Latha Rajendra Kumar, MD, PhD and Robin Yurk, MD, MPH e:

Transcription

1 Latha Rajendra Kumar, MD, PhD and Robin Yurk, MD, MPH e: An International Perspective on Health Insurance Health Insurance systems differ across the globe and can traditionally be separated into Universal Healthcare, Private Healthcare, Public Healthcare and the Uninsured with implementation of a combination of these different models. Health insurance is defined in this article as a program that pays for healthcare expenses. We present an International perspective on Health insurance by discussing Universal Healthcare, the healthcare system in the United States contrasted with that in Developing countries. Development of Medical Tourism Insurance is currently integrated into this International perspective as an option for increasing access to healthcare. Universal Healthcare : National Health Insurance is available to all residents of a country through legislation with a variation in financing mechanism and benefits. National Health Service Models are prevalent around the world with examples in Germany, the United Kingdom, Canada, France, Ghana, Columbia, Japan, South Korea, Switzerland, Taiwan, Nigeria, and the Philippines. Some countries fund these programs through taxation, employer and employee 1 contributions, or private contributions. Some of these countries have options for private health plans. For example, The United Kingdom has a Universal Health Insurance System called the National Health Scheme with the additional option for private patients who fund themselves or have private health insurance coverage. The 2 system is controlled through use of a General Practitioner who provides access to the private hospitals. Mexico has Universal Health Care implemented by the Mexican government in addition to a private healthcare system available to those with income. The Secretariat Health Agency implements a public health system with eligibility to all Mexican citizens regardless of their employment system. Two public systems are available for the employed: the Instituto Mexicana del Seguro Social(IMSS) and the Instituto de Seguridad y Servicios Sociales 3 de los Trabajodores del Estado(ISSSTE). United States : The majority of American have health insurance and these programs routinely pay for routine preventive care, emergency care, hospitalization and prescription drug coverage with varying benefit plans based on different financing models. The system is divided into a Private and Public Healthcare system. Managed Care is common Page 23

2 to both systems as a cost control mechanism to covered members. The categories of public insurance include Medicare, Medicaid, State Children's Health Insurance Program, Military, and Indian Health Service. The private insurance system is primarily employer based or student health insurance. Specialty insurance programs exist for Long Term Care, Disability and Supplemental coverage. The financing models of medical insurance are 4 separated into Fee for Service Plans, Private Plans, Health Maintenance Organizations, or Managed Care. The financing formula traditionally involves payment of a fixed rate, co-payment or premium with the price determined by the health plan benefits offered. Government programs sometimes implement waivers to study alternative programs of cost effective healthcare both domestically and overseas. Developing Countries : There is enormous mismatch in global healthcare financing. Developing countries have 84% of population & 6 90% of disease burden. Developing countries do not have Universal health insurance. The insurance system is a system of Private insurance for the wealthy and the uninsured who pay out of pocket. An estimate of 1% of the GDP in India is public financing, in comparison to a 2.8% average for low and middle 7 income countries. India is an example of the insurance program in developing countries where the majority of residents do not have healthcare coverage. An estimate is only 10% have health insurance and 75% pay out of pocket. The development of insurance programs is a growing business with the introduction of Third Party Administrators to manage insurance products instituted by the Insurance Regulatory Development Authority in India's health insurance program can be described in terms of three plans: private, social, and community based. There is growing interest to provide insurance coverage by developing a premium for insurance to both people 8 who can afford or not afford to pay the premium. India has several challenges in financing healthcare costs which include the increase in healthcare costs, new diseases and risks, burden of the poor, low level of awareness, need for long term and nursing care for seniors, and lack of preventive and primary care. India's insurance companies need to overcome barriers to implementing an insurance program which include limited control over healthcare systems, consumer awareness which is small, inadequate pricing of insurance products due to lack of standardization and data, restricted product development in the area of healthcare 10 informatics, and low level of medical penetration. The government needs to develop an insurance system 11 for the public which should begin as a preventive healthcare system. There are many steps involved in 5 9 Page 24

3 promoting the insurance system in India which include creating awareness of rights & responsibilities, data pool, standardization of costs, increased tax benefit, portability of insurance, comprehensive health benefits, 12 and having a government role. Medical Tourism Insurance : Global Healthcare is marketed to all citizens in all countries regardless of socioeconomic class. Different economic models of medical tourism exist in Developing and Developed countries. Medical Tourism is a mechanism to develop the public health system in developing countries and is an option to provide an alternative option for elective, diagnostic, lifestyle procedures for countries with more developed insurance 13 systems. Global healthcare insurance is a newer concept and currently exists as a Fee for Service(FFS) or capitation model, where discounted rates are reimbursed through financing mechanisms for specific procedures or as part of a package. Insurance policies with premiums are available for travel insurance, medical travel insurance, medical complications/medical malpractice, and pilot employer sponsored programs to some 14 countries. The demand for a growth in medical tourism insurance policies is to increase access to medical tourism for potential patients from all countries with lower rates and portability of insurance policies. Health insurance is a barrier to the trade in healthcare as it isn't uniformly portable or useable globally. Insurance businesses could benefit from the trade of health services. However, issues regarding the quality of care, 15 malpractice, costs of monitoring care and the increased costs to the public health systems exist. Performance 16 of hospitals has been positively associated with quality improvement in the literature. To facilitate trade, Developing countries can improve the quality of service provided and require doctors and nurses to meet the standards of certification. 17 Universal Health Insurance is a goal of all countries to work towards. All countries are implementing a combination of financing mechanisms to deliver comprehensive health benefits to its citizens. Developing countries are working towards building a more sophisticated health system through the development of insurance and the building of higher quality facilities. Medical Tourism is assisting developing countries to develop its healthcare goals while providing an alternative solution to citizens in other countries who currently have barriers to achieving their health goals. Page 25

4 References : 1). National Health Insurance Models. Retrieved on October 12, Available at URL: en.wikipedia.org/wiki/national_health_insurance 2). 3). 4). 5). 6). 7). 8). 9). 10). 11). Insurance in the United Kingdom. Retrieved on October 12, Available at URL : Health Insurance in Mexico. Retrieved on October 12, Available at URL: Health Insurance in US. Retrieved on October 12, Available at URL: Warner, D and L. Jahnke, "Toward Better Access to Health Insurance Coverage for U.S. Retirees in Mexico," Salud Publica de Mexico 43, no. 1 (2001): Mathers, C. D., A. D. Lopez, and C. J. L.Murray. Forthcoming. The Burden of Disease and Mortality by Condition: Data,Methods, and Results for the Year In A.D. Lopez, C., retrieved on October 20, 2010, available at URL: siteresources.worldbank.org/...financing/ HFRFull.pdf Schieber and Maeda. A curmudgeon's guide to financing health care in developing countries, in George J Schieber edited Innovations in health care financing: Proceedings of a world bank conference. March 10-11, 1997, World Bank discussion paper No 365, The World BNK, Washington D.C. Health Insurance in India. Retrieved on October 12, Available at URL: Ahuja, R. Health Insurance for the poor in India, March 2004, presented at workshop on ICRIER on New Institutional and economic approaches to health insurance for the poor in India. Wise Geek, What Is Healthcare Informatics? Retrieved on October 12, Available at URL: Srinivasan R, 2001, Health insurance in India, Health and Population Perspectives and Issues, 24 (2),p Page 26

5 12). 13). 14). 15). 16). 17). Gumber A. 1997, Burden of disease and cost of ill health in India: setting priorities for health interventions during the ninth plan, Margin, Vol 29 (2), pp Bookman M and Bookman R. Medical Tourism in Developing Countries Palgrave Macmillan: NY. Yurk, RA. International Mediator Cover Business Plan. NY: Wallcott Holdings, LLC. December 16, 2009 Mattoo, A and Randeep Rathindran. How Health Insurance Inhibits Trade in Health Care, Health Affairs, 25, no. 2 (2006): Hibbard, J, J. Stockard, and M. Tusler, "Does Publicizing Hospital Performance Stimulate Quality Improvement Efforts?" Health Affairs 22, no. 2 (2003): Chanda, R. "Trade in Health Services," Bulletin of the World Health Organization 80, no. 2 (2002): Page 27