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HLTHAGE 1AA3 (276)
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Lecture 7

HLTHAGE 1AA3 Lecture 7: Health Care Systems

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Health, Aging and Society
Anju Joshi

March 1 Health Care Systems Meaning of Health Care System - Health care “systems” refer to the rules that govern formal health care relationships - But these systems more than a list of rules - actually shape how and where healthcare is delivered as well as health status itself. How? - Cost may influence whether a person uses formal or informal care - Who has access to certain services or treatments (which people are covered) - Whether care is preventative or corrective *HCS Commonalities I - Licensing - To increase trust, we use licensing ex. Physicians and nurses - Restricts who can provide health care by insisting they acquire credentials → Who can practice what (scope) regulated by state and professional bodies. Different people have different responsibilities within the healthcare system. Ex. Who’s allowed to provide prescription medication → Professional bodies (dentists, chiropractic, physio) train members to uphold values, penalties for running afoul. → Sometimes this does not go far enough to prevent issues - Although it builds trust, also increases cost by reducing labour pool (restricting foreign-trained, limiting scope). HSC Commonalities II - Insurance - When people are insured, health outcomes are better - Because health care needs are unpredictable and costly, some form of insurance exists in almost all systems… although not all insurance is equal → Informal (Ex. Village collection) → Formal (health insurance companies or public plans) - In most places both exist, including Canada - Private can include from work or from school - Importantly, we don’t pay providers directly - third party does via collection pools (Ex. gov) - If there are more things covered (which has been increasing lately due to medicalization) then the rate of coverage goes up and becomes more expensive - Coverage by Insurance companies are becoming more diversified and covering things outside of biomedicine like naturopaths, massages Insurance I Private (voluntary) vs Public (Universal) - In universal, opting out is not permitted Competition vs Monopoly - Choosing among plans or enrolling in the same coverage - Monopoly: when one company controls the market Three types: - Voluntary and competitive (old US model) - Universal and competitive (US since Affordable Care Act) must use healthcare or you have to pay a penalty - Universal and monopoly (Canada, NHS) its compulsory and there is only one provider (gov) How might underlying political philosophies shape this choice? Insurance II March 1 Health Care Systems - Some fear public insurance because of moral hazard problem: since people might opt to undergo more treatment if coverage is full, annual contributions go up for everyone (cost will go up for everyone) - Co-payment tries to tackle this problems, how successfully? To stop people from abusing the public health care you have to pay something → might make care inaccessible for some people → Decision to pursue care not only driven by patients - acting on physician’s recommendation means paying co-payment fees - When it comes to health we are deeply insecure, most of us when faced with illness or the potential are willing to go to extraordinary lengths ex. Purchasing expensive travel insurance - We place extraordinary amounts of trust with our doctor (doctors orders) due to this insecurity and doctors having a great say copayments are tri
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