Healthcare systems and practices

Health Care

Healthcare Questions

Compare the Dutch, German and British healthcare systems in terms of financing and delivery structures and incentives.

Dutch health care is financed with a mix of public and private funding. It has been described as a "hybrid of the German social insurance model and the American private insurance model" (Schippers 2002). Public funding, including social insurance, mandatory private insurance and tax subsidies, contributes over 85% of healthcare funding for the Dutch but their supply is predominantly private in character. Also, "one guiding principle" of the Dutch system is "that if people become able to pay for themselves they should...unlike their German neighbors who may, having reached an annually determined income threshold, choose whether or not to leave the statutory scheme, the Dutch must leave" (Schippers 2002).

With the exception of about 2 million permanent civil servants, and the self-employed, Germans who earn below Euro 3,862 gross salary per month in 2004 must join one of the 300 statutory sickness funds. Those above the mandatory insurance threshold may opt out of the state system and buy private insurance instead but many opt to remain in the state system - 10 per cent of the population are voluntarily insured" (Green 2005). "German sickness funds are required to be financially self-sufficient and premiums are set as a percentage of income" (Green 2005).These funds are competitive, and people shop around for insurers and physicians. "No money changes hands at the point of service. Instead, physicians are reimbursed by sickness funds via their regional physician associations. People who have opted for private insurance, however, generally pay by invoice for treatment received" (Green 2005).

The National Healthcare Service in Great Britain (NHS) in contrast is entirely publically funded from taxation, although a parallel private service is extant, and is occasionally used by small percentage of the population.

Should specialists be on hospital payroll or paid by third parties?

The question of whether specialists should be on the hospital payroll or be paid for by third parties depends upon the population the hospital serves. If specialists are regularly needed, and perform vitally needed care, this suggests that they should be on the hospital payroll. More esoteric and less vitally needed specialists might be better off employed on an as-need basis and paid for by third parties.

Define scope and scale economies. Explain hospital scope and scale economies

Economics of scope are based upon the idea that the average total cost of production decreases as a result of increasing the number of different goods produced ("Economies of scope," Investopeida, 2008). A large city hospital that provides many services is an example of an economy of scope. Economies of scale, in contrast, try to increase their financial efficiency by producing a greater number of the same goods with the same productive resources, such as a large dental, family planning, or ophthalmological clinic ("Economies of scale," Investopeida, 2008).

What is the "middle-income against all" public insurance problem? Would a parallel private system hence drain resources from the public system?

Charging even middle-income people based on their ability to pay for health care can discourage them from using the system as much, and divert them to using a private system as they will likely operation on the rationale that since they are paying, they might as well choose the less bureaucratic option, with shorter wait times and more flexibility of physician choice. Thus this can ultimately result in a financial loss for the public health system.

Why do public healthcare systems tend to exhibit an intrinsic tendency to produce waiting lists?

As more people use the system, the waiting lists tend to be longer. Also, as care is prioritized, those individuals deemed to be in a less urgent need of care are given a lower priority, which results in a wait list. Finally, as physicians are compensated on the same level of salary, fewer people may be attracted to the profession for its financial rewards. In a public system, patients shop around less for providers because most providers charge the same fees. Within a public system there is less 'siphoning' of middle-income people to higher-cost physicians with short waiting lists.

Visit: http://www.csc-surgery.com/contact.php.Whatexactly is this hospital? What would your policy response be?

According to its website, the Cambie Surgery Centre is a private healthcare clinic. The site notes that the "BC provincial government looks to private health care facilities like the Cambie Surgery Centre to help ease the long public wait lists." The hospital is a paying hospital that uses sophisticated technology to perform its services. Although it is unfair that cost can determine quality of care on one hand, on the other hand at least Canadian citizens, unlike their U.S. counterparts, have some access to medical care, regardless of their ability to pay at public facilities, and the center relieves some of the pressures inherent to the system. Ideally, the policy response should be to allow the clinic to continue, perhaps providing some financial incentives for the clinic to do some charity work to patients who cannot pay.

Emergency room waits are just inevitable." Evaluate.

The statement that "Emergency room waits are just inevitable" is not accurate in the sense that the length of all ER waiting times is justified. Bureaucracy and inefficiency, understaffed facilities, etcetera, can all increase wait time needlessly. In nations with private insurance systems, some uninsured patients may use the ER as their primary care facility, increasing overall wait time.