Health Care Models

Thursday November 1, 2012 – Periods 4 & 5

  There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills. For all the local variations, health care systems tend to follow general patterns and fall into four basic systems.

The Beveridge model is named after William Beveridge, who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments. Many hospitals and clinics are owned by the government. Some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you will never get a doctor bill. The system tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge. Countries using the Beveridge plan include Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge style health care, because the people refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach and it is the world’s purest example of total government control.

The Bismarck model was named for Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. This system uses an insurance system called “sickness funds” and is usually financed jointly by employers and employees through payroll deduction. Doctors and hospitals tend to be private in Bismarck countries. The Bismarck model is found in Germany, France, Belgium, the Netherlands, Japan, Switzerland, and in Latin America.

The National Health Insurance model has elements of both Beveridge and Bismarck. It uses private sector providers, but payment comes from a government run insurance program that every citizen pays into. The single payer tends to have considerable market power to negotiate for lower prices. The NHI system is found in Canada, Taiwan, and South   Korea.

The Out-of-Pocket model is used by most of the nations that are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die. In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access to a village healer using home-brewed remedies that may or not be effective against disease. In the poor world, patients can sometimes scratch together enough money to pay a doctor bill. Otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.

SSA Video Part 2

Wednesday October 31, 2012 – Periods 4 & 5

  Today we completed  the video Sick Around the World. We learned that in the 1990s, Taiwan researched many health care systems before settling on one where the governmen collects the money and pays providers. But the delivery of health care is left to the market. Taiwan adopted a National Health Insurance model in 1995 after studying other countries’ systems. Like Japan and Germany, all citizens must have insurance, but there is only one government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada’s and the U.S. Medicare program. Taiwan’s new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen in Taiwan has a smart card, which is used to store his or her relevant health information, medical history and bills the national insurer automatically. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country’s single insurer, Taiwan’s health care system has the lowest administrative costs in the world. But the Taiwanese are spending too little to sustain their health care system and the government is borrowing from banks to pay what there isn’t enough to pay the providers. The problem is compounded by politics, because it is up to Taiwan’s parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Our last stop is Switzerland, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal or the sickness, which set up a universal health care system. Switzerland didn’t have far to go to achieve universal coverage as 95 percent of the population already had voluntary insurance when the law was passed. Today, Swiss politicians from the right and left enthusiastically support universal health care. The Swiss system is social insurance like in Japan and Germany. All citizens are required to have coverage and those not covered are automatically assigned to a company. The government provides assistance to those who cannot afford the premiums. The Swiss shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. However, they can make money on supplemental insurance. Like Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government. The Swiss system is the second most expensive in the world, but it is still cheaper than U.S. health care. Drug prices are higher than in other European nations and are subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. The Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

We discovered that American health insurance companies routinely reject applicants with a preexisting condition, precisely the people most likely to need the insurers’ service. Insurance companies employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer’s rescission department digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this to survive in a tough business. Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital, usually within tight time limits. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage. Foreign health care models are not really foreign to America, because our health care system uses elements of all of them. For Native Americans or veterans, we are like Britain or Cuba. The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we are like Japan or Germany. Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we are like Taiwan or Canada. Everyone pays premiums for an insurance plan run by the government and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we are like Cambodia, Burkina Faso, Burundi, Burma, or rural India. In the world’s poor nations, sick people pay out of pocket for medical care and those who cannot pay stay sick or die. This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. We have blended them all into a costly, confusing bureaucratic mess. Which, in turn, punctures the most persistent myth of all: that America has “the finest health care” in the world. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero. Given our remarkable medical assets, the best-educated doctors and nurses, the most advanced hospitals, and world-class research; the United States could be and should be the best in the world.

SSA Video Part 1

Tuesday October 30, 2012 – Periods 4 & 5

  In Sick Around the World, we find out how other capitalist democracies deliver health care. Our first stop is the United Kingdom. The British system is socialized medicine because the government both provides and pays for health care. The British pay taxes for health care, and the government run National Health Service or NHS distributes those funds to health care providers. Hospital doctors are paid salaries while General Practitioners are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private pay patients. Because the system is funded through taxes, administrative costs are low. There are no bills to collect or claims to review. Patients have a medical home with their General Practitioners, who also serves as a gatekeeper to the rest of the system. Patients must see their General Practitioners before going to a specialist. General Practitioners are paid a bonus for keeping their patients healthy and are instrumental in preventive care. Preventive care is an area in which Britain is a world leader.

Next from Japan, we learn that the Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Japan spends about half as much on health care per capita as the United States. Japan uses a social insurance system in which all citizens are required to have health insurance. The Japanese receive insurance either through their work or purchased from a community based plan. Those individuals who cannot afford the premiums receive public assistance. Most health insurance is private and cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit. Doctors and almost all hospitals are in the private sector. In Japan there are no gatekeepers. Having no gatekeepers means there’s no check on how often the Japanese use health care. The Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down. Japan has been so successful at keeping costs down that Japan now spends too little on health care. The result is half of the hospitals in Japan are operating in the red.

Finally we visit Germany, the birthplace of the national health care system. Germany, like Japan, uses a social insurance model. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 240 private, nonprofit sickness funds. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. As in Japan, the poor receive public assistance to pay their premiums. Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they pay higher co-pay if they do. Like Japan, Germany is a single-payment system and medical providers must charge standard prices, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts. This system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. However, German doctors pay much less for malpractice insurance, and many attend medical school for free. Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

Media and Health Care Review

Wednesday October 24, 2012 – Periods 4 & 5

  Today, we answered learning journal questions. First, our opinions are shaped by the information we receive about the world. Most Americans looked to trusted news media for information on politics and public affairs. The news media serve as watchdogs, agenda setters, and marketplace for an exchange of ideas, information, and opinions. Using specific examples, explain how the program, Sick In America, performed these three roles. Finally, in the United   States, insurance companies can deny coverage to people who are sick or who have pre-existing conditions, and they can make a profit. Explain how these two factors impact American health care.

SSA Video 1

Tuesday October 23, 2012 – Periods 4 & 5

  Today we learned that when health care is free, governments deal with all that increased demand by limiting what’s available. The reality of free health care is that people wait. It’s just the law of supply and demand. Lowering prices increases demand. Lowering the price to nothing pushes demand through the roof. Government is less the answer to the health-care crisis. It was government that helped to create the system in which Americans get health insurance through their employer. In a country where four in 10 Americans change their job every year, this system makes little sense. The government also makes insurance expensive by mandating the medical services that policies must cover. Required services vary state by state and are a reason why an individual policy in New   Jersey costs around $4,000 a year while a policy in Iowa costs only a third of that. Additionally, insurance regulations make it illegal for someone in New Jersey to buy a policy from out of state.

Another problem that raises costs, and keeps individuals from controlling their own health care, is the way we pay for medical care. Most of us have our medical expenses covered by a third party, either an insurance company or the government. When we pay for health care with someone else’s money, it creates nasty incentives. It’s good to be covered in case of a medical catastrophe, like a heart attack or cancer, but when patients pay for almost everything using third-party money, they have no reason to care about cost. Because the buyers don’t care about cost, neither do the health-care providers. If patients cared about cost, health-care providers would compete to attract patients. They’d do innovative things to keep costs low while increasing quality. In nearly every sector of the economy, prices drop over time as technology improves. Not so in health care.

When patients are in control of their health-care spending, things get better. People care about prices when they spend their own money, so providers compete to offer services that are faster, better and cheaper. The more people control the money they spend on their own health care, the more people shop around and the more providers compete to attract patients by lowering prices while improving quality. It’s putting individuals in control that could turn the health-care sector into the vibrant, competitive marketplace that we see in nearly every other area of our economy.

SSA Research: Video 1

Monday October 22, 2012 – Periods 2, 3, 6, 7

  Today we watched two segments of Sick in America. John Stossel’s reports that most everyone agrees, America’s health care system is a mess. Millions of Americans lack health insurance and still our annual health care costs exceed $2 trillion. For the country with the world’s best medical care, a lot of people seem unhappy. Many hate the insurance industry. Employers have seen insurance premiums rise 87 percent over the last seven years. General Motors now spends more on its employees’ health insurance than on steel. Doctors are fed up, too; the average physician’s office spends 14 percent of its income filling out paperwork. No one seems angrier than the patients who have been denied care. Vicki Readling was diagnosed with breast cancer after she had quit her job and lost her employer’s insurance. Readling purchased temporary insurance for herself, but when it expired she was told that because of her pre-existing condition, she would now have to pay $27,000 a year for a new policy. With an income of $60,000 and twin sons in college, she couldn’t afford it. Michael Moore calls for “the elimination of private profit-making health insurance companies” and suggests turning over all health care spending to the government to provide “free” health care to everyone. Insurance industry spokeswoman Karen Ignani is eager to report that most people aren’t like Readling. Only 3 percent of health insurance claims are denied, she says. Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage.

SSA Research

Wednesday October 17, 212 – Period 5

  Today the class continued with the research component of social science analysis. The class identified and summarized the main ideas, facts, supporting details, and opinions in an informational selection to help support analysis and conclusions by presenting appropriate information from primary and secondary sources.

Social Science Analysis Research & Examine

Wednesday October 3, 2012 – Periods 4 & 5

  Today the class continued learning about the next two SSA components. The research component of social science analysis is using and evaluating researched information to support  analysis and conclusion(s) To present appropriate information from various primary and secondary sources. Use and connect information from various sources throughout the analysis with appropriate acknowledgment (e.g. attributes, quotes, citations, references, etc.) To note source credibility, biases, stereotyping, and/or misrepresentations.

The examine component is identifying and analyzing characteristics, causes, and consequences of an event, issue, or problem. It identifies and objectively explains with some detail multiple points of view related to the topic. To explain several factors which influenced or caused the event, issue, or problem. Also explains some probable implications, effects, and/or results and their relationship to the event, issue, or problem.

Developing Countries

Thursday May 24, 2012 – Period 7
Wednesday May 30, 2012 – Period 2

Sometimes it is difficult for those living in the United States to grasp the fact that about 2.8 billion people, or nearly half the world population, live on $2 or less a day. And about 1.2 billion live on less than $1 a day. Hunger, squalor, and disease are the norm in many nations of the world. Today, we learned about developing countries, their characteristics, and explored the obstacles that have impeded their economic growth.

Developing nations struggle with life threatening challenges such as widespread poverty and hunger. In many cases, developing nations must deal with keeping their people alive. Developing countries are usually characterized by low GDP per capita, emphasis on agriculture, poor health conditions, low literacy rates, and rapid population growth. They also encounter weak property rights which frequently undermine economic development. In comparison, developed countries have increased their standards of living by moving from agricultural to industrialized economies.

Most nations pass through three stages of economic development: agriculture, manufacturing, and finally a service based economy. Developing countries face numerous obstacles, including population pressures from high birthrates and increasing life expectancies. A shortage of natural resources, diseases, substance abuse, limited education and technology, a heavy burden of external debt, corruption, the aftermath of war, and capital flight add to their problems.

International Economic Summit

Friday May 18, 2012 – Period 7
Tuesday May 22, 2012

Monday May 21,2012 – Period 2
Wednesday May 23, 2012

We spent the entire class periods in the library. We researched information and completed pages 7, 11, 12, 13, 14, 20, 22,23, 26, & 28  in the IES Player’s Guide.

This project is also part of our social science analysis for this semester. The frame component guidelines are located in your IES handout and was discussed in class. The frame draft is due on the following dates: Period 7 – Thursday 5/24  Period 2 – Wednesday 5/30