary Information and Research Services. http://www2.parl.gc.ca/content/lop/researchpublications/944-e.htm. Updated May 16, 2005. Accessed January 23, 2017.

31. Financing Health Care, Part 1References – 3 – Lecture c References National Health Service. Help with health costs. http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Abouthealthcosts.aspx. Updated. January 15, 2015. Accessed January 23, 2017. National Health Service. Care equipment, aids and adaptations http://www.nhs.uk/conditions/social-care-and-support-guide/pages/equipment-aids-adaptations.aspx. Accessed January 23, 2017. National Health Service. NHS history. Updated July 5, 2007. http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx. Accessed January 23, 2017. National Health Service. What is NHS continuing healthcare? http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=155&SubCategoryID=155. Updated April 29, 2015. Accessed January 23, 2017.

32. Financing Health Care, Part 1References – 4 – Lecture c References National Health Service. Encyclopaedia Britannica. https://www.britannica.com/topic/National-Health-Service. Accessed January 23, 2017. NationTalk. Canada’s new government announces patient wait times guarantees with all the provinces and territories. http://nationtalk.ca/story/canadas-new-government-announces-patient-wait-times-guarantees-with-all-the-provinces-and-territories. April 4, 2007. Accessed January 23, 2017. Steinbrook R. Private health care in Canada. N Engl J Med. 2006;354:1661-1664.

33. Introduction to Health Care and Public Health in the U.S.Financing Health Care, Part 1Lecture c This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001.