What Is Health System Design

Submitted By tcohns27
Words: 505
Pages: 3

Issues: Health System Design

socialized= govt owns means of medicine in country
General alternatives socialized system – Veterans medicine/ England single payer system – single pay thru govt/ Canada public-private mix – USA/ Germany
Single payer system (Canada) – all payment ran by govt & eliminate private sector
Government role:
Defines coverage
Collects premiums
Negotiates fees with providers
How to control demand – ration demands= limit capital expenditure- regionalizing/ limits of what govt pays for/ queuing (waiting)
Freedom of choice of provider Employer mandate-require all employers to give healthcare
Everyone is guaranteed basic coverage
Employers must "pay or play"
New tax for “health fund”
1. Companies which provide insurance are exempt from this tax
2. Workers not covered by employers and unemployed are covered by fund
Large companies already have benefit plan/small businesses have an extra cost like employer mandate which decrease cost shifting-to cover uninsured use increase of cost of insured and level play field
Gov't role is 2 set requirement, set tax, collect tax, set up separate insurance coverage 4rm tax fund

Individual (consumer) mandate-
-Individuals required to purchase insurance - targeted @ young invincible/ volunteerly elect out insurance
-Regardless of whether their employers contributed
-Massachusetts 2011:
Individual mandate
Employers pay up to $295 annually per employee
Commonwealth Health Insurance Connector -Employers with more than 10 workers will be required to offer a “cafeteria plan” -Government-funded subsidies to low-income individuals to assist with the purchase of health insurance -Expands Medicaid to children up to 300 percent of the federal poverty level -strong incentive to pay insurance instead of fee
- Typical market place doesa mnot work in healthcare bcuz money does not always come out of pocket although already paid for & assume is free
Market based—managed competition- private sector
Create groups of providers which will compete

-Health plans compete for members ("Retail") – insurance companies selling to consumers
-Providers compete for access to plan members ("Wholesale")- providers sells themselves to the insurance companies /ex. PPOs
-Consumers have free choice among many plans