The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
Seminar 9 health care delivery system in united states of americaDr. Ankit Mohapatra
Health care organization
Health financing in US
Payment mechanism
Health expenditure
Human and physical recourses
Public health
Patient pathway into health care
Provision of services
ACA
US vs India Healthcare
This chapter examines the U.S. health care system—specifically, the organization of medical services; key governmental health programs such as Medicare and Medicaid; the crisis in health care, including attempts to curb health care costs; the large numbers of uninsured people; the impact of the American Medical Association on health care; and that of managed care in the American health care system.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
Kanoe India Healthcare, A division Of Kanoe Softwares proposes a special Medical insurance plan sponsored by Universal Sompo General insurance Co. Limited in joint venture with Allahabad Bank Limited, Indian Overseas Bank, Karnataka Bank Limited, Dabur Investments Corp and Sompo Japan Insurance Incorporation in Public Private Partnership (PPP), aiming to provide assurance of Government/Public sector and superb, hassle free service from private bodies.
Seminar 9 health care delivery system in united states of americaDr. Ankit Mohapatra
Health care organization
Health financing in US
Payment mechanism
Health expenditure
Human and physical recourses
Public health
Patient pathway into health care
Provision of services
ACA
US vs India Healthcare
This chapter examines the U.S. health care system—specifically, the organization of medical services; key governmental health programs such as Medicare and Medicaid; the crisis in health care, including attempts to curb health care costs; the large numbers of uninsured people; the impact of the American Medical Association on health care; and that of managed care in the American health care system.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
Assessing U.S. and International Experience with Health Reform and Implications for the Future by W. David Helms, Ph.D, President and CEO, Academy Health
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
CHAPTER 1History of the U.S. Healthcare SystemLEARNING OBJECTI.docxmccormicknadine86
CHAPTER 1
History of the U.S. Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Describe five milestones of medicine and medical education and their importance to health care.
■ Discuss five milestones of the hospital system and their importance to health care.
■ Identify five milestones of public health and their importance to health care.
■ Describe five milestones of health insurance and their importance to health care.
■ Explain the difference between primary, secondary, and tertiary prevention.
■ Explain the concept of the iron triangle as it applies to health care.
DID YOU KNOW THAT?
■ When the practice of medicine first began, tradesmen such as barbers practiced medicine. They often used the same razor to cut hair as to perform surgery.
■ In 2014, the United States spent 17.5% of the gross domestic product on healthcare spending, which is the highest in the world.
■ As a result of the Affordable Care Act, the number of uninsured is projected to decline to 23 million by 2023.
■ The Centers for Medicare and Medicaid Services predicts national health expenditures will account for over 19% of the U.S. gross domestic product.
■ The United States is the only major country that does not have universal healthcare coverage.
■ In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.
▶ Introduction
It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat-screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And last, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy.
As the U.S. population’s life expectancy continues to lengthen—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2014 statistics, the ...
Observations on the needs for, the contents of, and many of the practical effects of the Affordable care Act or Obamacare. Understanding its benefits and shortcomings
Running Head THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRA.docxaryan532920
Running Head: THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
1
THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
10
Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System
Abstract
The medical care system of the United States of America for the past years has been considered to be the most expensive in the world. The government of the United States has to spend huge amounts of money for medical care in relation to the gross domestic product and these sums are systematically increasing. Now many scholars came to the conclusion that it is the government programs, which held the responsibility for the growth of uncontrolled spending on medical care, with which such growth is a threat to the financial stability of the United States. The issue is worth-discussing, thus, the given work is devoted to the overview of the structure and the main issues of the US healthcare system to find the effective solution.
Unlike other developed countries the medical care system in the United States of America demands more and more funds while its quality remains the same. 1/3 of the US citizens are still uninsured and there is no future hope for improving the situation. People suffer from rapidly growing prices of medical services and slow growth of salaries inclement. Furthermore, the department of insurance loses its integrity and honesty; since they use such an opportunity to fraud money as well as not paying the workers. The risk of becoming bankrupt is very high in medical care system because of unplanned budget. The insurance programs, financed by the state, are also becoming more expensive, and the government is forced to pay more and more money, which later brings about increase in state financial expenditure that immensely contribute to the poor economy. Employees do not have the free will to change their job due to the high cost of insurance and the monopolization (Stone, et al., 2008,p.2-57). This paper will provide evidences by giving the most effective solution to control this problem and also encouraging people make decisive market decisions by finding new approaches.
There are many ways of handling this subject issue of “The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System,” but this research paper primarily will focus on the five articles that represent scholarly articles concerning the subject issue on this topic. The five scholarly articles are: Nolin, (2015) in his study about “Jail overcrowding a perennial issue for many counties; (Stone, P., Hughes, R., & Dailey, M. 2008)about “Creating a safe and high-quality health care environment: Agency for Healthcare Research and Quality (US); U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings; Unit ...
Overview - Health Care IssuesHealth Care IssuesOpposing .docxgerardkortney
Overview - Health Care Issues
Health Care Issues
Opposing Viewpoints Online Collection, 2015
In recent years, the availability and affordability of health insurance in the United States has become
the subject of much debate. The United Nations’ Universal Declaration of Human Rights lists medical
care among the basic human rights to which all people are entitled. In 2011, however, about 17
percent of Americans had no health insurance at all. For many people who are insured, the cost of
coverage is a financial hardship. This situation has led some people to call for the government to
provide health insurance for all citizens. Others, however, are skeptical of government’s ability to
efficiently manage health insurance and oppose any plans that involve government. The issue is made
more urgent by rapidly rising health care costs that threaten to overwhelm the country’s current
system of health insurance, and the national economy in general. Health care reform has become one
of the most important issues in contemporary American politics.
The Basics of Health Care
In most developed countries, health care systems involve government control or sponsorship. For
instance, in Great Britain, Scandinavia, and the countries of the former Soviet Union, the government
controls almost all aspects of health care, including access and delivery. For the most part, health
services in these countries are free to everyone; the systems are financed primarily by taxes. Other
countries, such as Germany and France, guarantee health insurance for almost all their citizens, but
the government plays a smaller role in managing health care. Both systems are financed at least in
part by taxes on wages.
The US government, by contrast, does not pay for most of its citizens’ health care. Generally,
Americans receive health care through employer-sponsored insurance, or they arrange to pay for
insurance on their own. Like all forms of insurance, health insurance operates by pooling the
resources of a group of people who face similar risks. This creates a common fund that members can
draw upon when needed. Each person in the group pays a certain amount, called a premium, every
month. These premiums are used to cover the medical expenses of group members who become sick
or injured.
Health Insurance in the United States
Today, most Americans receive health insurance through their place of work. Employers typically pay
for part of the premiums. Most employer-sponsored plans are administered through payroll
contributions. People who are self-employed and those whose employers do not provide health
insurance must purchase individual health insurance. Individual plans are generally more expensive
than group plans. Certain low-income individuals and families may be eligible for Medicaid, a form of
government-sponsored health insurance. In 1997, the US government introduced the Children’s
Health Insurance Program (CHIP) to assist the children of families who do not qualify f.
Chapter 9 Comprehensive BenefitsAnother important measure of heJinElias52
Chapter 9
"Comprehensive BenefitsAnother important measure of health care systems is whether they offer all of theessential services individuals need. The difficulty lies in defining what is essential.Although all observers would agree that comprehensive health care must includecoverage forprimary care, agreement breaks down quickly when we begindiscussing specialty care. Some individuals, for example, consider coronary bypasssurgery an essential service, but others consider it an overpriced and overhypedluxury. Similarly, some favor offering only procedures necessary to keep patientsalive, but others support offering procedures or technologies such as hip replace-ment surgery, home health care, hearing aids, or dental care, which improvequality of life but don’t extend life.Any system that does not provide comprehensive benefits runs the risk ofdevolving into a two-class system in which some individuals can buy more carethan others can. To those who believe health care is a human right, such a sys-tem seems unethical. Others object to such systems on economic grounds, argu-ing that it costs less in the long run to plan on providing care for everyone thanto haphazardly shift costs to the general public when individuals who can’t affordcare eventually seek care anyway.AffordabilityGuaranteeingaccessto health care does not help those who can’t afford topur-chaseit. Consequently, we also must evaluate health care systems according towhether they make health care coverage affordable, restraining the costs notonly of insurance premiums but also ofco-payments, deductibles, and othercrucial services such as prescription drugs and long-term care. Although the ACAoffers some subsidies and tax credits to help people pay their premiums, it stillleaves millions with many bills for these latter costs.For health care to be affordable, individual costs must reflect individualincomes. As noted earlier, most insured Americans receive their insurancethrough employers. Typically, employers pay part of the cost for that insuranceand deduct the rest from each employee’s wages. Because low- and high-wageworkers have their salaries reduced by the same dollar amount, low-wage work-ers are effectively hit harder: Paying $3,000 per year for health insurance might,for example, force a wealthier worker to scale back his vacation plans but force apoorer worker to put off fixing his roof. For this reason, the US system is con-sideredfinancially regressivein that poorer people must pay a higher percent-age of their income than do wealthier people. In contrast, in countries such asGreat Britain and Canada, health coverage is paid for through graduated in-come taxes. Poorer persons pay alowerpercentage of their income for taxesand therefore for health care than do wealthier persons, creating afinanciallyprogressivesystem. Either way—whether through taxes or lowered wages—the nation’s citizens pay all the costs of health care" "Financial EfficiencyAnother critical measure of ...
This lecture details the science of sepsis care in 2015 with compliments to the multiple online sources used, some of which are other lectures on SlideShare.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Power-sharing Class 10 is a vital aspect of democratic governance. It refers to the distribution of power among different organs of government, levels of government, and social groups. This ensures that no single entity can control all aspects of governance, promoting stability and unity in a diverse society.
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Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
10. Health Insurance Coverage of the U.S. Population, 2002 Total = 285 million Note: Data do not total 100% due to rounding. SOURCE: Urban Institute and Kaiser Commission estimates based on March 2002 Current Population Survey.
11. Health Insurance Coverage of Children and Nonelderly Adults, 2002 Total: 77.3 million Total: 173.6 million SOURCE: Kaiser Commission on Medicaid and the Uninsured (KCMU) and Urban Institute analysis of the March 2003 Current Population Survey. Children Adults under 65
12. Barriers to Health Care by Insurance Status, 2002 Source: NPR/Kaiser Family Foundation/Kennedy School of Government Health Care Survey, May, 2002.
13.
14. Characteristics of the Uninsured, 2002 Income Work Status Total = 43.3 million uninsured Age Note: Percentages may not total 100% due to rounding. SOURCE: KCMU and Urban Institute analysis of the March 2003 Current Population Survey. 1 Full-Time Worker 56% No Workers 19% Part-Time Workers 12% 2 or More Full-Time Workers 14%
15. The Nonelderly Uninsured by Race, 2002 Total = 43 Million Distribution by Race/Ethnicity Risk of Being Uninsured Note: Asian group includes Pacific Islanders; American Indian group includes Aleutian Eskimos. SOURCE: KCMU and Urban Institute analysis of the March 2003 Current Population Survey. National Average 17.3%
16. Health Insurance Coverage by Poverty Level, 2002 Employer Medicaid Uninsured Notes: The federal poverty level was $14,348 for a family of three in 2002. Percentages may not total 100% due to rounding. SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured, analysis of the 2003 Current Population Survey. Other 285 million 52 million 54 million 51 million 128 million
17. Uninsured Rates Among the Nonelderly by State, 2001-2002 <13% Uninsured (19 states) 13 to <17% Uninsured (13 states & DC) > 17% Uninsured (18 states) National Average = 17% SOURCE: KCMU and Urban Institute analysis of the March Current Population Survey, 2002 and 2003, two-year pooled data.
30. Health Care System Around the World Universal healthcare action network - http://www.uhcan.org
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Editor's Notes
The United States is the only industrialized nation that does not guarantee access to health care as a right of citizenship.
Approaches to health care vary enormously between countries. As well as the ideas presented here, U.S. can look to other countries for ideas. Presented here are a few snapshots of foreign health systems, Public health care systems have existed successfully in other countries for a number of years now, no reason why it can’t exist in U.S. In France 80% of healthcare is financed from a compulsory insurance scheme built up by payments from employers and employees. The private market is also quite large – 20% of all spending is individuals buying private care. A charge is levied to see your GP, 75% of which can be claimed back from the compulsory insurance fund, although this system is expensive to administer. In Germany about 13% of an employee’s income is put into a non-profit sickness fund, matched by an employer’s contribution. Patients can seek free appointments with GPs or directly with specialists. The amount of money being spent directly on patient care is far lower than in the UK, but there is little evidence of long waits for treatment. In Spain GPs are gatekeepers for the rest of the service, as in the UK. There are also charges for prescriptions and dental treatment, but the remainder of care is free. A fifth of the population has private healthcare compared with about 13% in the UK and 80% of the population rely on a system largely financed from general taxation.
The National Health Service or NHS as it is more commonly known, was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay. Equal access to healthcare regardless of income is the cornerstone of the NHS. The NHS is now the largest organisation in Europe. It is recognised as one of the best health services in the world by the World Health Organisation. The national government owns and operates over 2,000 hospitals, directly employs most hospital staff and most physicians. With about 1 million employees, including over 50,000 physicians, the British National Health Service is one of the world's largest employers. The health care system in Great Britain is funded, controlled and administered totally by the National Health Service. It is managed by the Department of Health, which sets overall policy on health issues. It is the responsibility of the Department of Health to provide health services to the general public through the NHS. It was launched as a single organisation based around 14 regional hospital boards. originally split into three parts: hospital services family doctors, dentists, opticians and pharmacists local authority health services, including community nursing and health visiting The United Kingdom spends just under 7% of its gross domestic product on its health service. UK Spending on the NHS was £46bn – about £790 per person – in 1998/1999. the lowest in Europe. Healthcare spending is decided via a bidding process involving all the Government departments, each putting forward an estimate of the funds it needs. The Treasury may allocate less than the bid to ensure the expenditure across all departments does not exceed its spending targets. This process is known as the Public Expenditure Survey. Before putting in its bid the Department of Health estimates future activity from past levels and looks at changes in a range of costs. It does not attempt to estimate the health needs of the population and work out a total budget to meet them. The NHS is funded by the taxpayer. The system is paid for through general tax revenues, and the proceeds are divided among regional health authorities that plan local health services. Hospitals receive global budgets -- yearly government grants to cover operating expenses. Citizens have access to a primary care physician, with some limitations on who they see, at no charge and can obtain prescription drugs at a nominal cost of less than $4, although 80% of the population is exempt from that charge. There are no hospital or physician charges for tests or in-hospital treatment. Participation in the NHS is not mandatory, and about 11% of the population choose to be insured privately. Many physicians and dentists combine their NHS work with private practice. Older people are the largest users of the health service and have undoubtedly suffered as result of it being under pressure.
Three principles have guided evolution of the German health care system since its inception in 1883: self-governance, decentralization, and solidarity. Through self-governance and decentralization, the German health care system traditionally has operated almost independently of the government. Some 1,200 autonomous, nonprofit insurers known as &quot;sickness funds&quot; serve as intermediaries among individuals, employers, providers and the government. The federal government through statute, sets parameters for the system such as caps on annual incomes of providers, but leaves practically all operational decisions to the sickness funds and associations representing providers. The German system prides itself on solidarity within the population to meet the needs of those less able to provide for themselves. Those with higher incomes help pay for health care services for lower income people; the employed help pay for services for the unemployed or partially employed; younger and healthier people help pay for the older and sicker; the single and childless help support health care for families and children. While this is the intention of the German system, it has not always described reality. Relatively poor younger people, who use few services, subsidize relatively wealthy elderly, who use more services. Further, while members of a sickness fund are subject to equal payroll deduction rates, in recent years the payroll deduction rates varied dramatically among sickness funds. The sickness funds insure about 90% of the population; approximately 75% of Germans are insured mandatorily. Participation is compulsory for employees whose gross income is less than a threshold income level (DM 5,400/$3,460 per month in 1993), and for farmers, students, apprentices, the unemployed, and many retirees. Of the remaining 10% not covered by sickness funds, most have private insurance or are civil servants for whom the government administers health coverage. Fewer than .5% have no health insurance; these individuals have incomes above the income threshold and may choose to remain uninsured. When choice of funds is granted, the choice is left to the individual, not the employer. White-collar workers (and some blue-collar workers) may choose their local sickness fund or from among the white and blue-collar substitute funds. Generally, blue-collar workers are assigned to a specific fund, with no opportunity for choice. This limitation on choice has led to distortions, including a concentration of higher risk, lower income individuals in particular funds, especially the local and craft funds. The German health insurance industry was criticized for its role in increasing risk segmentation in the health care financing system and the resultant inequitable distribution of health care costs. In response, a risk structure compensation mechanism was instituted in 1994. This is hoped to increase equity and enhance efficient competition among insurers.
Japan provides all citizens with access to primary and tertiary health care. The government regulates the insurers by requiring mandatory coverage of large groups of the population. The payments are then disbursed to independently operating care providers or hospitals, according to a government set fee schedule which lists prices for individual procedures. The total cost of health care in Japan in 1993 was about 7.3% of GDP, about half of the American figure: 14.3%. Although some of this difference is due to social factors, such as less violence and drug use in Japan, such factors do not provide a sufficient explanation. Paradoxically, the gross outcomes based on life expectancy and infant mortality are significantly higher in Japan than in the U.S. (See life expectancies .) Japan finances medical care through multiple insurers, with mandatory enrollment based on employment or residence, and premiums proportional to income. In contrast to what happens in Canada , plans enrolling those with relatively low risks and high incomes tend to have lower premium rates and more benefits (extra benefits are for preventive services only, since diagnostic and treatment services are the same for everyone). Although the Japanese system is most similar to the German one, Japan's is more egalitarian, with government subsidization of plans covering inherently less healthy and poorer populations, and no opportunity for people to opt out by buying private insurance. For employees of large companies and public-service agencies, the health plans are established at the level of the company or agency and administered by committees representing management and labor. Health care costs are wholly covered by premiums. For employees of small companies, who are on average less well off and less healthy, the Ministry of Health and Welfare acts as the insurer and directly subsidizes 14 percent of the expenditures. For the self-employed and pensioners, the least wealthy and healthy, municipal governments are the insurers and the central government contributes half the costs. Inequalities in income level and need are thus compensated for by subsidies to groups, not to individuals. Despite the multiple insurers, payments to providers all flow through a single faucet. This is the national fee schedule, which applies to all Japanese, regardless of their health plans and where they receive their care. The fee schedule lists all procedures and products that can be paid for by health insurance and sets their prices. Billing the patient for fees not covered by insurance is strictly prohibited, so nearly all revenues of medical care providers are determined by the fee schedule. Hospitals receive direct subsidies from government or university budgets for capital and even some operating expenses above what they receive from the fees for provided services. Freedom of choice for both patients and physicians is an obvious benefit from this system. Any Japanese can choose virtually any physician or hospital, and all physicians can decide for themselves about appropriate treatments, although claims are reviewed retrospectively by a committee of physicians at the local level. The simplicity of this review-and-reimbursement mechanism keeps administrative costs down as does the mandatory, and therefore non-competitive health insurance system, and the lack of opportunity for physicians to manipulate the system. Along with its many advantages, Japan's fee-schedule system has some inherent problems that have been the focus of efforts to reform health care in the 1980s and 1990s. The key problems include the difficulty of controlling volume, particularly of medications and laboratory tests, in the absence of natural time constraints; the effect of uniform fees and therefore uniform incentive structures in making it more profitable to provide primary than tertiary care leading to too much primary care even at university and large public hospitals; and the effect of fee-for-service payments for long-term care, leading to overtreatment. These problems under discussion in Japan are leading to modest reform that would not alter the fundamental characteristics of the health care system. The Japanese system remains very popular (see desired changes ).
Canada History In 1947 the province of Saskatchewan introduced the first publicly funded insurance program applicable to hospital services. This program provided universal insurance for hospital care. Each person was entitled to have any basic hospital bills paid in exchange for an annual premium, with the residents of the province required to pay for the premium. By 1957 hospital care insurance had spread to other provinces, in separate political battles, and in 1958 the federal government got involved. The Canadian government offered to cooperate with the provinces to &quot;cost-share&quot; on roughly a 50-50 basis for hospital and diagnostic services. By 1961 all provinces and 2 territories had introduced public insurance plans that provided universal coverage for at least inpatient hospital care. In 1962 again Saskatchewan lead the way with the introduction of the first Medicare program, which extended the universal coverage to include office visits. A well publicized twenty three day strike by doctors resulted, during which only emergency services were given. The federal Medicare Act of 1966 gave incentives for the provinces to follow Saskatchewan's example, and since 1971, all of Canada's provinces have provided universal hospital and physician insurance. Financing Canada's Medicare program is an interlocking set of the separate provincial and territorial health insurance schemes, each being universal and publicly funded. The federal government gives block grants to the provinces, which are equal per capita contributions. This system, called the Established Programs Financing (EPF), helps with financing the insured health services, extended health services, and educational services for post-secondary education. This system of payment has been largely financed through a graduated progressive income tax. Most provinces have financed part of the cost of hospital and medical care through premiums, although the premiums have never accounted for more than one-third of the provincial program costs. Sales taxes and payroll taxes have also been used as financing means. This financing scheme based on progressive income tax ensures that the system is financed based on ability to pay. Even in those provinces with premiums (British Columbia and Alberta), public assistance is given to lower income individuals to help with the payment. Private funding of health care has been restricted largely to health services and good which are considered supplementary to medically necessary services. These include dental services, eyeglasses and out-of- hospital prescription drugs. Hospitals in Canada are mostly non-profit entities owned by voluntary organizations, municipal/provincial authorities, or, less often, religious orders. Their operations are guided by community boards of trustees. About 5% of the hospitals are privately owned, mostly those dealing with long-term care. Hospital financing is accomplished through &quot;global budgets&quot;, which gives money to hospitals based on prospective operating costs. If a hospital runs over budget, it is possible to get extra money from the government. Most physicians work as independent practitioners on a fee-for-service basis and submit their claims to provincial health insurance plans for payment. Fee schedules are negotiated periodically between the provincial governments and medical associations. Although generalist physicians earn approximately the same amount in Canada as in the U.S., specialists earn much less compared to specialist salaries in the U.S. Using Medicare Canadians may visit any doctor they wish at any time when they can arrange an appointment, regardless of their level of income. Patients can get a second opinion, or even a third. There is no limitation on access to physician services at the individual patient level. And not surprisingly, then, Canadian visits to physicians are higher per capita than in the U.S. Private insurance still exists in Canada for services not covered under Medicare -- services such as dental care, and payment for some prescription medication.
The United States can claim the highest standards of care, which costs 14% of GDP. But it is an unfair system that provides high-quality care to the minority who can afford it. The private market accounts for 64% of all spending. Medicaid and Medicare provide less well-resourced care to the poor and over 65s. Over 30 million children are not covered by any type of medical insurance. Overall life expectancy is lower than in Europe and infant mortality is higher. Financing healthcare through a progressive tax system – as the UK does – means that each citizen contributes according to the size of their income. Equal access to healthcare regardless of income is the cornerstone of the NHS. Systems that use a central insurance fund tend to spread the cost less fairly and have higher administration costs. Countries with a large private healthcare market such as the US also spend a high amount on marketing and advertising health services. Single payer universal health care costs would be lower than the current US system due to lower administrative costs. The United States spends 50 to 100% more on administration than single payer systems. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money