00:00:00
are you confused by the various
00:00:01
Healthcare Systems in your country and
00:00:03
around the world you're not alone this
00:00:05
is the anatomy of healthcare Dr jbal med
00:00:07
school insiders.com perhaps you think
00:00:09
healthcare is broken and like many of us
00:00:11
you want change but we must first
00:00:13
understand Healthcare before trying to
00:00:15
fix it in this three-part series we'll
00:00:17
explore the major Healthcare models of
00:00:18
the world how the US fares in comparison
00:00:20
and what changes to make moving forward
00:00:22
anytime you think about Healthcare
00:00:24
whether abroad or here in the US this is
00:00:26
the blueprint that should come to your
00:00:27
mind at the root level Healthcare
00:00:29
Systems come down to to four
00:00:30
constituents the government the insurers
00:00:32
the patients and the providers which
00:00:34
includes doctors Healthcare
00:00:35
professionals and hospitals depending on
00:00:37
the healthare system in consideration
00:00:39
the interaction and dynamic between
00:00:41
these constituents vary for example
00:00:43
sometimes the government is the insurer
00:00:44
which means it takes on the financial
00:00:46
responsibility other times the
00:00:47
government is completely out of the
00:00:49
picture or it may play a regulatory role
00:00:51
there are four factors to consider
00:00:52
between the four major Healthcare models
00:00:54
the first factor is the number of
00:00:56
sources of coverage or financial support
00:00:58
that exist under the model if there is
00:01:00
one source of coverage we call it a
00:01:01
single-payer model and if there are
00:01:03
several sources of coverage we call it a
00:01:05
multi-payer model the second factor is
00:01:07
the source of coverage itself this could
00:01:08
be the government in single-payer models
00:01:11
or private insurance companies in
00:01:12
multi-payer models the third factor is
00:01:14
the source of funding how are the
00:01:16
government and insurance companies
00:01:17
getting money to provide coverage the
00:01:19
last factor in consideration is the
00:01:21
sector responsible for delivering care
00:01:23
the private sector or the public sector
00:01:25
this has to do with whether the
00:01:26
hospitals are government-owned or
00:01:27
privately owned and whether the doctors
00:01:29
are govern government employed or
00:01:30
privately employed this has major
00:01:32
implications for the government's
00:01:33
regulatory power autonomy of providers
00:01:36
and Innovation each of the four major
00:01:37
Healthcare models sits on different
00:01:39
points of the nationalization
00:01:40
privatization Spectrum with one end
00:01:42
representing 100% nationalization in
00:01:45
which the government fully funds and
00:01:46
delivers care and the other end
00:01:48
representing 100% privatization in which
00:01:50
the private sector fully funds and
00:01:52
delivers care with no input from the
00:01:53
government broadly speaking
00:01:55
nationalization is associated with
00:01:57
greater accessibility to care lower
00:01:59
costs and reduced administrative
00:02:00
complexity whereas privatization is
00:02:02
associated with less regulation greater
00:02:04
freedom for Physicians and a more
00:02:06
fertile ground for Innovation out of the
00:02:07
four Global Healthcare models there are
00:02:09
two Single Payer models one private
00:02:11
payer model and one multi-payer model
00:02:13
the two Single Payer models are the
00:02:15
beverage model found in Britain and the
00:02:17
national health insurance model found in
00:02:19
Canada in both of these models the
00:02:20
government funds Healthcare but the
00:02:22
primary difference between these models
00:02:23
is in the delivery of care in the
00:02:25
beverage model there is public delivery
00:02:27
of care which means that the Physicians
00:02:29
hospitals and clinics are all
00:02:30
government-owned or part of the public
00:02:32
sector in the national health insurance
00:02:34
model there is private delivery of care
00:02:36
which means that hospitals clinics and
00:02:37
Physicians are all part of the private
00:02:39
sector and have greater freedom to
00:02:40
practice as they please without
00:02:41
government input there is often an
00:02:43
expectation that greater government
00:02:45
involvement translates to increased
00:02:46
bureaucratic complexity but that isn't
00:02:48
necessarily true in a single-payer
00:02:50
system there is no Market competition
00:02:52
and with the government financing care
00:02:54
the costs that providers charge are kept
00:02:55
low benefits are standardized and with
00:02:58
no Financial motives to deny claims and
00:03:00
no concern for profit the delivery of
00:03:01
care is cheaper and often simpler to
00:03:03
navigate the frustrating complexity of
00:03:05
insurance plans claims processing and
00:03:07
claims disputing factors that drive
00:03:09
administrative expenses through the roof
00:03:11
under the US Healthcare System are
00:03:13
absent from the picture entirely more on
00:03:15
this in the next few videos in both of
00:03:17
these single-payer systems there is
00:03:18
universal coverage which means that
00:03:20
every citizen is financially backed by
00:03:22
an insur with little out-of-pocket cost
00:03:24
to the citizen the beverage model is
00:03:25
often criticized for its potential risk
00:03:27
of overutilization as policy makers fear
00:03:29
that free access would drive patients to
00:03:31
demand unnecessary Services resulting in
00:03:33
higher costs and taxes that said these
00:03:35
systems have regulations and proactive
00:03:37
prevention campaigns to circumvent these
00:03:39
issues to put this all into perspective
00:03:41
let's say your friend Harry a British
00:03:43
citizen gets into a crazy car accident
00:03:45
and Britain he'll be rushed to the
00:03:46
hospital government owned he'll be
00:03:48
treated by physicians government
00:03:50
employed and he'll also walk out without
00:03:51
any bill because the government pays
00:03:53
this is Public Funding and public
00:03:55
delivery on the other hand let's say
00:03:57
your friend Justin gets into a crazy car
00:03:58
accident in Canada there under the
00:04:00
national health insurance model he'll
00:04:02
receive Care at a privately owned
00:04:04
hospital and all his follow-up visits
00:04:05
will take place with Physicians of his
00:04:07
choice in the private sector even though
00:04:09
the government is footing the bill it
00:04:10
does not control how Healthcare is
00:04:11
delivered by the doctors nor does it
00:04:13
mandate its citizens to visit select
00:04:15
providers the doctors have greater
00:04:16
freedom to practice and generally
00:04:18
patients also have greater freedom to
00:04:19
choose their providers the third model
00:04:21
is the out-of-pocket model this model is
00:04:23
essentially the absence of any
00:04:25
formalized Healthcare System and we coin
00:04:27
it a private payer model instead of a
00:04:29
Single Payer pay or multipay model
00:04:31
because citizens are forced to pay for
00:04:32
care directly out of their pockets with
00:04:34
no external coverage most nations are
00:04:36
too poor to systematically provide Mass
00:04:38
Medical Care folks in such countries
00:04:40
scramble to pay unaffordable bills in
00:04:41
the face of emergencies Medical Care is
00:04:43
a luxury reserved for the wealthy the
00:04:45
fourth and final model is the bismar
00:04:47
model which the German Healthcare System
00:04:49
is derived from this model is the most
00:04:51
privatized of the four models with the
00:04:52
government having the least involvement
00:04:54
at a surface level it may resemble the
00:04:56
US healthcare system because insurance
00:04:57
is linked to one's employment just as as
00:04:59
it is for most working Americans the
00:05:01
source of coverage is private insurance
00:05:03
companies and citizens dedicate a
00:05:05
portion of their payroll tax to remain
00:05:06
insured with the delivery of care being
00:05:08
mostly private the theoretical Bismark
00:05:10
model is meant to provide Universal
00:05:12
coverage but a criticism of the system
00:05:14
is that even though Universal coverage
00:05:15
is the intent it fails to financially
00:05:17
cover those who are transitioning
00:05:19
between jobs or are unemployed and it's
00:05:21
starkly different from the US for
00:05:23
reasons we will visit soon the final
00:05:25
point to consider is the source of
00:05:26
coverage for each of these Healthcare
00:05:27
models funding for the beverage a
00:05:30
national health insurance model comes
00:05:31
from income taxes the government
00:05:32
collects a tax from its citizens that
00:05:34
ultimately enable government-based
00:05:36
funding to support healthcare costs in
00:05:38
the bismar model funding comes from a
00:05:39
payroll deduction employers take a
00:05:41
portion of their employees salary and
00:05:42
put it towards paying a premium to keep
00:05:44
their employees enrolled under the
00:05:45
health insurance plan note that
00:05:47
Universal coverage is an intended
00:05:49
feature of all three of these models and
00:05:51
it can in fact be achieved in systems
00:05:52
that are not single paay of models
00:05:54
despite what you may hear from policy
00:05:55
makers in fact most countries with
00:05:58
universal health insurance programs rely
00:05:59
on multi-payer systems most of these
00:06:01
countries use a hybrid of these four
00:06:03
models implemented uniformly across the
00:06:06
nation's borders the United States is
00:06:08
fundamentally different and more
00:06:09
complicated the major difference between
00:06:11
other nations and the United States is
00:06:13
the fact that here in the US the
00:06:15
healthcare system is a hodgepodge of
00:06:17
systems the US is one of few countries
00:06:19
that provide care non-uniformly in four
00:06:21
different ways depending on the patient
00:06:23
population in consideration those four
00:06:25
populations are veterans citizens aged
00:06:27
65 or older uninsured citizens and
00:06:29
working citizens with employer sponsored
00:06:31
health insurance in the past the term
00:06:33
socialized medicine ignited fears of the
00:06:35
us moving towards becoming a communist
00:06:37
or socialist state today the term
00:06:39
ignites an expectation for poor medical
00:06:41
outcomes horrendous waiting lines
00:06:42
excessive Taxation and the erosion of
00:06:44
free private Enterprise while the
00:06:46
concept of socialized medicine makes
00:06:48
some Americans uncomfortable the reality
00:06:50
is that a major portion of our healthc
00:06:52
care system functions analogously to the
00:06:54
British system which is regarded as the
00:06:55
closest example of socialized medicine
00:06:57
in the world we do this through the
00:06:59
veterans Health Administration the VHA
00:07:01
is a government funded and government
00:07:03
managed vehicle that treats veterans at
00:07:04
government-owned hospitals under the
00:07:06
service of government employed doctors
00:07:08
US citizens over the age of 65 receive
00:07:10
care in a national health insurance
00:07:12
model- like fashion as found in Canada
00:07:14
manifesting in the form of Medicare the
00:07:16
government pays for the health care cost
00:07:18
of the elderly people under 65 with
00:07:20
certain disabilities and people of all
00:07:22
ages with endstage renal disease
00:07:23
Medicare is financed through tax revenue
00:07:26
a 2.9% dedicated payroll tax split
00:07:28
evenly between employer years and
00:07:30
employees and monthly beneficiary
00:07:31
premiums Medicare funds 70% of
00:07:34
healthcare spending by the elderly with
00:07:35
the other 30% accounted for by out of
00:07:37
pocket spending or supplementary private
00:07:39
insurance the key takeaway is that for
00:07:41
this patient population the government
00:07:43
is publicly financing the cost of care
00:07:45
but the delivery of care remains in the
00:07:46
hands of the private sector just as in
00:07:48
Canada the third patient population is
00:07:50
the uninsured with 30 million Americans
00:07:52
uninsured our nation happens to be the
00:07:54
only developed country that lacks a
00:07:55
system of Universal Health Coverage the
00:07:57
unfortunate reality is that medical e
00:07:59
strike when least expected and in such
00:08:01
scenarios many Americans are forced to
00:08:03
potentially face Financial ruin in their
00:08:05
effort to seek care expanding coverage
00:08:07
remains one of our biggest Healthcare
00:08:09
challenges but the politicization of
00:08:11
care and the doctrine of American
00:08:12
exceptionalism often prevents any
00:08:14
meaningful conversation about Healthcare
00:08:16
reform from taking place veterans
00:08:18
citizens aged 65 and older and the
00:08:20
uninsured represent only a portion of
00:08:22
the US population for most US citizens
00:08:24
health insurance is provided in a
00:08:26
Bismark like fashion with insurance
00:08:28
linked to one's employment status in a
00:08:29
manner that is similar to the system in
00:08:31
Germany again the tenant of the bismar
00:08:33
model is that employers and employees
00:08:35
fund Their Own Private health insurance
00:08:37
through sickness funds financed by
00:08:38
payroll deductions the primary criticism
00:08:40
of both the Bismark model and the
00:08:42
variant used in the United States is
00:08:43
that coverage isn't necessarily granted
00:08:45
to those who are between jobs or unable
00:08:47
to work for years people have been
00:08:49
asking whether it makes sense for health
00:08:50
insurance to be linked to one's job the
00:08:52
pandemic has laid clear that in precise
00:08:54
moments where friends and families and
00:08:56
neighbors are most in need of care they
00:08:58
may also be least likely to have have a
00:08:59
job and by extension access to the very
00:09:02
care they need however this variant is
00:09:04
starkly different from the theoretical
00:09:06
Bismark model under the theoretical
00:09:07
model insurance companies are required
00:09:09
to be nonprofit and every citizen is
00:09:11
supposed to be covered this is not the
00:09:13
case in the United States where our
00:09:14
insurance companies have a history of
00:09:16
marginalizing those with pre-existing
00:09:18
conditions from being covered and are
00:09:20
profit driven as our hospitals and
00:09:22
providers Bill insurers seeking
00:09:23
reimbursement for services insurers
00:09:25
fiercely push back denying claims this
00:09:27
insur provider battle drives billing
00:09:29
related administrative expenses soaring
00:09:31
through the roof revisiting the
00:09:33
nationalization privatization Spectrum
00:09:35
as we move from left to right we see the
00:09:37
beverage model implemented in Britain
00:09:38
followed by the national health
00:09:40
insurance model implemented in Canada
00:09:41
and the bismar model found in Germany
00:09:43
farthest to the right lies the United
00:09:45
States healthcare system which is the
00:09:46
most privatized and Market driven a
00:09:48
feature that cultivates the nation's
00:09:49
fertile ground for Innovation each of
00:09:51
these Healthcare models has its own
00:09:52
unique basket of pros and cons generally
00:09:55
those that are more privatized are
00:09:56
driving Innovation and enjoying greater
00:09:58
autonomy and those that are more
00:09:59
government regulated have a simpler
00:10:01
delivery of care less administrative
00:10:03
complexity and a population with greater
00:10:04
accessibility to care join us in part
00:10:06
two of the series to explore which
00:10:08
country has the best Healthcare System
00:10:10
much love and I'll see you guys there
