Transcript
Chapter 22 – Comparative Health Care Systems and Health Systems Reform
Key Ideas
Different countries vary in their health care systems. Comparing them provides insights into potential health care system improvements.
One can broadly categorize most health benefit systems in four categories: (1) traditional sickness insurance; (2) national health insurance; (3) national health service; (4) mixed systems.
The Canadian health care system provides useful insights into possible reforms of the United States system. Although many analysts feel that the Canadian system is a comprehensive and universal program that is popular among Canadian citizens, others feel that it would be difficult to transfer it to the United States.
National health systems appear to reduce health spending. However, one must impute time costs and adjust for difference in quality of care in evaluating the full costs of alternative systems
Teaching Tips
This chapter has a new section on the Chinese health system. It provides some insights of a quickly changing system, about which we have traditionally had little information.
Table 22-1 provides useful comparisons among countries. Which countries spend the highest percentages? lowest percentages? Which countries have better outcomes? worse outcomes? How does the United States compare with other industrial countries?
Many University libraries have free on-line access to the OECD database. It provides a wealth of data on health care systems in the more advanced countries. A reasonably simple interface allows advanced undergraduates to access country-specific data. The OECD is careful in trying to provide similar measures from country data that can often be difficult to compare.
What do people in other countries think about their health systems? Canadian newspaper web sites often provide useful insights about the Canadian health care system from their point of view.
For class discussion, it is useful to consider whether different societies are different. The authors of this book are U.S. economists, living in the United States. Do students in the United States recognize differences between themselves and students elsewhere regarding attitudes toward government and preferences for health care? Do the students outside the United States who use the book recognize similar differences?
Here is a set of questions (adapted from Don Lewis at the University of Wollongong, Australia) that might prove useful in conducting comparative analyses. You can fill in your own country
Does the health care system of any other country seem preferable to the ______ (your own country) system?
Are there parts of the health care systems of other countries that might be adapted to improve the ________ system?
Difficulties of the ________ system are easy to identify. Why do you think that _______ politicians have so much difficulty in reforming the system?
Advocates of the American system emphasize that it provides consumers with a freedom of choice of health care plans, new technologies are available sooner for American patients than those in other countries and that it doesn’t use queues (waiting lines) to allocate resources and limit spending. Do you agree?
Chapter 22 – Comparative Health Care Systems – Multiple Choice
Gordon developed a typology of health care systems. They include traditional sickness insurance, national health insurance, _______, and __________:
national health services; mixed systems.*
socialized health insurance; private systems.
Medicare; Medicaid.
entitlements; means-tested programs.
Table 22-1 shows health expenditures and outcomes in selected industrial countries. In looking at the table for 2009, one finds that _________ spent the highest percentage on health care and ______ spent the lowest.
Canada; Australia.
the United States; Mexico.*
the United States; the United Kingdom.
Switzerland; Greece.
In Table 22-1, one finds that for 2007 ________ had the highest number of deaths per 1,000 population, and _______ had the lowest number.
the United States; Switzerland.
Finland; the United States.
Hungary; Korea.*
the United States; France.
In Table 22-1, one finds that for 2006 Italy spent 45.2% of their health expenditures on inpatient care, while the United States spent 24.5%. However U.S. inpatient expenditures per person are higher because:
total U.S. expenditures are higher than Italy.*
the U.S. has more wasteful expenditures than Italy.
the U.S. measures inpatient care differently.
Answers (a) and (c) are correct.
Table 22-2 compares several countries regarding health care resources. One finds that for 2008 United Kingdom has about ___________ beds per 1,000 and about _____ practicing physicians per 1,000 than the United States.
the same number of; 60 percent more.
10 percent more; 12 percent more.*
20 percent fewer; 4 percent more.
30 percent more; 20 percent fewer.
Figure 22-1 examines health care spending among several advanced countries. It suggests that since 1960:
health expenditure shares have risen in all of the countries noted.
health expenditure shares have risen faster in the U.S. than in the other countries noted.*
U.S. expenditures have been rising and Canadian shares have been falling.
Answers (a) and (b) are correct.*
Figure 22-1 looks at health expenditure shares and shows that:
health expenditure shares have grown equally fast in all countries.
the United Kingdom has the lowest share of GDP going to health expenditures.*
France and the United Kingdom have similar shares of GDP going to health expenditures.
no country spends more than 15 percent of GDP on health.
In the figure above, the supply curve for a national health service is drawn vertically because:
demand does not equal supply.
quantity supplied is unresponsive to price.*
price is administered at P.
Answers (b) and (c) are correct.
In the figure above, if the administered price P* in the NHS were to be raised we might expect:
price in the private market to rise.
price in the private market to fall.
excess demand in the NHS sector to fall.
Answers (b) and (c) are correct.*
In the figure above, an increase in demand in the NHS system will:
increase the administered price.
increase excess demand in the NHS market*
increase demand in the private market
Answers (b) and (c) are correct.
In the figure above, an increase in demand in the NHS system will:
increase the NHS expenditure share.
increase NHS waiting times.*
decrease demand in the private market.
Answers (a) and (b) are correct.
The Chinese health care system has changed since the 1970s from a:
centralized command system to a more privatized system with smaller subsidies.*
centralized command system to a national health care system.
national health insurance system to a national health care system.
“mixed” health care system to a centralized command system.
Figure 22-3 suggests that recently in China, :
insurance coverage has increased in all areas.
insurance coverage has increased in rural areas, but decreased in urban areas.*
insurance coverage has increased in urban areas, but decreased in rural areas.
insurance coverage has decreased in all areas.
Table 22-5 compares Canada, Japan and the United States regarding available health care technologies. It shows that the United States has about _____ magnetic resonance imaging (MRI) machines available per million persons as does Japan, and about _____ as does Canada.
sixty percent as many; three times as many.*
the same number of; twice as many.
1.5 times as many; 2 times as many.
3 times as many; 3 times as many.
Table 22-5 compares Canada, the United Kingdom and the United States regarding available health care technologies. It shows that the Canada has about _____ computed tomography (CT) scanners available per million persons in the United States and _____ as the United Kingdom.
the same number of; the same number .
twice the number of; the same number.
40 percent of the number; almost twice the number.*
twice the number of; half the number.
Table 22-5 compares a number of countries regarding available health care technologies. ____ has the largest number of MRI per million population, and _____ has the smallest.
Japan; Mexico.*
The United States; New Zealand.
Germany; Canada.
Iceland; Hungary.
Critics of the U.S. health care system argue that the Canadian single-payer system has lower administrative costs. Estimates of the potential cost savings from a Canadian system range from:
Zero – it would provide no savings.
$28 to 45 per person.
$489 to $752 per person.*
$1,085 to $1,511 per person.
In an early study, Fuchs and Hahn compared the U.S. and Canadian systems and found that U.S. consumers paid _____ prices and received ____ services than otherwise similar Canadians.
lower; more.
higher; more.
higher; fewer.*
lower; fewer.
Comparing the Canadian and the U.S. systems, O’Neill and O’Neill find that U.S. residents worry most about _____ while Canadians worry most about ______.
quality; cost.
cost; quality.
cost; waiting time.*
waiting time; quality.
O’Neill and O’Neill, in comparing the Canadian and the U.S. systems, find that:
increased income had no impact in either country.
increased income increased health by about the same percentages in each country.*
the health of U.S. subjects increased with income, but the health of Canadians did not.
the health of Canadian subjects increased with income, but the health of U.S. subjects did not.
In the discussion accompanying Table 22-7, Schoen and colleagues find that residents of _____ had the most difficulty getting same day access to medical care.
Norway
Canada
The United States
Answers (a) and (b) are correct.*
In the discussion accompanying Table 22-7, Schoen and colleagues find that residents of _____ had the most difficulty paying previous years’ medical bills.
Norway
Canada
The United States*
New Zealand
Several critics argue that in rationed systems, analysts do not account for the economic costs of waiting for service. If the United States has less waiting time than other countries for various procedures, and resource costs take these into account, then:
resource cost differentials will be widened.
resource cost differentials will be narrowed.*
there will be no impact on resource cost differentials because one can’t add time and money together.
the adjustment will depend on how much people value their time.
If we define the health expenditure share s of the GDP as:
s = PQ/Y,
where P is the price of health care, Q is the quantity, and Y is GDP, then if Y increases by 10% and Q increases by 8%, then:
share s will rise.
share s will fall.*
there will be no change in share s.
there is not enough information to determine the answer.
If we define the health expenditure share s of the GDP as:
s = PQ/Y,
where P is the price of health care, Q is the quantity, and Y is GDP, then if P increases by 10% and Q decreases by 6%, then:
share s will rise.*
share s will fall.
there will be no change in share s.
there is not enough information to determine the answer.
Many of the more industrialized countries have sought to reform their health care systems by introducing elements of:
rationing.
price controls.
government service provision.
market mechanisms.*
In monopolistic health care systems, expenditures are higher because:
providers give higher quality care.
providers extract monopoly rents from the payers.*
providers offer too many services.
Answers (a) and (b) are correct.
In monopsonistic health care systems, expenditures are lower because:
providers give lower quality care.
providers are paid below-market wages.
system administrators extract economic rents from the health care providers.*
Answers (a) and (b) are correct.
Anderson and colleagues (2005) looked at the costs due to malpractice litigation and found that practices in the United States increased health care costs by about ____ per person.
$16*
$45
$110
$924
Mello and colleagues examined the claim that the malpractice liability system leads to unneeded care and extra expenses. They find that _____ and suggest that ____:
the costs constitute about 14 percent of all health care expenses; great savings could accrue in reforming the system.
there are no additional costs; the system need not be changed.
the costs constitute about 4.8 percent of all health care expenses; a Canadian-type system would provide improvements.
the costs constitute about 2.4 percent of all health care expenses; some benefits in terms of improved care may offset the increased costs.*
