Health Sciences 4044A/B Study Guide - Midterm Guide: Health Insurance Mandate, World Health Organization, Patient Protection And Affordable Care Act
11 Nov 2016
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US & CA Health System Comparison
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Health Partnerships 4044
US & Canadian Healthcare
Capitalism as a Context
• Multinational corporations market to developing countries to promote privatization (WTO encourages)
• NAFTA ( Euro Union)- encourages open markets in developing countries to private companies of the developed
world
o Free markets competition is thought to provide best services at lowest price
.Equity :
• Metholodologically thinking how comparative analyses of different health systems can be used as tool to discuss
issues of equity
o Uses equity to measure the failure & successes of another health care system
o Lens to understand how HS fund & to compare how other health systems function
o Idea of equity MEASURE of successes & failures o different health systems
• Racial Equity: means the fairness and justice in the distribution of benefits, power, resources, and responsibilities
between different racialized identities. The concept recognizes that different racialized groups have different
needs, power and access to resources, and that these differences should be identified and addressed in a way
that fixes this imbalance (i.e. Colonialism and Indigenous Health)
Intersectionality
• Methodological approach to understanding how health policy can be used to influence the development of
equitable health systems
• Considers context, social environment in which health systems are developed, maintained, organized & funded
• Intersectionality is concerned with the intersections between aspects of social difference and identity as related to
meanings of race, ethnicity, gender, class, sexuality, age, ability etc. and forms of systemic oppression such as
racism, classism, sexism, homophobia, ableism).
• A macro and micro approach to understanding difference, power, hierarchies, and relationships of power
▪ Always using idea of intersectionality
• Thinking about gender class, ability, language, affects our ability as consumers or
providers to be successful in a healthcare system
Social System of Healthcare :
Canada Healthcare System
Moses : US is so fragmentized & differently funded across states
( Canada has no national, these is a clear set of accountabilities built in that ensures basic level of healthcare for all
Canadian citizens)
Racialization & Health Systems
Racial Equity : Fairness and justice in distribution of resources among different racial identities, identify different needs in
different groups & these needs should be addressed in a manner that reduces inequalities
How does it impact delivery of healthcare ?
Racial Equity - much more useful comprehensive term- inequity is what were referring
Equity & Health Systems
• Working towards redressing social and health inequities and toward social justice, requires social change
• Health inequities cannot be resolved without addressing the structural conditions that produce inequities in the first
place
• Researchers need to engage with both the biomedical and intersectional understandings of equity and justice
• Social policy research has tended to focus on analyzing public policies themselves, to the neglect of analyzing
governance systems in which policy processes are embedded
Importance of biomedical existence but qualitative is important
I.e. HIV person in Toronto vs. Africa → better access environment etc, social context has a huge impact on their health
and outcomes of health
Healthcare in the United States ( Cartoon)
Background
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US & CA Health System Comparison
2
• Facilities are largely owned & operated by private sector businesses
o Almost entirely private - private sector businesses - healthcare is a lot of money
• According to the World Health Organization (WHO), the United States spent more on health care per capita
($8,608), and more on health care as percentage of its GDP (17.2%), than any other nation in 2011
• In a 2013 Bloomberg ranking of nations with the most efficient health care systems, the United States ranks 46th
among the 48 countries included in the study
• 6065% of healthcare provision and spending comes from programs such as Medicare, Medicaid, TRICARE, the
Children's Health Insurance Program, and the Veterans Health Administration. Most of the population under 67 is
insured by their or a family member's employer, some buy health insurance on their own, and the remainder are
uninsured. Health insurance for public sector employees is primarily provided by the government
Medicare + Medicaid US :
All state funded (The biggest percentage of funding comes from funded services )
Public Sector : Usually provided through employer ( Private employee)
Medicare : National social insurance program administered by US federal government since 1966,
- Uses 30 private insurance companies across US
- Guarantees access to health insurance if you 65+ who have worked & paid into the system (geared towards
elderly) + younger people with disabilities
Medicaid : Social health care program for families and individuals with low income + resources
- Largest source of funding for medical and health related services for people with low income
- Those with more access to economic $$ have better health ,
American Hospitals : certain cards from insurance get you access to certain hospitals,
Patient Protection & Affordable Care Act (Obama Care) :
• PPACA ( Obamacare) came into law march 2010 provided major change in health insurance
o Similar to Canada 1984 ( 2 years after charter of rites), mirrors social change - what people expect from
government
o Reduces cost
• Most significant regulatory overhaul of the US healthcare system since the passage of Medicare & Medicaid in
1965
• Goal increase quality and affordability of health insurance
o Lower uninsured rate via expandure of public + private insurance
o Reduce Individual + collective cost on government
• Requires insurance companies to cover all applicants within new minimum standards & offer same rates
regardless of preexisting conditions or gender
Obamacare :
Reduce Costs of healthcare - spend more initially ( offer more coverage) charge more, but it will be cheaper later
Requires Insurance companies to cover all applications - Obama ensured some kind of care too all people
Not Covered Under ObamaCare
• People who will remain uninsured
o Illegal immigrants, estimated at around 8 millionor roughly a third of the 23 million projectionswill be
ineligible for insurance subsidies and Medicaid. They will also be exempt from the health insurance
mandate but will remain eligible for emergency services under provisions in the 1986 Emergency
Medical Treatment and Active Labor Act (EMTALA).
o Citizens not enrolled in Medicaid despite being eligible.
o Citizens not otherwise covered and opting to pay the annual penalty instead of purchasing insurance,
mostly younger and single Americans.
o Citizens whose insurance coverage would cost more than 8% of household income and are exempt from
paying the annual penalty.
o Citizens who live in states that opt out of the Medicaid expansion and who qualify for neither existing
Medicaid coverage nor subsidized coverage through the states' new insurance exchanges
WHY DID PPACA SUCCEED ( FIERBEK 287-288)
• Mandated Individual Insurance:
o Mandated individual insurance' means that all adults buy insurance for themselves and their families, or
face a fine. It encourages individuals to shop for the best plan, and it allows them to keep Mandated
Private Insurance 291 their insurance regardless of their employment status (as long as they can pay the
premiums)
Conclusions :
Increase equity, must make financing available to a larger group of people
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US & CA Health System Comparison
3
Delegate the power to finance & regulate it to the state - make it available to largest amount of consumers
Expanding coverage, allows ALL TO have some basic healthcare
Controversy & Legal Issues :
Opting out was tacked on by republicans
• General feeling of republicans that federal doesn't have right,
• Obamacare forces you to buy health insurance - if you're a republican it disrupts you view
o Republicans see a larger separation between federal & their life
In case of health and health insurance the federal government has the right to intervene
MOSES – The Anatomy of Healthcare in the US
• US healthcare is not a system, neither coordinated by a central entity not governed by individuals & institutions
that interact in predictable ways
• Healthcare and medical care are non synonymous
• Health care in the United States includes a vast array of complex interrelationships among those who receive,
provide, and finance care.
• Health care and medical care are not synonymous.
o Prevention requires tools that are often unfamiliar because educational, behavioral, and social
interventions, not usually considered to be part of medicine, may be most effective for many diseases.
o Provider does not accurately describe the dozens of different professions and organizations required for
a patient’s care.
o Payers are paid not to pay too easily; insurers do only modest amounts of insuring because government
and employers accept most risk. Economic concepts of cost and value are ambiguous, as measurement
is elusive and because one segment’s cost is another’s value.
o Market is a misnomer because few prices are transparent and many are controlled.
• Price (hospital charges), professional services, Drugs & devices and administrative costs make up 91% of cost
increases ( not service or elderly demands)
• Chronic disease accounts for 84% of costs among the entire population
• 3 factors produced most change :
o Consolidation–+ Industrialization more single specialty
▪ Primarily horizontal firms merge with other firms in the same sector drives competition
o Information technology investment occurred but elusive value
▪ Investments can be made w/ little immediate accountability or political issues
▪ Increase effiency, lower costs
o Patient as consumer - Influence is sought from outside traditional
▪ Patients want convenience care delivery becomes more fragmented w/ more demand for wider
breadth of HCP at more locations.
▪ Physicians desire for patients best interests but incentives for restrict diagnostic test &
procedures Focus on
• Iron Triangle: HC caught IT - conflicting expectations among patients, clinicians and public health and
government policy makers not all forces can be satisfied w/ some mutually exclusive
o Goals desires expectations – conflicts among patient desires ,p physician interests & social policy
▪ May inhibit other changes address each constituency in isolation
• Focus on individual autonomy, - switching to a population view
o Biggest driver of change is organized consolidation and integration pursued under individual- institution
competitive success.
Key Point ** He is also advocating for increasing the role of patient - fits into capitalism, patients as consumers : both
useful and problematic
• greater purchasing power - bigger part of pie - more money spent = more pull
Moses Conclusions :
• Iron Triangle : competing interests - policy gets stopped because unwillingness of stakeholders to work together
Common goals
• Patients Roles As Consumers
o Patients are taught to think in a certain way because of the way healthcare is framed IN US
o Canadians are taught that health is a right
• US Healthcare System $$$$
• *If you're low SES or poor health you're especially disadvantaged
o All Canadians regardless of $$ have access to healthcare
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