M11: Comparative healthcare systems
6 important questions on M11: Comparative healthcare systems
Which systems does belong to which?
- Traditional sickness fund insurance
- National Health Insurance
- National health services
- Mixed systems
- Bismarck-model
- None
- Beveridge-model” and “Somashkomodel”
- None
What is the rationale for a third party in healthcare?
- Risk and uncertainty;
- Information asymmetry;
- Externalities (e.g. “altruïstic preferences”; contagious diseases).
What are the main functions for third parties in healthcare?
- Insurance function;
- Agency function;
- reducing moral hazard;
- providing information about the quality of care;
- being a prudent buyer of care on behalf of the consumer;
- Access function: to guarantee universal access to basic health services
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What are the major goal of healthcare reforms?
- In many European / OECD countries: a Third Party acting as an effective agent on behalf of the consumer (the second function);
- in low-income countries: all three functions!
- Always ask: who is the purchaser (or payor) of health care?!
Who can perform the third party role?
- Employers;
- Unions;
- Providers of care (e.g. polyclinicfund holder);
- Integrated insurer-provider organizations;
- Government (national, regional and local).
How does the money go from the one party to another party? There are three models of paying providers by third party payers, which?
- Reimbursement model
- Contract model
- integrated model
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