Deck 16: International Comparisons of Health and Health Expenditures

Question 1

The U.S comprises the single largest purchaser of health care services in the world, even though it accounts for only 2% of the world's population.

Answer 1

False

Question 2

Since health care expenditures in many poor African countries such as Ghana average about $12 per person per year, there is no misallocation of resources.

Answer 2

False

Question 3

Health care expenditures in high-income countries average a much higher percentage of GDP; compared to health expenditures in low-income countries.

Answer 3

True

Question 4

In general, spending more is correlated with improved health; however, differences in spending and income across countries, differences in cultural and medical practices, and the interrelationship among all three make this a statement that can be made only very roughly.

Question 5

The statement "correlation does not imply causality" is especially demonstrated when comparing the relationship between health expenditures and health outcomes in the U.S. with that in Japan or Sweden.

Question 6

In low-income countries, family control over income and education play key factors in improving health of children.

Question 7

In low income countries, the same challenges that their governments face in economic development challenge the dissemination of health care services: lack of infrastructure in markets such as food delivery and disorganization and poor control of budgets and money supply.

Question 8

In low income countries, living in rural areas is highly correlated with worse health outcomes than living in urban centers.

Question 9

Ghana' status has been recently redefined from a "poor lower income" country to a "lower middle income" country, with income per capita of about $1600 per year in 2010. In theory, universal health coverage is available for everyone, but only 34% of the population chose to enroll, as of 2010.

Question 10

Intensity of services provided rather than number of physician or hospital day inputs seems to explain the U.S. as an outlier in health expenditures.

Question 11

In general, European countries have managed to maintain health care expenditures in the range of 6 to 11 percent of GDP by using social insurance programs along with supply side measures such as global controls on the number of health care workers. The U.S. on the other hand, remains an outlier. Supply side measures such as limiting the number of physicians are not practiced in the U.S.

Question 12

In low income countries, increasing expenditures on public health programs can be expected to have much less impact in terms of decreasing infant and child mortality than do increases in expenditures in high income countries.

Question 13

Increases in the proportion of health expenditures as a percentage of GDP in low income, middle income and high income countries reflect both an increase in costs and an increase in the proportion of a country's resources dedicated to health care.

Question 14

Detroit, USA and Windsor, Canada are the two cities on either side of the border between the U.S. and Canada. Crossing the border by car usually does not take much time when all of the documents are in order. Because of the nursing shortage in the U.S. it has been a long standing practice for many Detroit hospitals to fill the shortages by hiring Canadian nurses from Windsor who cross the border back and forth every day. This is an example of international trade in healthcare which is recorded in world economic accounts.

Question 15

How would you interpret the following statement: "The curve depicting the relationship between national income per capita and life expectancy has shifted upward over time"?

A) Over time, even if a certain country's national income does not change, it is likely that the country will observe a higher life expectancy due the impact of new knowledge and transfer of that knowledge across national borders.
B) Over time, even if a certain country's life expectancy does not change, its national income will tend to grow anyway.
C) Over time all countries' national incomes will grow, and that would lead to a higher life expectancy in turn.
D) Over time life expectancy in all countries tends to grow, and that would lead to higher national incomes too, as healthier people are more productive.
E) The relationship between national income and life expectancy is unstable over time.

Question 16

Which of the following statements about the healthcare systems of middle-income countries is false?

A) A characteristic of middle income countries such as Mexico is a great disparity between health outcomes between urban and rural citizens. This is true because most citizens live in rural areas.
B) A characteristic of middle income countries such as Mexico and Poland is social insurance programs which are often supplemented by private care by the wealthy.
C) Large variations in quality of service provision and social insurance schemes originating with employee coverage are characteristic of both Poland and Mexico's health care systems.
D) The most common source of income for Mexican physicians is from salaried positions in government insurance agencies and/or Ministry of Health.
E) The term "cost-shifting" is most likely to be interpreted differently in the U.S. vs. in Poland.

Question 17

Which of the following trends has started years ago in the U.S. healthcare sector and now can be observed in the Polish healthcare industry as well?

A) Use of predetermined reimbursement rates and limits on the number of services by public insurers.
B) Increased consumer cost-sharing as a tool to reduce moral hazard.
C) System-wide trend to actively encourage substitution of hospital care with other, less expensive treatment modalities.
D) Prominence of employer-sponsored private health insurance.
E) Mandatory insurance for all workers.

Question 18

Which of the following statements about the healthcare system in China is false?
Recent healthcare reforms in China

A) aimed to provide universal healthcare for all.
B) have considerably improved the nation's health outcomes.
C) have not led to a significant decrease in the nation's health expenditures.
D) encouraged an increase in the public share of the nation's health expenditures.
E) have led to a significant reduction in the share of healthcare expenditures individuals have to pay out-of-pocket.

Question 19

Which of the following is not a correct statement about the Japanese healthcare system?

A) The problem of cost containment is one of the common issues in both American and Japanese healthcare systems.
B) The Japanese healthcare system is characterized by a strict system of administered prices for physicians and hospitals.
C) In modern Japan, medical care to the elderly is provided free of charge, no cost sharing required, which is one of the major reasons why the growth of Japan's healthcare costs has recently become unsustainable.
D) Long-term care insurance in Japan was introduced as a less expensive alternative to long hospitals stays many elderly patients used to have. Changed family structure and increased burden of caring for the elderly in the society have also played a significant role.
E) Health care insurance premiums in Japan are based on income and ability to pay.

Question 20

The statements below attempt to describe different aspects or features of the German healthcare system. Which of these statements is correct?

A) In spite of the mandatory requirement in modern Germany for all citizens to have health insurance, the number of uninsured in this country is still around 200,000.
B) Privately insured citizens in Germany tend to be sicker than citizens insured under the government plans, because when people develop a serious health problem, they tend to switch to private insurance to seek better quality of care.
C) German citizens can freely choose between several types of government insurance (sickness funds) or private insurance without penalties. The only factor that matters is their ability to pay premiums.
D) Capitated (per insured) payments to sickness funds in Germany are uniform across the population.
E) If a person covered by private health insurance in Germany develops an expensive chronic condition, the insurer will not have the right to adjust premiums in accordance with the changed risk.

Question 21

Why was cream skimming popular among the sickness insurance funds in Germany before the payment reforms in 2009?

A) Capitation payments to sickness funds were uniform across the population.
B) Capitation payments to sickness funds had inadequate risk adjustment by age and sex only.
C) Capitation payments to sickness funds were too complicated and unbalanced, requiring categorization into one of 152 risk groups.
D) Payments to sickness funds were based on a fee-for-service system.
E) The most profitable patients used to be the sickest patients, as Morbi-RSA set some of its morbidity-adjusted payments too high.

Question 22

What does the future (i.e. economic forecast) most likely hold for the pharmaceutical industry worldwide?

A) Most of the R&D efforts will remain concentrated in the three major pharmaceutical markets in the world: the United States, European Union and Japan.
B) R&D activities are likely to move to the two most rapidly developing countries in the 21^st century: India and China.
C) R&D activities are likely to become more diffused all over the world, with no major areas of concentration, as it is significantly cheaper to conduct clinical trials in low- or middle-income countries.
D) Most of the R&D efforts are likely to move to Africa, where the cost of conducting R&D is among the lowest.
E) Canada is likely to become one of the major centers of pharmaceutical R&D, as it recently started to recognize international patent protection.

Question 23

Which of the following statements about the international trade in healthcare is true?

A) The European Union is the only international group in which citizens travel freely from one country's health care system to another.
B) Licensure and immigration laws restrict the flow of health care service workers among countries.
C) Enforcement of international patent laws means that price discrimination does not occur in the international pharmaceutical market.
D) It is much more likely for the German government to allow work permits for nurses from less developed countries than it is for the U.S. government to allow work permits for nurses from less developed countries.
E) The largest component of the international trade in medical goods and services is trade in medical services.

Question 24

Analysis of the evolution of payment systems across countries suggests that

A) the concept of managed care has limited applications outside of the high-income countries.
B) the principles of governmental regulation in countries where the healthcare system is primarily public have limited applications in countries where the healthcare system is mostly private.
C) European countries have been largely motivated at the individual level, using deductibles and copayments to moderate demand, yet the use of pooled financing that protects patients from risks also insulates them from costs.
D) the United States has operated largely on the supply side, constraining the provider system rather than individual demand.
E) public and private sectors in most countries are likely to converge in a blended contractual model - what is known in the United States as managed care.

Question 25

Compare the impact on incentives of licensure restrictions on physicians on pharmaceutical sales in the U.S. with those in Japan.

Question 26

Discuss the public good aspect of medical knowledge and the international diffusion of medical knowledge. Why do low income countries like Ghana and Sudan spend a disproportionate amount of funds on state of the art urban hospitals when care is so limited in rural areas?

Question 27

Discuss the international flow of health care workers and "brain drain" from low- and middle-income countries.

Question 28

What does Dr. Getzen mean by saying that "In many ways, high-income countries face the same problems of maldistribution and misallocation in the delivery of medical care as low-income countries, but at a different level"?

Question 29

Explain the fact why there is no unemployment of physicians in the U.S., while there is a 30% unemployment rate of physicians in Mexico, where there are significantly less physicians per capita than in the U.S.

Question 30

Discuss the role and extent (or lack thereof) of private markets' penetration in the healthcare sector across countries of all ranges of income. Provide an opinion on whether there is room for for-profit businesses in the countries where the healthcare system is primarily public.

Question 31

As was highlighted in the text, many countries regulate prices of pharmaceutical products, which often results in imported pharmaceuticals' prices being lower than prices manufacturers charge to domestic consumers. This creates an opportunity for a "free ride" for such countries, which avoid paying for R&D expenses, but enjoy all the benefits of newly developed drugs. Is it truly a "free" ride?