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 May receive SS benefits beginning at age 62. 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 Long term care is not covered by traditional health insurance or Medicare.

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

U.S. Health Care System and Policies Affordable Care Act (2010)-Obamacare will Expand coverage; lower health care costs; enhance the quality of care for all Americans; keep young adults covered (<26 yrs., will be eligible under parent’s plan); preventive care at no cost; low income adults will be guaranteed coverage through Medicaid. – Coverage, Cost, Care Good News: before healthcare premiums were too expensive; insurance companies denied coverage to anyone who had a preexisting medical condition Bad news: very confusing; fine 2.5% of income with no coverage (or $695/adult, $347.50/child with no household limit) http://www.hhs.gov/healthcare/rights/

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