Healthcare Provider Industry Overview - Products & Services

Primerli

22 Nov 202203:13

Summary

TLDRThis video script discusses the variance in healthcare experiences globally, influenced by the payer dynamics. It outlines two public spending systems: national health services like the UK's NHS and national insurance programs like Canada's Medicare. It also covers private spending, including employer-funded and individual insurance, exemplified by the U.S. market. The script highlights out-of-pocket spending as an indicator of healthcare burden, contrasting Mexico's high rate with the U.S.'s low rate. The ultimate goal across countries is to provide accessible, high-quality healthcare at the lowest cost.

Takeaways

🌍 Healthcare systems worldwide have the same components but vary in patient experience based on payment sources.
🏥 Public spending can be administered through national health systems where the government is both payer and provider, like the NHS in England.
💼 National health insurance is another public spending model where the government covers costs through a public insurance program, with private providers, like Canadian Medicare.
🏢 Single-payer models, like in the UK and Canada, have the government as the primary payer, exerting control over provider and pharmaceutical prices.
💸 Private spending comes from health insurers, either through employer-funded plans or individual policies, and is the largest in the U.S.
💵 Out-of-pocket spending, direct payments from patients, varies significantly even among countries with similar private health care spending levels.
📉 In Mexico, out-of-pocket spending is nearly 40% of total health care spending, compared to only 10% in the U.S.
🤝 Countries use a mix of public and private payment sources, often with multiple payment structures.
🌐 Despite the complexity and variation, the goal of health care systems is universal: accessibility, quality, and affordability.
🎯 Governments in single-payer systems have significant negotiating power to control health care costs.

Q & A

What is the primary factor that influences the patient's experience of accessing healthcare?
-The primary factor influencing a patient's experience of accessing healthcare is the payment system, which includes who the payers are and how they function.
What are the two main sources of healthcare payment mentioned in the script?
-The two main sources of healthcare payment mentioned are private sources, such as insurers or out-of-pocket spending, and public sources, such as government payments.
How does the split of private versus public spending vary across countries?
-The split of private versus public spending varies widely across countries, with examples given being Norway's government paying for 85 percent of healthcare expenditures, while Switzerland is closer to 30 percent.
What is a national health system?
-A national health system is a system where the government acts as both payer and provider, funding and operating a national network of public hospitals accessible to all citizens mostly free of charge.
What is an example of a national health system?
-England's National Health Service (NHS) is an example of a national health system.
What is national health insurance?
-National health insurance is a system where the government covers the bulk of healthcare spending through a public insurance program, with most providers being private but receiving payment for services through the government insurance.
How does Canadian Medicare differ from the United States Medicare?
-Canadian Medicare is a form of national health insurance offered to all citizens, while the United States Medicare covers only seniors.
What is the significance of single-payer models in healthcare?
-In single-payer models, like the UK and Canada, the majority of healthcare spending comes from the government, allowing significant control over the prices paid to providers and pharmaceutical companies.
What are the two main forms of private spending in healthcare?
-The two main forms of private spending in healthcare are payments made by private health insurers through claims against insurance policies, and direct out-of-pocket payments from patients to providers.
How does out-of-pocket spending impact the healthcare burden on patients?
-Out-of-pocket spending can significantly impact the healthcare burden on patients as it is typically less predictable than insurance premiums or taxes and can vary greatly even among countries with similar levels of private healthcare spending.
What is the general objective of healthcare systems across different countries?
-The general objective of healthcare systems across different countries is to make healthcare accessible to as many people as possible while ensuring it is high quality at the lowest possible cost.

Outlines

00:00

🌍 Overview of Global Healthcare Payment Systems

This paragraph introduces the variation in healthcare access across different countries, emphasizing that while healthcare components are similar worldwide, the patient experience is shaped by how healthcare is paid for. The paragraph defines private and public spending sources, highlighting examples from Norway and Switzerland to demonstrate the wide range of government healthcare funding.

🏥 Public Healthcare Systems: National Health Service and Insurance Models

This section explains two common models of public healthcare funding. The first is a national health system, where the government acts as both payer and provider, exemplified by England’s NHS and the U.S. Veterans Health Administration. The second model is national health insurance, where the government funds healthcare through public insurance while providers remain private. Canada’s Medicare is an example of this system, and the U.S. has national health insurance programs like Medicare and Medicaid.

💰 Single-Payer Models and Government Control in Healthcare

Here, the focus shifts to single-payer models, where most healthcare spending comes from the government. Countries like the UK and Canada are highlighted as examples. These systems allow governments to have significant control over pricing for healthcare services and pharmaceuticals, either directly or through negotiation. This ensures greater regulation of healthcare costs.

🏦 Private Healthcare Spending: Insurers and Out-of-Pocket Payments

This paragraph discusses private healthcare spending, which can take the form of payments by private health insurers or out-of-pocket payments by individuals. It mentions that in some countries, individuals must purchase health insurance, and highlights the U.S. as having the largest private insurance market globally. The unpredictability of out-of-pocket payments is seen as a significant financial burden for patients, especially compared to regular insurance premiums.

📊 Variations in Out-of-Pocket Spending Across Countries

The focus here is on the variation in out-of-pocket healthcare spending between countries with similar levels of private spending. Mexico and the U.S. are compared, with Mexico having a much higher percentage (40%) of out-of-pocket spending compared to the U.S. (10%). This difference is an important indicator of the healthcare burden on patients.

🔄 Mixed Payment Sources in Global Healthcare Systems

In the final paragraph, it is explained that all countries use a combination of public and private funding sources for healthcare. Most countries also have multiple payment structures in place. Despite the complexity and variation of healthcare systems across the globe, the ultimate goal remains the same: to make healthcare accessible, high-quality, and affordable for as many people as possible.

Mindmap

Keywords

💡Healthcare ecosystem

The healthcare ecosystem refers to the different components and stakeholders that make up the healthcare system in any country. These include patients, providers, insurers, and governments. The video highlights that while these components are similar across countries, the way patients experience healthcare can vary depending on who the payers are and how the system is structured.

💡Public spending

Public spending refers to the portion of healthcare expenditures that are covered by the government. In the video, it mentions how different countries, such as Norway and Canada, rely heavily on public spending to cover healthcare costs. The concept is key to understanding how governments provide healthcare through public funds and influence prices in the healthcare system.

💡Private spending

Private spending involves payments made by private insurers or directly out-of-pocket by individuals. The video contrasts public and private spending, explaining how in countries like Switzerland and the United States, a larger share of healthcare funding comes from private sources, which can affect accessibility and cost.

💡National health system

A national health system is a public healthcare model where the government acts as both the payer and provider of healthcare services. The video uses the example of England's NHS, which operates public hospitals that provide healthcare to citizens free of charge. This system allows the government to directly fund and control healthcare delivery.

💡National health insurance

National health insurance is a model where the government provides insurance to cover most healthcare costs, but healthcare services are still delivered by private providers. The video uses Canada's Medicare system as an example, where the government pays for healthcare services while citizens access care from private providers.

💡Single-payer model

In a single-payer model, the government is the primary source of healthcare funding, covering most or all healthcare expenses. The video discusses how countries like the UK and Canada use this model, which gives the government substantial power to negotiate costs with healthcare providers and pharmaceutical companies.

💡Private health insurance

Private health insurance refers to insurance policies that individuals or employers purchase to cover healthcare costs. The video notes that the U.S. is the largest market for private health insurance, with nearly 40% of healthcare spending coming from private insurers. This form of spending allows people to access healthcare outside of public systems.

💡Out-of-pocket spending

Out-of-pocket spending refers to direct payments made by individuals for healthcare services not covered by insurance or government programs. The video highlights that this spending can vary widely across countries, such as Mexico, where 40% of healthcare spending is out-of-pocket, compared to 10% in the U.S.

💡Medicare and Medicaid

Medicare and Medicaid are national health insurance programs in the U.S. Medicare covers seniors, while Medicaid provides healthcare for low-income individuals. The video uses these programs as examples of government-administered insurance that helps specific populations access healthcare.

💡Cost control

Cost control refers to efforts by governments or private insurers to manage and reduce healthcare costs. The video explains how single-payer systems allow governments to exert significant control over prices paid to providers and pharmaceutical companies, often by negotiating or directly setting prices. This is a key objective for all countries trying to balance quality, accessibility, and affordability in healthcare.

Highlights

Patients' experience of accessing healthcare varies greatly across countries, influenced by who the payers are and how they function.

Payment for healthcare can come from private sources (insurers or out-of-pocket) or public sources (government), and the balance of these varies by country.

Norway's government covers 85% of healthcare expenditures, while in Switzerland, government spending is closer to 30%.

Two common public spending systems are the national health system (where the government acts as both payer and provider) and national health insurance (where the government funds healthcare but services are provided by private providers).

The UK's NHS is an example of a national health system, where the government operates a national network of public hospitals.

The U.S. Veterans Health Administration is a national health system for military veterans.

Canada’s Medicare is an example of national health insurance, where the government covers healthcare costs, but providers are mostly private.

Countries like the UK and Canada are considered single-payer models, where the government provides the majority of healthcare spending.

Single-payer systems allow governments to have significant control over prices paid to providers and pharmaceutical companies, either directly or through negotiation.

Private health insurance, typically funded by employers or purchased individually, covers healthcare in many countries, with the U.S. having the largest private health insurance market.

In some countries, individuals are mandated to purchase private health insurance to increase coverage.

Nearly 40% of healthcare spending in the U.S. is paid by private insurers.

Out-of-pocket payments, costs directly paid by patients, vary significantly across countries, with 40% of spending in Mexico coming from out-of-pocket, compared to only 10% in the U.S.

Out-of-pocket payments can be a good indicator of healthcare burden, as they are often less predictable than insurance premiums or taxes.

All countries use a mix of public and private payment sources and have multiple payment structures, with the common goal of providing accessible, high-quality, and cost-effective healthcare.