1. Chapter 27: Global Models of Health Care

2. Learning Objectives
Compare the aging policies of Japan, Germany, England, and Canada with those of the United States.
Describe the effects of an aging population on health policy.
Explain how morbidity and mortality can influence policies for the elderly.
Analyze the benefits of social security.
Contrast the Medicare and Medicaid programs.
List the benefits and barriers to long-term care insurance.

3. International Models of Health Care
Japan
Universal healthcare system through National Health Insurance, variety of employer-based health insurance plans, and Health Insurance for the Elderly
Everyone in Japan must enroll in a health insurance plan
Home care
Long-term care insurance provides services to help relieve stress on caregivers; not monetary benefits

4. International Models of Health Care
Germany
1st country to establish a national healthcare program
Social insurance is a mandatory transfer system whereby employees and employers make equal contributions for LTC.
Solidarity principle: “members of society are responsible for providing adequately for another’s wellbeing through collective action”
Private insurance option
Long-term care insurance integrated into the social security system

5. International Models of Health Care
England (Great Britain)
National Health Service: universal health care system based on clinical need rather than employment status
Private health services used by 12% of population
Patient Choice helped alleviate long wait times
Long-term care is considered social care, so not provided free under NHS; policy discussions will continue in the future

6. International Models of Health Care
Canada
Universal health coverage system called Medicare, provides at no cost
Each of the 10 provinces responsible for healthcare services according to national guidelines
Wait times have been an issue but are improving
Canadian Health Act does not guarantee coverage for long-term care or end-of-life services

7. U.S. Health Care System and Policies
Effects of an aging society
By 2035, 20% of U.S. population will be 65+
Challenges to policy makers
Culturally diverse and educated population
How to finance long-term care
Need for interdisciplinary teams with expertise in geriatrics
Disequilibrium in demographics between working- age and elderly population

8. U.S. Health Care Effects of mortality Life expectancy
78.49 years for a child born in the U.S. in 2012
U.S. ranks 50th out of 221 countries in life expectancy according to the CIA (central intelligence agency)
Health practices in childhood and young adulthood influence health as we age
Currently, health expenditures for elderly are disproportionate to percentage of population

9. U.S. Health Care Social Security
Social Security Act of 1935
U.S. one of the last countries to establish a federal old-age pension program
Never intended to be the sole source of a person’s retirement income
Defined retirement age as 65: Now 66 years 2 mo
May receive SS benefits beginning at age 62.
Delayed retirement credit (DRC):If a worker postpones retirement past full retirement age (66 y 2 mo) and up to age 70, the worker will receive more than the earned full benefit

10. U.S. Health Care Medicare Title XVIII of Social Security Act
For those age 65+ who have paid into the Social Security program
Part A: financed by payroll taxes, no charge to eligible recipients; Hospital insurance
Part B: non-mandatory medical insurance, monthly premium, yearly deductible: supplemental insurance
Part C: Medicare Advantage HMO or PPO option
Part D: Prescription drugs; doughnut hole

11. U.S. Health Care Medicaid Title XIX of Social Security Act
Health insurance for low-income families and people with disabilities
Long-term care for older Americans and persons with disabilities
Supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare (e.g., eyeglasses, hearing aids, prescription drugs) as well as Medicare Part B premiums.

12. U.S. Health Care System and Policies
Long-term care insurance
Nursing home care averages $72,000/year
Assisted living facilities average $38,000/year
Home care services average $21/hour
Average cost of a comprehensive long-term care policy for an eligible person would be $2,207/year for 4.8 years of benefit at the rate of $160/day
Long term care is not covered by traditional health insurance or Medicare.

13. U.S. Health Care System and Policies
Long-term care insurance (cont’d)
10-15% of elderly have this coverage
Benefit trigger: ADLs or cognitive impairment
Elimination period: waiting period of 30, 60, or 90 days when beneficiary must pay out of pocket
Long-term financial viability of insurers is in question

14. U.S. Health Care System and Policies
Affordable Care Act (2010)-Obamacare will
Expand coverage; lower health care costs; enhance the quality of care for all Americans; keep young adults covered (<26 yrs., will be eligible under parent’s plan); preventive care at no cost; low income adults will be guaranteed coverage through Medicaid. – Coverage, Cost, Care
Good News: before healthcare premiums were too expensive; insurance companies denied coverage to anyone who had a preexisting medical condition
Bad news: very confusing; fine 2.5% of income with no coverage (or $695/adult, $347.50/child with no household limit)

15. Summary
Policies on aging within models of health care vary internationally
As the 65+ population grows worldwide, policymakers will review care delivery systems to determine best practices
Gerontological nurses will have input through research, analysis, and evaluation
Help patients and families navigate healthcare system by understanding reimbursement for benefits issues