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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