chapter 27: global models of health care. learning objectives compare the aging policies of japan,...

Chapter 27: Global Models of Health

Care

Learning Objectives• Compare the aging policies of Japan, Germany,

England, and Canada with those of the United States.

• Describe the effects of an aging population on health policy.

• Explain how morbidity and mortality can influence policies for the elderly.

• Analyze the benefits of social security.• Contrast the Medicare and Medicaid programs.• List the benefits and barriers to long-term care

insurance.

International Models of Health Care• Japan

– Universal healthcare system through National Health Insurance, variety of employer-based health insurance plans, and Health Insurance for the Elderly

– Everyone in Japan must enroll in a health insurance plan

– Home care– Long-term care insurance provides services to

help relieve stress on caregivers; not monetary benefits

International Models of Health Care• Germany

– 1st country to establish a national healthcare program

– Social insurance is a mandatory transfer system whereby employees and employers make equal contributions for LTC.

– Solidarity principle: “members of society are responsible for providing adequately for another’s wellbeing through collective action”

– Private insurance option– Long-term care insurance integrated into the

social security system

International Models of Health Care• England (Great Britain)

– National Health Service: universal health care system based on clinical need rather than employment status

– Private health services used by 12% of population

– Patient Choice helped alleviate long wait times– Long-term care is considered social care, so not

provided free under NHS; policy discussions will continue in the future

International Models of Health Care• Canada

– Universal health coverage system called Medicare, provides at no cost

– Each of the 10 provinces responsible for healthcare services according to national guidelines

– Wait times have been an issue but are improving

– Canadian Health Act does not guarantee coverage for long-term care or end-of-life services

U.S. Health Care System and Policies

• Effects of an aging society– By 2035, 20% of U.S. population will be 65+

– Challenges to policy makers

• Culturally diverse and educated population

• How to finance long-term care

• Need for interdisciplinary teams with expertise in geriatrics

• Disequilibrium in demographics between working-age and elderly population

U.S. Health Care• Effects of mortality

– Life expectancy

• 78.49 years for a child born in the U.S. in 2012

• U.S. ranks 50th out of 221 countries in life expectancy according to the CIA (central intelligence agency)

– Health practices in childhood and young adulthood influence health as we age

– Currently, health expenditures for elderly are disproportionate to percentage of population

U.S. Health Care• Social Security

– Social Security Act of 1935

– U.S. one of the last countries to establish a federal old-age pension program

– Never intended to be the sole source of a person’s retirement income

– Defined retirement age as 65: Now 66 years 2 mo

• Delayed retirement credit (DRC):If a worker postpones retirement past full retirement age (66 y 2 mo) and up to age 70, the worker will receive more than the earned full benefit

U.S. Health Care • Medicare

– Title XVIII of Social Security Act

– For those age 65+ who have paid into the Social Security program

• Part A: financed by payroll taxes, no charge to eligible recipients; Hospital insurance

• Part B: non-mandatory medical insurance, monthly premium, yearly deductible: supplemental insurance

• Part C: Medicare Advantage HMO or PPO option

• Part D: Prescription drugs; doughnut hole

U.S. Health Care • Medicaid

– Title XIX of Social Security Act

– Health insurance for low-income families and people with disabilities

– Long-term care for older Americans and persons with disabilities

– Supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare (e.g., eyeglasses, hearing aids, prescription drugs) as well as Medicare Part B premiums.

U.S. Health Care System and Policies

• Long-term care insurance– Nursing home care averages $72,000/year

– Assisted living facilities average $38,000/year

– Home care services average $21/hour

– Average cost of a comprehensive long-term care policy for an eligible person would be $2,207/year for 4.8 years of benefit at the rate of $160/day

U.S. Health Care System and Policies

• Long-term care insurance (cont’d)– 10-15% of elderly have this coverage– Benefit trigger: ADLs or cognitive impairment– Elimination period: waiting period of 30, 60, or

90 days when beneficiary must pay out of pocket

– Long-term financial viability of insurers is in question

Summary• Policies on aging within models of health

care vary internationally• As the 65+ population grows worldwide,

policymakers will review care delivery systems to determine best practices– Gerontological nurses will have input through

research, analysis, and evaluation

• Help patients and families navigate healthcare system by understanding reimbursement for benefits issues