Beveridge Model - Answers everything done by government through taxes; single payer controls;
hospitals and clinics are public/ doctors are public and private; example countries are Great
Britain, Spain, Cuba; US similarities are treating veterans (the VA)
Bismarck Model - Answers uses an insurance system usually financed jointly by employers and
employees through payroll deduction; cost control through tight regulation; health insurance
plans have to cover everybody and don't make a profit (unlike US); doctors, hospitals, and non-
profit sickness funds tend to be private; example countries are Germany, France, Belgium,
Netherlands; US similarities are working Americans who get insurance on the job
National Health Insurance Model - Answers uses private sector providers but payment comes
from a government run insurance program that all citizens pay into; healthcare financed through
tax payments; single payer has power to negotiate lower prices; control costs by limiting
medical services that they will pay for or by making patients wait to be treated; private providers,
public run national insurance; example countries are Canada, Taiwan, South Korea; US
similarities are for Americans over the age of 65
The Out-Of-Pocket Model - Answers individual payments; rich get medical care; most poor
people go their whole lives without seeing a doctor; example countries are Cambodia, rural India,
Africa, China, South America; US similarities are 15% of Americans who have no health
insurance with access to a doctor available if you can pay the bill out-of-pocket
US healthcare system compared to others - Answers spend the most; Mostly worse outcomes ◦
Obesity in adults ◦ Life expectancy at birth ◦ Asthma and COPD hospital admission ◦ Diabetes
hospital admission; Some better outcomes ◦ Daily smoking in adults ◦ Breast cancer relative
survival ◦ Ischemic stroke case fatality ◦ AMI case fatality; all the other countries have settled on
one model, which is simpler, fairer, and cheaper; One of the most complex healthcare systems
in the world, formed by intertwining relationships between providers, payers, and patients
receiving care
Problems in US healthcare system - Answers many baby boomers currently who need Medicare;
life expectancy lower than other countries; spend way more compared to other countries; more
obesity; hospital admissions for heart failure, diabetes, asthma, and COPD; about 10% of U.S.
citizens lack health insurance and a similar percent is underinsured; about 16% of Americans
say they skipped medication due to cost while 33% of persons without insurance chose not to
fill Rx; prescribing antibiotics when not necessary and not using corticosteroids when necessary
for things like COPD
quality - Answers the degree to which health care services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current professional
knowledge
, value - Answers quality/ cost or what do we get for what we pay
National Academy of Medicine aims for healthcare quality - Answers safe, effective, patient-
centered, timely, efficient, equitable
equitable care - Answers does not vary in quality due to ethnicity, gender, geographic location,
income
patient centeredness - Answers 97% of patients said that the provider explained things clearly
and 97% said the provider listened carefully; 84% said they usually or always get an appointment
for routine care as soon as needed; results tend to be slightly lower for Medicaid patients
safety problems - Answers 1 in 4 hospital admissions result in an adverse event, and 1 of 4 of
the events are preventable; warfarin prescriptions result in high error rate; many errors due to
adverse drug effects
diabetes - Answers 23% met all goals; NO IMPROVEMENT in goal attainment since 2005
is quality improving in the US - Answers Quality of healthcare improved overall from 2000
through 2018, but the pace of improvement varied by priority area
drug related morbidity - Answers the failure of a therapeutic agent to produce the desired
outcome; encompasses the concepts of "therapeutic failure" and the creation of new problems
or harm; leads to billions of dollars in avoidable costs; often preceded by a Drug-Related
Problem
drug related problems - Answers Untreated indications; Improper drug selection; Sub-
therapeutic dosage; Overdosage; Failure to receive a drug and/or non-adherence; Adverse drug
reaction; Drug interactions; Drug use without indication
non-adherence to medication - Answers 50% of people don't take their medications as
prescribed
Medicare - Answers federal health insurance program for those age 65 & older; HHS
administers; increases because of baby boomers; life expectancy has increased; now covers 3x
more people; spends 40x more; it will collapse if no reform
Medicaid - Answers insurance program for the poor to be administered by the states; use has
increased to 25% of US population (28% of Ohio); pandemic led to surge; 5% drive majority of
cost; many are working; HHS administers
CHIP - Answers State Children's Health Insurance Program; Joint federal/state funding with an
enhanced match to states; Provides health insurance to children whose families: are uninsured
or are low income but earn too much for Medicaid;
Medicaid Administration - Answers Joint state-federal program