Dawn Roberts, Jamie Miller, Rebecca Seymour, Cory Anderson Healthcare USA/UK Dawn Roberts, Jamie Miller, Rebecca Seymour, Cory Anderson 09/16/08 LIR 554

Presentation Overview Models of healthcare Description of US & UK systems Mechanics of US & UK systems Strengths and Weaknesses

Models of Healthcare Dawn Roberts

Models of Healthcare 1. Beveridge Model Provided by: Medical providers whose salaries are paid by Government Financed by: Federal Government, from income taxes Admin. by: Federal Government Examples: England, Spain, Scandinavia, Cuba, New Zealand, Hong Kong

Models of Healthcare 2. Bismarck Model Provided by: Private medical providers Financed by: Nonprofit insurance companies, Premiums paid by employees, employers, government Admin. by: Government (closely regulated) Examples: Germany, France, Switzerland, Belgium, Japan, Latin America

3. National Health Insurance Models of Healthcare 3. National Health Insurance Provided by: Private medical providers Financed by: Federal Government-run insurance program, from taxes of all citizens Admin. by: Federal Government Examples: Canada, Taiwan, South Korea

Models of Healthcare 4. Out-of-Pocket Model Provided by: Private medical providers Financed by: Patients, directly Admin. by: No one; Each provider collects Examples: Rural parts of Africa, India, China, South America

Models of Healthcare US uses all of these: 1. Beveridge (VA, Military) 2. Bismarck (Employer-supported insurance) 3. National Health Insurance (Medicare, Medicaid) 4. Out-of-Pocket (Everyone else)

Description of Systems Jamie Miller

Description of Systems US System is notable because: 1. Numerous plans; Not universal 2. Costly 3. For-profit providers, financiers, and administrators

Description of Systems Costs covered by many separate legal entities: Private Insurance Private out-of-pocket Federal government State/local governments Other private funds

Description of Systems More dollars spent per capita than any nation 15.2% of GDP, with projection of 19.5% by 2017 $2.26 trillion → $7,439 per person, in 2007

Description of Systems

Description of Systems UK National Health Service (NHS)

Description of Systems UK System is notable because: 1. Universal 2. Providers receive salary from Federal Government 3. Government decides on care

Description of Systems Dramatic differences in health care provision Are these reflected in actual health differences?

Description of Systems Life Expectancy United States: 78 United Kingdom: 78.7 Mortality Rate United States: 6.4 United Kingdom: 5

Mechanics of Systems Rebecca Seymour

US: Multiple Ways to Finance Care Mechanics of Systems US: Multiple Ways to Finance Care Employer-Supported Insurance Privately-Purchased Insurance Government-Sponsored Insurance The Uninsured

Mechanics of Systems Uninsured 15%

Employer Supported Healthcare Mechanics of Systems– Employer Supported Healthcare Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Point of Service (POS) Health Savings Account (HSA)

Mechanics of Systems– Employer-Supported Healthcare = 59%

Mechanics of Systems– Privately Purchased Insurance = 9% Self-employed or Work for companies not offering health benefits Premiums based on individual health history, age, weight, smoking status and deductible chosen

Mechanics of Systems– Government Sponsored = 28% Medicaid Medicare VA Health Insurance

UK: One Way to Finance Care Mechanics of Systems UK: One Way to Finance Care National Health Service World’s largest health service and fourth largest employer Publicly funded by the taxation of the general public Separate administration in UK colonies, but reciprocity

Mechanics of Systems UK: One Way? All citizens, Expats with work permits, Students there > 6 months Most services free How does it work? GPs inform hospital of a patient's condition. Hospital judges urgency, against other patients’ conditions. Urgent need is met almost immediately. Others receive appointments. (Median wait time ~ 3 weeks)

Mechanics of Systems UK: Private Insurance Currently, 12% of persons 2/3 employer-provided; 1/3 individually-purchased Privately insured go to NHS hospital or one of five private hospital groups. Average individual premium = $260/month

Strengths and Weaknesses Cory Anderson

Strengths and Weaknesses US Strengths World-Class facilities and physicians Relatively short wait-time for treatment Government directly covers 27.8% of the population through health care programs for the elderly, disabled, military service families and veterans, children, and some of the poor *Information obtained from the National Institute of Health www.nih.gov/

Strengths and Weaknesses US Weaknesses ~47 million people without health insurance High administrative cost Financial problems for the under- or un-insured Private plans have exclusions or “carve outs” Disparities in access to health treatments *Information obtained from the National Institute of Health www.nih.gov/

Strengths and Weaknesses UK Strengths Universal coverage Guaranteed treatment regardless of income level Health care paid through taxes Little paper work or bureaucracy *National Health Service http://www.nhs.uk/Pages/homepage.aspx

Strengths and Weaknesses UK Weaknesses Higher tax rate Underfunding Long waits for specialists and elective procedures Lower quality facilities Exclusions for new or experimental treatment *National Health Service http://www.nhs.uk/Pages/homepage.aspx

Companies with Best Healthcare Coverage *Forbes 100 Best Companies to Work For 100% Healthcare Coverage for employees

FOR MORE INFORMATION: Descriptions of 5 capitalist countries’ systems: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ With links to more resources: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/links.html Very cool interactive comparison by country http://www.npr.org/news/specials/healthcare/healthcare_profiles.html World Health Organization—International health www.who.int/en/ UK System www.nhs.uk US System—Resources & Links http://www.pbs.org/pov/pov2008/criticalcondition/resources.html