presentation for business policy class

1. Foreign Health Care Policy

2. Why look overseas? Many countries mandate health care for all their citizens The Commonwealth Fund’s 2007 health policy survey compared U.S. system with 6 nations: Australia, Canada, Germany, the Netherlands, New Zealand, and the U.K. 2007- The U.S.A. spent $6697 per capita on health expenses 2007- Canada spent $3326 per capita (next highest) 23% of Americans prevented by expense to fill prescriptions 13% of Australians could not afford to fill prescriptions 20% of Americans and Australians experienced medical error while under care

3. How do the others pay for insurance? Single payer model Tax payers and employers pay into national fund Pays for regular treatment and prescriptions Providers are compensated through fund Multi payer model Both private and public funds are used Employers can opt to pay for insurance or buy into government plan Self-employed are given many affordable plans Disadvantaged get subsidized or free insurance Both models utilize price-control mechanisms

4. Canada’s Health Policy Public administration, comprehensiveness, universality, portability and accessibility The Federal-Provincial Arrangements and Established Programs Financing Act of 1977 Provided block funding to provinces Concern that funds were diverted for non-health activities Canada Health Act of 1984 Established criteria to be met in order to receive federal funds Provinces given 3 years to comply

5. Canada Health Act Universal health insurance coverage for all Canadians Financed through federal government and provincial revenues Services are mostly fee-for-service basis Nearly half of the estimated $100 billion budget spent on hospitals and physicians Physicians exhibit direct influence on health care costs Other health care professionals may be more effective and less expensive Includes nurses, chiropractors and midwives

6. Canada Health Act Guaranteed health care, not access to conditions leading to good health Determining factors: SES, age, gender, occupation SES—affects mortality, morbidity, disability Age—affected mostly by the young and the elderly Gender—women may live longer, but have more health problems Occupation—may be affected by hazardous working conditions Needs to shift focus onto maintaining and improving health from different dimensions Develop and promote programs that enhance overall wellness Health interventions starting with young children

7. Taiwan’s Health Policy Promoting social equity, raising efficiency, elevating the quality of care and forging a national consensus National Health Insurance (NHI) enacted in 1995 Original goal was to improve access to health care Social insurance program organized by the federal government Operated by the Bureau of National Health Insurance Four committees—The NHI dispute mediation committee, NHI medical expenditure negotiations committee and NHI task force Required enrollment for all Taiwanese citizens and any legal residents Payroll-based premiums Subsidies for the disadvantaged

8. NHI Premiums set by ability to pay and pooling of resources Taiwan’s population is subdivided into 6 groups Groups 1-3 pay based on income, 4-6 based on average premiums paid by general population Civil servants, teachers, self-employed Occupational union members, foreign crew Farmers, fishermen Military Low income workers Unemployed

9. NHI Notes: Income basis: amount of income which premiums are levied based on a payroll bracket Insurance premium rate: 4.55% since 2002 Contribution ratio: set by bureau of NHI Number of dependents: maximum of 3 counted Average monthly premium for cat 4 and 5 is entirely subsidized by govt, cat 6 is 60%

10. NHI Financing—not for profit Required by law to maintain reserve fund for at least one month Funded mostly by paid premiums Rates are reviewed bi-annually adjusted once since 1994 Private sector employees pay 30%, employer or registration organization 60%, government pays 10% Pay for service copay by the insured Copay is higher at medical centers and hospitals than in clinics Copayment exemption for patients with catastrophic illnesses, childbirth, veterans, disadvantaged, children under age 3 Other financial sources include fines on overdue premiums, lottery, tax surcharge on cigarettes

11. NHI Currently NHI focus is shifting to quality of care: 3 goals Expand patients’ knowledge by making information on quality and services transparent Pay greater attention to quality of medical services delivered to the disadvantaged Greater emphasis on patient safety Now includes holistic care for chronic ailments Global budgeting system initiated in 1998 Targeted dental, traditional Chinese medicine, Western medicine clinics and hospitals Helped to prevent supplier induced demand

12. NHI Access to Health Care As of December 2008 98% of all health care facilities were contracted with NHI Insured members receive a card that enables him to choose any contracted facility for treatment Cut waiting times to visit a doctor Insured members receive reimbursement for emergency procedures performed overseas Since 2006, insurance premiums can be deducted from income taxes

13. Germany’s Health Care Three health insurance options for Germans Government regulated public health insurance GKV Private health insurance PKV A combination of both The health insurance reform of 2007 requires all German residents to be insured for at least hospital and outpatient medical treatment Meant to drive competitions between insurance providers In order to reduce costs, out of pocket expenses have risen

14. GKV Most popular among Germans (approx. 70 million people) Membership compulsory for citizens earning less than 48,600 Euro annually Competition is based on service not price Premiums are 15.5% of monthly income Maximum threshold is 570 Euro Approximately 45% is paid by employer Benefits to the insured In-patient hospital care Out-patient care with registered doctors Basic dental care

15. PKV Private Medical Insurance Covers wider choice of medical and dental treatment than GKV Private insurance holders may receive more specialized service Premium costs are higher than GKV Prices are based on benefits chosen as well as age, gender, and pre-existing conditions Premiums are traditionally per person rather than per family Private insurance companies cannot cancel a policy if the insured submits a claim 10% of monthly premiums are put aside to help stabilize premium prices after retirement

16. Benefits from these models Canada- Canada offers similar patents for prescription drugs as in the U.S. but they regulate drug prices on all patented drugs Patented Medicines Review Board Canadian health care encompasses the idea that all Canadians are entitled to accessible affordable health care Taiwan- The insured is given freedom to choose doctors and services as well as their venues Alternative and Chinese medicine are offered through NHI Germany- By regulating premium rates in any GKV, competition is based on performance and benefit to the insured rather than price There are several options for PKV benefits that can supplement GKV