Ans) 1) HEALTH CARE INSURANCE COVERAGE AND HOW IT IS FUNDED
In both the US and Canada, health insurance is the primary way individuals pay for their health care. The main difference is in how that health insurance is funded.
THE UNITED STATES HEALTH CARE SYSTEM:
The US requires individuals to fund their own health care
insurance. The only exception is if they qualify for eligibility in
one of the government-provided insurance programs offered to
individuals in particular income, age, or disability brackets. This
includes programs like Medicare, Medicaid, or the Veterans Health
Administration.
Health insurance in the US is often, but not always, tied to
employment, with employers providing insurance coverage in the
package of benefits they offer their employees. The type of
coverage offered will vary from employer to employer, and coverage
is not guaranteed.
THE CANADIAN HEALTH CARE SYSTEM:
In Canada, on the other hand, the federal government provides
funding support for health care insurance to provincial governments
as long as the province follows regulations outlined in the Canada
Health Act (CHA) of 1984. This funding is used to provide all
Canadian citizens with health insurance through the national health
care system.
2. THE ROLE OF PRIVATE INDUSTRY AND COMPETITION IN HEALTH
CARE
Private industry plays a role in both the US and Canadian health
care systems, just in different ways.
THE UNITED STATES HEALTH CARE SYSTEM:
Private enterprises are the primary providers of both health care
insurance and health care services in the US. Insurers compete for
customers, selling insurance policies to employers as benefits
packages for employees or selling health care insurance policies
directly to individual consumers. Health care providers compete for
patients, often through areas of medical specialty, quality, or
cost.
- Individual consumers have influence in this market, but it can
be limited. Their choices are often constrained by the types of
services covered by insurance providers, the types of insurance
benefits employers negotiate, or the doctors available within the
insurance provider’s network of physicians.
THE CANADIAN HEALTH CARE SYSTEM:
Most health care services are provided by private providers, rather
than federal or provincial providers. This means that doctors and
physicians work independently in private practice, or are employed
by private hospitals or private health service management
organizations. Rather than being paid through claims made through
private insurers, they derive much of their revenue by billing
government health insurance.
3. TYPES OF CARE COVERED BY HEALTH INSURANCE
Regardless of how health care insurance is funded, consumers in
both the US and Canada have concerns about which health care
services are covered under their respective health care systems.
Because of differences in how the systems are funded, consumers in
each country end up having different access to types of health care
services.
THE UNITED STATES HEALTH CARE SYSTEM:
In the US, health care coverage through private insurance varies
depending upon the types of benefits packages negotiated by
employers or the types of policies individual consumers choose or
can afford.
- However, with the introduction of the Patient Protection and
Affordable Care Act (ACA) in 2010, individuals are required to
secure a minimum essential coverage, either through an employer or
through private insurance. It also mandates that insurers cover
essential health benefits (EHBs). These have been defined to
include emergency services, hospitalization, ambulatory patient
services, maternity and newborn care, mental health and substance
use services, prescription drugs, rehabilitative services,
laboratory services, preventative care services, and pediatric
services.
THE CANADIAN HEALTH CARE SYSTEM:
The universal health care system that provides coverage for all
Canadian citizens limits that coverage to services provided by
hospitals, medical practitioners, or surgical dental services
provided in a hospital.
- Beyond these required health care services, provinces are
allowed to (but not required to) provide insurance for additional
services, such as coverage for prescriptions, home care, long-term
care, vision care, dental care, mental health care, etc. In
practice, dentists typically work outside of hospitals, so dental
care services usually end up financed through other means—either
out-of-pocket or through private insurance.
4. DELIVERY OF PRIMARY CARE
Primary care providers, or general practitioners (GPs), play a
significant role in both countries. Interestingly, both the US and
Canada are facing shortages of these vital medical providers. Of
those who do go into primary care, many are either self-employed or
employed in small private practices. But there are differences in
how their care is delivered.
THE UNITED STATES HEALTH CARE SYSTEM:
Primary care physicians account for approximately one-third of all
US doctors. They do not have a formal gatekeeping function for
providing referrals to specialists or other health care service
providers.
- Patients have free choice of doctor, but often choose based on
whether that doctor falls “in-network” with their health insurance
provider. Physicians are typically paid through negotiated fees
with private insurers, capitation through private insurers, or set
fees through public insurance (or some combination of these).
Patients are usually responsible for some portion of physician
payment, unless the patient is uninsured and qualifies for waived
or reduced fees.
THE CANADIAN HEALTH CARE SYSTEM:
Approximately half of practicing physicians in Canada are GPs. They
act largely as gatekeepers for health care services, referring
patients to specialists as needed. In fact, specialists receive
lower fees for non-referred consultations.
- GenerallyGenerally, patients have free choice for their primary care doctor, with some requirements for patient registration, which varies by province or territory. Physician fees are paid based on fee schedules that are negotiated by provincial and territorial ministries of health, with financial incentives sometimes linked to performance depending upon the province. Patients are not directly responsible for physician payment as long as the health care services are covered by the universal health care plan.
what is governments role in financing healthcare systems and public or private insurance in the united...
In the United States, the public role in education is enormous. In some countries, education is provided primarily by private entities. Why does the government in the United States play such a large role in education? Is education a public good? Should governments offer education alternatives, like school vouchers to attend private schools of parents’ choosing? If many school budgets are already strained, how might vouchers exacerbate inequality? Justify your position.
public health Question 39 Which of the following best describes how the United Kingdom's healthcare system is more focused on social justice than the healthcare system in the United States? Not yet Por out of 1.00 Flag question Select one: O A. Privately owned and administered hospitals provide premium services for selected individuals. O B. Healthcare insurance coverage is universal and comprehensive with little cost sharing involved O C. There are no financial incentives for general practitioners or physicians. OD....
Please answer the following in regards to healthcare economics: Why are private prices so high in the United States? How are commercial insurance prices set for hospital services? How are Medicare prices set for physicians’ services? Should governments be involved in private price negotiations? Would consumers be better off if healthcare prices were nationally negotiated? Are other countries’ governments involved in healthcare pricing?
what is the role of the government in the German healthcare plan and the united states healthcare plan?
Health insurances are provided by public and private agencies and organisations in Australia. Describe the role of the following organisations in relation to health insurance and financial support 1) Private Healthcare Australia (Role) (Financial Support)
Answer critical analysis questions. ISSUES AND APPLICATIONS Private or Public Auto Insurance: What is Best for Canada? Concepts Applied: Capitalist, Command, and Mixed Systems; Productive Efficiency, Allocative Efficiency; and Equity t the cost of he codents a How does t In response to public outrage over styrocketing car insurance premiums, the consumers' Association of a completed a comprehensive report on auto insurance rates in Canada September 2003 in presenting the report the association noted that government-owned or public auto insurance...
What is the proper role of governments and public health authorities with respect to food and eating behavior?
What important policy issues are related to healthcare financing in the United States. How are key stakeholders impacted?
1. What is the role of data and healthcare systems in the accreditation process? (Minimum of 3 sentences.) 2. What is the role of standards and measures in the accreditation process? (Minimum of 2 sentences.) 3. Why is it important for healthcare workers to be familiar with accreditation and the accreditation process? (Minimum 3 sentences) 4. Why is it important for healthcare workers to be familiar with the interaction between healthcare systems and accreditation? (Minimum of 2 sentences.)
In the U.S., health insurance plays a major role in our healthcare system, and (not surprisingly) absorbs a big chunk of our healthcare dollars. A single payer system, either private or government run, could eliminate or reduce the complex system of traditional insurance, and could divert funds into provision of care. (A single payer system is popular in many/most of our peer countries, such as Canada, the UK, Australia, etc. Our own Medicare system is single payer, but predominantly restricted...