In simple terms, describe some of the key features of the multi-payer and single payer health systems in the United Kingdom and Canada. What are the similarities and differences between them? How are they different than the multipayer US system?
In simple terms, describe some methods or approaches that might be taken to control rising costs and improve the quality of care?
Single payer refers to a health system that is financed by a single entity; in its common usage, that single entity is government. Government is the payer for services, and such payments are financed by taxes, but there is no implication that government employs the providers or actually owns or operates the health system. There still may be intermediaries between the government as payer and the provider, such as exists now with Medicare and health insurance intermediaries. In its “purest” form, in a single-payer system, health care services are paid for only by the government; in the case of Medicare, beneficiaries also contribute to payments through premiums.
Multiple payer refers to a health system that is financed
through more than a single entity, one of which may include
government. Private health insurance companies participate in
multiple-payer systems, with financing through individual premiums
paid directly by beneficiaries, employers, and, in some cases,
Whether a health care system is single or multiple payer does not in and of itself define the system in terms of coverage. Universal coverage means simply that all people within a particular jurisdiction have health insurance, be it single or multiple payer. Universal coverage requires governmental mandate; however, the form of that mandate may be through either single or multiple payer or a hybrid model.
Health care in the United States is currently a unique hybrid, multiple-payer system, but with elements of single payer (i.e., Medicare, although beneficiaries also contribute through premiums), publicly subsidized private payers (e.g., employer-sponsored health insurance), socialized medicine (e.g., Department of Veterans Affairs, in which government is both the payer and the employer), and self-pay (i.e., out of pocket).There are a few ways that single-payer can work, but at its core it is the government paying for healthcare services through revenue generated via taxation.In another way, people who live in a country pay into a pot of money through their taxes. The government then takes this pot of money and pays drugmakers, healthcare facilities, and doctors.One of the hallmarks of a single-payer system is the ability for the government to have more control over prices.For instance, in many single-payer systems, the government can negotiate prices for prescriptions drugs since it controls the purse for much of the spending. This makes sense because in the case of the UK, nearly 80% of the healthcare spending comes from the government. So if a drug is not bought by the government, it almost totally closes off the market to a pharmaceutical company. This gives the government a lot of bargaining power.Payments to healthcare providers, prescription drugs, and other aspects of the system are all subject to price negotiation with the government in single-payer systems.
The UK technically has four different national healthcare systems, one for each country that makes up the union, but the general construct is known as the National Health System.Within the NHS, there is a system of smaller community health boards that help ensure that national standards for care, cost, and efficiency are maintained.For patients, the NHS is generally "free at the point of use," meaning that when you go to a hospital or doctor's office there are no bills or co-pays.The UK pays for all this using both a specific national insurance tax on people making more than £157 per week and general tax funds to provide 98.8% of the funding for the NHS. The other 1.2% is paid for by out-of-pocket costs for things like prescriptions and dental care. The cost of co-payments for the out of pocket procedures are set by the NHS.About 66% of primary-care doctors are private contractors. The doctors, called general practitioners (GPs), receive payment at a rate set between their lobbying group the British Medical Association and the NHS. In contrast to the US, many doctors assign a patient a specific time to arrive at the doctor, rather than providing options the patient can choose from.A large majority of patients get their services from NHS-funded hospitals, but there are private-care facilities that can offer more specialized care or shorter wait times.
Healthcare in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician.Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, every doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private insurance represents a minimal part of the overall system.In general, costs are paid through funding from income taxes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care
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