Healthcare Policy & Nosocomial Infections [Clark County, NV]

Source 01 - CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings

1. Leadership 1. Ensure that the governing To be successful, infection prevention programs require
Support body of the healthcare visible and tangible support from all levels of the
References and facility or organization is healthcare facility’s leadership.
resources: 1-12 accountable for the
success of infection
prevention activities.
2. Allocate sufficient human
and material resources to
infection prevention to
ensure consistent and
prompt action to remove
or mitigate infection risks
and stop transmission of
infections. Ensure that
staffing and resources do
not prevent nurses,
environmental staff, et.
al., from consistently
adhering to infection
prevention and control
practices.
3. Assign one or more
qualified individuals with
training in infection
prevention and control to
manage the facility’s
infection prevention
program.
4. Empower and support the
authority of those
managing the infection
prevention program to
ensure effectiveness of
the program.
2. Education 1. Provide job-specific, Training should be adapted to reflect the diversity of
and Training of infection prevention the workforce and the type of facility, and tailored to
Healthcare education and training to meet the needs of each category of healthcare
Personnel on all healthcare personnel personnel being trained.
Infection for all tasks.
Prevention a. Require training
References and before individuals
resources: 1-4, are allowed to
6-8, 10-13 perform their
duties and at least
annually as a
refresher.
b. Provide additional
training in
response to
recognized lapses
in adherence and
to address newly
recognized
infection
transmission
threats (e.g.,
introduction of
new equipment or
procedures).
2. Develop processes to
ensure that all healthcare
personnel understand and
are competent to adhere
to infection prevention
requirements as they
perform their roles and
responsibilities.
3. Provide written infection
prevention policies and
procedures that are
available, current, and
based on evidence-based
guidelines (e.g., CDC/
HICPAC, etc.).
3. Patient, 1. Provide appropriate Include information about how infections are spread,
Family and infection prevention how they can be prevented, and what signs or
Caregiver education to patients, symptoms should prompt reevaluation and notification
Education family members, visitors, of the patient’s healthcare provider. Instructional
References and and others included in the materials and delivery should address varied levels of
resources: 2-5, caregiving network. education, language comprehension, and cultural
7-8, 10-11 diversity

4. Performance 1. Identify and monitor Performance measures should be tailored to the care
Monitoring and adherence to infection activities and the population served.
Feedback prevention practices and
References and infection control
resources: 1-14 requirements.
2. Provide prompt, regular
feedback on adherence
and related outcomes to
healthcare personnel and
facility leadership.
3. Train performance
monitoring personnel and
use standardized tools
and definitions.
4. Monitor the incidence of
infections that may be
related to care provided
at the facility and act on
the data and use
information collected
through surveillance to
detect transmission of
infectious agents in the
facility.
5. Standard Use Standard Precautions to care Standard Precautions are the basic practices that apply
Precautions for all patients in all settings. to all patient care, regardless of the patient’s suspected
Standard Precautions include: or confirmed infectious state, and apply to all settings
5a. Hand hygiene where care is delivered. These practices protect
5b. Environmental cleaning and healthcare personnel and prevent healthcare personnel
disinfection or the environment from transmitting infections to
5c. Injection and medication other patients.
safety
5d. Risk assessment with use of
appropriate personal protective
equipment (e.g., gloves, gowns,
face masks) based on activities
being performed
5e. Minimizing Potential
Exposures (e.g. respiratory
hygiene and cough etiquette)
5f. Reprocessing of reusable
medical equipment between each
patient or when soiled
5a. Hand 1. Require healthcare Unless hands are visibly soiled, an alcohol-based hand
Hygiene personnel to perform rub is preferred over soap and water in most clinical
References and hand hygiene in situations due to evidence of better compliance
resources: 3, 7, accordance with Centers compared to soap and water. Hand rubs are generally
11 for Disease Control and less irritating to hands and are effective in the absence
Prevention (CDC) of a sink.
recommendations. Refer to “CDC Guideline for Hand Hygiene in
2. Use an alcohol-based Health-Care Settings” or “Guideline for Isolation
hand rub or wash with Precautions: Preventing Transmission of Infectious
soap and water for the Agents in Healthcare Settings, 2007” for additional
following clinical details.
indications:
a. Immediately
before touching a
patient
b. Before
performing an
aseptic task (e.g.,
placing an
indwelling
device) or
handling invasive
medical devices
c. Before moving
from work on a
soiled body site to
a clean body site
on the same
patient
d. After touching a
patient or the
patient’s
immediate
environment
e. After contact with
blood, body fluids
or contaminated
surfaces
f. Immediately after
glove removal
3. Ensure that healthcare
personnel perform hand
hygiene with soap and
 water when hands are
visibly soiled.
4. Ensure that supplies
necessary for adherence
to hand hygiene are
readily accessible in all
areas where patient care
is being delivered.
5b. 1. Require routine and When information from manufacturers is limited
Environmental targeted cleaning of regarding selection and use of agents for specific
Cleaning and environmental surfaces as microorganisms, environmental surfaces or equipment,
Disinfection indicated by the level of facility policies regarding cleaning and disinfecting
References and patient contact and should be guided by the best available evidence and
resources: 4, 7, degree of soiling. careful consideration of the risks and benefits of the
10, 11, 13, 21 a. Clean and available options.
disinfect surfaces Refer to “CDC Guidelines for Environmental Infection
in close proximity Control in Health-Care Facilities” and “CDC Guideline
to the patient and for Disinfection and Sterilization in Healthcare
frequently Facilities” for details.
touched surfaces
in the patient care
environment on a
more frequent
schedule
compared to other
surfaces.
b. Promptly clean
and
decontaminate
spills of blood or
other potentially
infectious
materials.
2. Select EPA-registered
disinfectants that have
microbiocidal activity
against the pathogens
most likely to
contaminate the
patient-care environment.
3. Follow manufacturers’
instructions for proper
use of cleaning and
disinfecting products
(e.g., dilution, contact
time, material
compatibility, storage,
shelf-life, safe use and
disposal).
5c. Injection 1. Prepare medications in a Refer to “Guideline for Isolation Precautions:
and Medication designated clean Preventing Transmission of Infectious Agents in
Safety medication preparation Healthcare Settings, 2007” for details.
References and area that is separated
resources: 7, 11, from potential sources of
16-20 contamination, including
sinks or other water
sources.
2. Use aseptic technique
when preparing and
administering
medications
3. Disinfect the access
diaphragms of
medication vials before
inserting a device into the
vial
4. Use needles and syringes
for one patient only (this
includes manufactured
prefilled syringes and
cartridge devices such as
insulin pens).
5. Enter medication
containers with a new
needle and a new syringe,
even when obtaining
additional doses for the
same patient.
6. Ensure single-dose or
single-use vials, ampules,
and bags or bottles of
parenteral solution are
used for one patient only.
7. Use fluid infusion or
administration sets (e.g.,
intravenous tubing) for
one patient only
8. Dedicate multidose vials
to a single patient
whenever possible. If
multidose vials are used
for more than one patient,
restrict the medication
 vials to a centralized
medication area and do
not bring them into the
immediate patient
treatment area (e.g.,
operating room, patient
room/cubicle)
9. Wear a facemask when
placing a catheter or
injecting material into the
epidural or subdural
space (e.g., during
myelogram, epidural or
spinal anesthesia)
5d. Risk 1. Ensure proper selection PPE, e.g., gloves, gowns, face masks, respirators,
Assessment and use of personal goggles and face shields, can be effective barriers to
with protective equipment transmission of infections but are secondary to the
Appropriate (PPE) based on the nature more effective measures such as administrative and
Use of Personal of the patient interaction engineering controls.
Protective and potential for Refer to “Guideline for Isolation Precautions:
Equipment exposure to blood, body Preventing Transmission of Infectious Agents in
References and fluids and/or infectious Healthcare Settings, 2007” as well as Occupational
resources: 7, 11, material: Safety and Health Administration (OSHA)
19, 20 a. Wear gloves when requirements for details.
it can be
reasonably
anticipated that
contact with
blood or other
potentially
infectious
materials, mucous
membranes,
non-intact skin,
potentially
contaminated skin
or contaminated
equipment could
occur.
b. Wear a gown that
is appropriate to
the task to protect
skin and prevent
soiling of clothing
during procedures
and activities that
could cause
contact with
blood, body
fluids, secretions,
or excretions.
c. Use protective
eyewear and a
mask, or a face
shield, to protect
the mucous
membranes of the
eyes, nose and
 mouth during
procedures and
activities that
could generate
splashes or sprays
of blood, body
fluids, secretions
and excretions.
Select masks,
goggles, face
shields, and
combinations of
each according to
the need
anticipated by the
task performed.
d. Remove and
discard PPE, other
than respirators,
upon completing
a task before
leaving the
patient’s room or
care area. If a
respirator is used,
it should be
removed and
discarded (or
reprocessed if
reusable) after
leaving the patient
room or care area
and closing the
door.
e. Do not use the
same gown or pair
of gloves for care
of more than one
patient. Remove
and discard
disposable gloves
upon completion
of a task or when
 soiled during the
process of care.
f. Do not wash
gloves for the
purpose of reuse.
2. Ensure that healthcare
personnel have
immediate access to and
are trained and able to
select, put on, remove,
and dispose of PPE in a
manner that protects
themselves, the patient,
and others
5e. Minimizing 1. Develop and implement Refer to “Guideline for Isolation Precautions:
Potential systems for early Preventing Transmission of Infectious Agents in
Exposures detection and Healthcare Settings, 2007” for details.
References and management (e.g., use of During periods of higher levels of community
resources: 1, 7, appropriate infection respiratory virus transmission*, facilities should
11, 21, 22 control measures, consider having everyone mask upon entry to the
including isolation facility to ensure better adherence to respiratory
precautions, PPE) of hygiene and cough etiquette for those who might be
potentially infectious infectious. Such an approach could be implemented
persons at initial points of facility-wide or targeted toward higher risk areas (e.g.,
patient encounter in emergency departments, urgent care, units
outpatient settings (e.g., experiencing an outbreak) based on a facility risk
triage areas, emergency assessment.
departments, outpatient
clinics, physician offices) *Examples of potential metrics include, but are not
and at the time of limited to, increase in outbreaks of healthcare-onset
admission to hospitals respiratory infections, increase in emergency
and long-term care department or outpatient visits related to respiratory
facilities (LTCF). infections.
2. Use respiratory hygiene
and cough etiquette to
reduce the transmission
of respiratory infections
within the facility.
3. Prompt patients and
visitors with symptoms of
respiratory infection to
contain their respiratory
secretions and perform
hand hygiene after
contact with respiratory
secretions by providing
tissues, masks, hand
hygiene supplies and
instructional signage or
handouts at points of
entry and throughout the
facility
4. When space permits,
separate patients with
respiratory symptoms
from others as soon as
possible (e.g., during
 triage or upon entry into
the facility).

5f. 1. Clean and reprocess Manufacturer’s instructions for reprocessing reusable

Reprocessing of (disinfect or sterilize) medical equipment should be readily available and
Reusable reusable medical used to establish clear operating procedures and
Medical equipment (e.g., blood training content for the facility. Instructions should be
Equipment glucose meters and other posted at the site where equipment reprocessing is
References and point-of-care devices, performed. Reprocessing personnel should have
resources: 2-4, blood pressure cuffs, training in the reprocessing steps and the correct use of
7-8, 11-13 oximeter probes, surgical PPE necessary for the task. Competencies of those
instruments, endoscopes) personnel should be documented initially upon
prior to use on another assignment of their duties, whenever new equipment is
patient or when soiled. introduced, and periodically (e.g., annually).
a. Consult and Additional details about reprocessing essentials for
adhere to facilities can be found in HICPAC’s recommendations
manufacturers’ Essential Elements of a Reprocessing Program for
instructions for Flexible Endoscopes (Essential Elements of a
reprocessing. Reprocessing Program for Flexible Endoscopes –
2. Maintain separation Recommendations of the HICPAC).
between clean and soiled Refer to “CDC Guideline for Disinfection and
equipment to prevent Sterilization in Healthcare Facilities” for details
cross contamination.
6. 1. Implement additional Implementation of Transmission-Based Precautions
Transmission-B precautions (i.e., may differ depending on the patient care settings (e.g.,
ased Transmission-Based inpatient, outpatient, long-term care), the facility
Precautions Precautions) for patients design characteristics, and the type of patient
References and with documented or interaction, and should be adapted to the specific
resources: 7, 11 suspected diagnoses healthcare setting.
where contact with the Refer to “Guideline for Isolation Precautions:
patient, their body fluids, Preventing Transmission of Infectious Agents in
or their environment Healthcare Settings, 2007” for details.
presents a substantial
transmission risk despite
adherence to Standard
Precautions
2. Adapt transmission-based
precautions to the
specific healthcare
setting, the facility design
characteristics, and the
type of patient
interaction.
3. Implement
transmission-based
precautions based on the
patient’s clinical
presentation and likely
infection diagnoses (e.g.,
syndromes suggestive of
transmissible infections
such as diarrhea,
meningitis, fever and
rash, respiratory
infection) as soon as
possible after the patient
enters the healthcare
facility (including
reception or triage areas
in emergency
departments, ambulatory
clinics or physicians’
offices) then adjust or
discontinue precautions
when more clinical
information becomes
available (e.g.,
 confirmatory laboratory
results).
4. To the extent possible,
place patients who may
need transmission-based
precautions into a
single-patient room while
awaiting clinical
assessment.
5. Notify accepting facilities
and the transporting
agency about the need for
transmission-based
precautions based on
suspected or confirmed
infections or presence of
targeted
multidrug-resistant
pathogens when patients
are transferred.

7. Temporary 1. During each healthcare Early and prompt removal of invasive devices should
invasive encounter, assess the be part of the plan of care and included in regular
Medical medical necessity of any assessment. Healthcare personnel should be
Devices for invasive medical device knowledgeable regarding risks of the device and
Clinical (e.g., vascular catheter, infection prevention interventions associated with the
Management indwelling urinary individual device, and should advocate for the patient
References and catheter, feeding tubes, by working toward removal of the device as soon as
resources: 8, 11 ventilator, surgical drain) possible.
in order to identify the Refer to “CDC Guidelines for Environmental Infection
earliest opportunity for Control in Health-Care Facilities” and “CDC Guideline
safe removal. for Disinfection and Sterilization in Healthcare
2. Ensure that healthcare Facilities” for details.
personnel adhere to
recommended insertion
and maintenance
practices
8. Occupational 1. Ensure that healthcare It is the professional responsibility of all healthcare
Health personnel either receive organizations and individual personnel to ensure
References and immunizations or have adherence to federal, state and local requirements
resources: 1, 7, documented evidence of concerning immunizations; work policies that support
18, 19 immunity against safety of healthcare personnel; timely reporting of
vaccine-preventable illness by employees to employers when that illness
diseases as recommended may represent a risk to patients and other healthcare
by the CDC, CDC’s personnel; and notification to public health authorities
Advisory Committee on when the illness has public health implications or is
Immunization Practices required to be reported.
(ACIP) and required by Refer to OSHA’s website for specific details on
federal, state or local healthcare standards: Occupational Safety and Health
authorities. Administration – Infectious Diseases (OSHA
2. Implement processes and Healthcare
sick leave policies to
encourage healthcare ).
personnel to stay home
when they develop signs
or symptoms of acute
infectious illness (e.g.
fever, cough, diarrhea,
vomiting, or draining
skin lesions) to prevent
spreading their infections
to patients and other
healthcare personnel.
3. Implement a system for
healthcare personnel to
report signs, symptoms,
and diagnosed illnesses
that may represent a risk
to their patients and
coworkers to their
supervisor or healthcare
facility staff who are
responsible for
occupational health
4. Adhere to federal and
state standards and
directives applicable to
protecting healthcare
workers against
transmission of infectious
agents including OSHA’s
 Bloodborne Pathogens
Standard, Personal
Protective Equipment
Standard, Respiratory
Protection standard and
TB compliance directive.

Source 02 - Healthcare Systems: Models, Pros & Cons, Smart Health Card Contribution

​Types of healthcare systems

The healthcare sector is an essential part of our society due to its resources, roles taken by the state or regional
authorities, and many stakeholders that it links, either directly or indirectly.

And the idea of universal health care - providing health care and financial protection to all – is not new.

Indeed, government programs for healthcare, retirement benefits, family allocations, and health insurance are
national traditions' legacies.

They have been developed according to four different models.

What is universal health care? Discover this video from the World Health Organization.

Benefits of universal health care (the World Health Organization)

Let's discover the four basic models​and some mixed schemes.

#1 The Bismarck model

Otto von Bismarck created this universal healthcare model in Germany and enacted social legislation between
1881 and 1889.

Therefore, health insurance and healthcare access are linked to employment in this system.

The model is financed through social contributions rather than taxes.

It relies on health insurance funded through social contributions (by employers and employees), managed by
companies and employees' representatives.

The state must decide on the scope of intervention of health insurance funds and take the appropriate measures
if a financial imbalance arises.

The German example was used as a blueprint in Austria.

It was also the case in Belgium, France, with the decrees of 1945, Luxemburg, and the Netherlands.

In all countries that have adopted the Bismarck model, protection has been extended to include population
categories that were not protected initially (students, independent workers, etc.)

In France, the CMU, now PUMa (Protection Universelle Maladie - universal coverage), was voted in 1999,
implemented in 2000, and modified in 2016. De facto, France, is one of the many countries with universal
health care.

#2 The Beveridge model​​

Implemented in 1942 in the United Kingdom following Lord Beveridge's report, this social protection system is
based on the principle of universal access to health care, non-dependent on employment.

This access to healthcare is not considered contingent on employment but rather an intrinsic part of citizenship.
Public authorities fund this system through taxes rather than through social contributions.

A centralized system is in place in the United Kingdom and Ireland (NHS​for National Health System).

Denmark, Finland, Norway, Spain, Sweden, and New Zealand have adopted this model.

The National Health Service (Servizio sanitario Nazionale or SSN, created in 1978) provides universal
coverage in Italy. It automatically covers all citizens and residents.

More on how to get an Italian health insurance card (tessera sanitaria) is on this page in English.

In contrast, a decentralized system has been adopted by Mediterranean countries (Greece, Spain, and Portugal).

#3 The Semashko ​model

This model, developed during the 1920s in the Soviet Union, spread to tUSSR'sR's satellite states after 1945. It
is named after Nicolai Semashko, USSRR's health minister from 1918 to 1930.

This socialized medicine is, of course, the product of a specific political ideology.
Healthcare services belonged to the state, and the state paid healthcare professionals. Services were usually free,
but patients had to pay out-of-pocket fees for medication, for example.

The system provided universal access to health care. It was broadly a benefit in the kind system. Central
authorities defined coverage levels and the amounts set aside for healthcare spending (share of GDP).

Healthcare and health insurance systems are radically changing in Central and Eastern European countries.

For example, public healthcare in Russia is free through a "Bismark-type" compulsory state health insurance
system (Obligatory Medical Insurance). Your employer usually pays 2 to 3% of your salary in social charges. A
part is paid to the Russian healthcare fund.

The public system is funded by the federal and regional budgets (and through contributions to the mandatory
insurance fund).

According to The World Bank, public spending on health has been around 5% of the country's GDP for many
years (4.6% in 2020). It's much below the EU average of 10% and well under the Soviet levels of the 1960s
(6.6%) or the 1970s (6.1%). It even reached an all-time low at 2.4% in 2004.

Obligatory Medical Insurance plan services are limited, mainly covering emergency medical attention.

One must pay separately for each provided medical service or procedure for more comprehensive care. Many
voluntary medical insurances in the country offer far more extensive coverage.

Except for Moscow and St Petersburg, hospitals are reportedly worsening, with a lack of modern equipment,
medicine, hospital beds and a shortage of specialists.

Access to healthcare institutions is complicated in rural areas, where their number decreased by 75 % between
2005 and 2013 (due to the "optimization" of health reform). Some 17,500 cities and villages have no medical
infrastructure at all.

Despite these significant healthcare gaps, only 5% of Russians use private healthcare.

Russia's system ranks 58 out of 89 in the 2021 list of countries with the best healthcare systems, with a meagre
score for quality of infrastructure.
#4 The out-of-pocket model

The fundamental principle of the American healthcare system is that health is a matter of individual
responsibility and private insurance.

What's the story here?

There is no compulsory national system and a preponderance of private organizations (two-thirds of Americans
under 65 are covered by employment-related insurance).

Public healthcare is only provided for the elderly (Medicare) and disadvantaged (Medicaid), not unlike the
Beveridge model.

These two programs started in 1965 under the administration of Democrat L.B. Johnson.

● Medicare is a federally funded and managed healthcare system for citizens over 65
● Medicaid is a jointly funded system between the federal and state governments for low-income
families and resources.​

Both Medicare and Medicaid are under the federal agency's responsibility (the Centers for Medicare and
Medicaid Services -CMS). CMS directly manages Medicare and oversees Medicaid.

The states manage their individual Medicaid programs for their citizens.

The case for universal healthcare in the USA

The idea of universal healthcare - a system that delivers good-quality medical care to all citizens and residents,
regardless of their ability to pay- dates back to 1912.

Theodor Roosevelt, who had served nearly eight years as a Republican president - decided to run again on a
progressive ticket. He promoted a platform that called for creating a centralized national health service. He
ultimately lost the 1912 elections.

But the program planted a seed.

Accessible and affordable medical care might one day be seen as a right, more than a privilege.

Harry Truman proposed a national healthcare system twice: in 1945 and 1949. After a bruising fight with the
American Medical Association and the Republican Party, he ended up with no results.

More on this: The Accidental President.

Lyndon Johnson's Great Society campaign included the idea of helping those populations the market economy
had left behind (instead of a radical change and challenging head-on private insurance).

Medicaid and Medicare were initiated in 1965.

According to the New Yorker, this blended system functioned well enough in the '70s and '80s, covering 80% of
Americans through their jobs or one of these programs (Nov.2, 2020).

The 1993 Clinton Health Care Plan included universal coverage and a basic benefits package. The government
was to give every American "a health-care security card that will guarantee a comprehensive package of
benefits" (23 September 1993).

But the bill was never enacted into law.

Needless to say that nearly a fifth of the population lived just one illness or accident away from personal
bankruptcy.

In 2010, more than 48 million Americans were uninsured (source CDC reports), and millions more were
underinsured (an estimated 16 million adults in 2003).

To top it off, premiums for family coverage had increased by 97% from 2000 to 2009.

Affordability was the reason #1 why adults were not insured in 2019 (CDC survey).

The American Medical Student Association (AMSA), in a 2015 study, pointed out that, contrary to prevailing
stereotypes, 80% of the uninsured are hardworking Americans. But they can't obtain insurance through their
work for three main reasons:

● Their employer does not offer it,

● The employee's premium share is too high,
● They are not eligible for health insurance (newly employed or part-time).

The 2006 Massachusetts Health Care Reform, also known as « RomneyCare » because Mitt Romney was the
Governor, inspired the 2010 Patient Protection and Affordable Care Act (ACA), also called «ObamaCare.»

At the time, the "RomneyCare" reform had been a real success, driving the uninsured rate down to 4%. As of
2019, the rate is even lower at 2.9%.

According to Gallup, the ACA increased the number of insured citizens and residents but did not achieve
universal health coverage.

The ACA originally mandated that all residents buy a health insurance policy or face a fine or penalty. Trump's
Tax Cuts and Jobs Act (TCJA) repealed the penalty.

The percentage of uninsured US adults reached 10.6 in Q3 2016 and rose again in 2017 and 2018 to 13.7 by Q4
2018.

It rose again in 2019 to an estimated 14,5% and started to decline in 2020 and 2021.

In 2021, only 8.3%, or 27.2 million people, were uninsured at any point during the year, indicating a reduction
in the percentage and total number of uninsured individuals from the previous year (8.6% or 28.3 million).
It stayed at 8.3% for the first six months of 2022, according to a December 2022 CDC report.

According to the American analytics and advisory company, Gallup, the ACA still earned a split decision from
Americans in 2019.

However, the ACA proved resilient over time.

Now, Democrats have a chance to amplify Obamacare provisions, and even with a narrow majority, they are
well-positioned to get a few projects rolling.

Between 2020 and 2021, there was an overall increase in public coverage. Specifically, 35.7% of people held
public coverage for some or all of the year in 2021, according to a September 2022 report from the census.gov
website.

#5 European mixed-model plans

Mixed-model plans aimed at ensuring healthcare for all.

The Bismarck and Beveridge models have had a lasting influence on most European countries.

So what has been done?

During the second half of the 20th century, all European countries progressively extended universal health care
to cover nearly all citizens.​

Since implementing the CMU (universal healthcare coverage), the French system, for example, has ensured
everyone has access to healthcare. Employment no longer determines access to healthcare, as is theoretically the
case.

But funding methods have not been called into question.

In all countries influenced by the English model, funding mainly comes from taxes.

Social protection is funded through contributions in countries influenced by the Bismarck model, such as France
or the Netherlands.

These differences in funding are linked to how the system is organized:

● F
​ inancing through taxes corresponds to a state-run organization,
● In contrast, funding through social contributions usually involves trade unions and employers'
organizations.

So, how is healthcare funded in Europe?

Each country has its system.

 There is no single European healthcare system as such. Social protection does not fall under the jurisdiction of
the European Commission.

It is an example of the principle of subsidiarity and, therefore, under the jurisdiction of national governments.

Europe-wide cooperation exists, particularly concerning patients' cross-border mobility (with measures like the
EHIC and the European Health Insurance Card.

It gives the holder the right to access healthcare temporarily in another EU country, the UK, Norway, Iceland,
Liechtenstein, or Switzerland.).

In other words:

Healthcare is a national topic only.

Cooperation also facilitates the exchange of knowledge and best practices.

More than €1,500 billion is spent on healthcare in the European Union (including the UK).

Faced with the sharp rise in healthcare costs, all European countries have tried to rein in spending while
improving universal healthcare systems' efficiency.
Note that the United States spending per capita is twice as much as Germany's or France's. The situation was
unchanged in 2021. US healthcare spending reached 17,4% of GDP in 2021.

In other words, any major healthcare bill means readjusting a sixth of the American economy.

Universal healthcare pros and cons

PROs

#1. Increase longevity

Life expectancy covers many aspects (from genetics to hygiene, lifestyle, and crime rate) but can be correlated
with health and easy access to health care.

Overall, universal coverage creates a healthier population and workforce (in comparable countries). That's what
we see here.
 Life Gap
Coun Population in 2020 Life expectancy in The gap with
expectancy with
try (in millions) 2020 (years) the US (years)
(males) US

Italy 60 83.57 4,6 81.2 Over 5

Franc Almost
67 82.73 Almost 4 79.7
e 4

Cana
38 82.52 3,6 80 4
da

Germ
84 81.41 2.5 78.6 2.6
any

UK 68 81.15 Over 2 79.4 3.4

USA 331 78.93 - 76 -

Note that western European and Canadian males' lifespan is 3 to 5 years longer than their US counterparts. This
difference is very significant.

For 2021, life expectancy rebounded in most comparable countries but continued to decline in the US (76.1
years in 2021).

In these countries, all are offered access to care and high-quality healthcare services.

We must give a word of warning here: we all know correlation is not causation.

More on this topic: Why is life expectancy shorter in the US?

#2. Lower health care costs for all

US healthcare spending does not compare well with other developed countries.

As we said, it represents 17,4% of GDP for 2021 compared to less than 10% in the UK, Norway, Sweden, and
Denmark, 11% in Italy, France, or Germany, and 11,5% in Canada.

US health care is also 70 to 80% more expensive than in Western Europe and Canada.
Lower costs of health care and prescription drugs are obtained through negotiation and regulation, fewer
administrative costs, and a simplified and unified system.

For example, administrative costs account for 8% of total national health expenditures in the US. The other
countries range from 1 to 3% (CNBC - why health care costs so much in the US.)

In a private healthcare system, costs appear substantially amplified.

Read more:

● More Californians are skipping medical care because of cost and are sicker for it (24 February 2021-
San Francisco Chronicle.)
● Why are insulin prices in the US 6 times higher than those in Canada and nine times higher than in the
UK? ( 6 October 2020 - RAND corporation.)

#3. Enhance pricing transparency

With universal healthcare systems, pricing is more transparent and subject to rules. Medical acts are coded and
have the same price tag across the country. Patients can also anticipate their bills.

We see much more opacity in the United States.

In its article dated 18 December 2018, Vox illustrates with many examples of how medical billing across the US
can be costly, opaque, and unpredictable.

According to Vox searches, patients pay extravagant prices for all kinds of care, which are also hard to prevent.

As Vox puts it, "Even with a PhD in surprise billing," you can't avoid steep medical bills".

In the US, injuries or serious diseases can quickly generate hundreds of thousands of dollars in bills, dry out
your savings and retirement account, or even cost you your home.

The result?

IUnsurprisingly, medical expenses are the #1 reason for personal bankruptcy (62%) in the US.

That's pretty hard to grasp when you live in Canada, the UK, Italy, or Germany.

Medical price roulette: from CBS This Morning

Read more:
 ● I read 1,182 emergency room bills this year. Here's what I learned.
● The problem is the prices.

#4. Improve health care equality

In countries where socialized medicine is implemented, health and health care are less related to social or
financial status or education.

In the US, healthcare inequality is patent and is very much correlated with income inequality, as reported by
The Balance in its article dated 02 November 2020.

There's more.

The socialized healthcare systems are built on the principle of solidarity.

No one is left behind. Everyone can access medical services and has health insurance.

And obviously, it's worth mentioning no one goes bankrupt from medical charges.

Read more: COVID-19, health equity and the battle of pre-existing conditions (24 February 2021)

CONs

#1. Require healthy people to pay for those in need

The rich pay for the poor.

Healthier people pay for those in need of health care, and treatment is undoubtedly a question of governance.

● In which society do we want to live?

● What are a Welfare State and its limits?

Social protection laws or the absence of these (health and health insurance) mainly define people's healthcare
coverage rights.

#2. Need careful public management

Healthcare costs can crush central or regional government budgets if expenses overrun the funding source
(social contribution or income taxes).

This can be caused by long-term trends like an ageing population, unemployment, a steady increase in chronic
diseases, or unexpected events like a pandemic.

For example, COVID-19 tests and injections are free for all insured and beneficiaries in France.
COVID-19 treatments at the hospital are free as well.

#3. Make medical careers less rewarding

Medicine can become a less financially attractive career to embrace. It's all the more sensitive in the US, where
studies are very costly. Medical doctors often have to pay their student loans many years after they have left
university.

However, this is not the case in Europe, where university studies are almost free.

General physicians in the US made an average of $218K in 2016 (Harvard report). That's twice the average of
generalists in comparable countries, where pay ranged from $86K in Sweden to $154K in Germany.

The same study notes that the US's quality of care is not significantly different from other countries and excels
in many areas.

#4. Make access to medical resources more difficult

In France and the UK, getting an appointment with a dentist can take weeks. It can take months with an
ophthalmologist or a dermatologist.

Consequently, emergency rooms are often used for the wrong purpose and are overcrowded.

More reading about the topic: The Best Health Care System in the World: Which One Would You Pick?

However, our study shows that fraud, abuse, and error are not just an issue for one specific healthcare system.
They occur everywhere, regardless of the share of public and private funding, levels of technology, and the type
of culture (the Mediterranean, Anglo-Saxon, European, and others).

The healthcare system management and its challenges

Let's see the three significant challenges when considering healthcare system management.

1. Providing long-term healthcare

The first challenge is maintaining or improving citizens' health by providing healthcare that meets the general
public's legitimate expectations (medical or otherwise).

Issues surrounding the system's funding, continuity, and proper management are fundamental.

There are several priorities for managing the resources available, such as:

● optimizing the system by rendering procedures paperless,

● freeing patients up from the many administrative processes linked to healthcare management.​​
 ​If the aim is to implement lasting improvements, the fight against error, fraud, and abuse must be included.

Take, for example, the unintentional effects or complications resulting from medical errors (treatment or
advice), known as iatrogenesis.

This is an issue of some magnitude.

In the United States, the total number of deaths from iatrogenesis in 2001 reached 738,936.

The deaths caused by cardiac disease were 699,697, and 553,251 deaths were caused by cancer (American
Iatrogenic Association 2002).

In France, in 2004, the number of deaths resulting from iatrogenesis was higher than 10,000, and 3.19% of
hospital stays were due to medical and medication errors.

A financial assessment of this issue is difficult to carry out.

No realistic study relating to the amounts involved was to be found. But the causes of the phenomenon are
known.

Iatrogenesis can be linked to many factors, such as:

● doctors lacking information or training,

● patients requiring information or education,
● prescription errors (inappropriate medication: dose, protocol, treatment),
● over-prescription or incomplete prescription,
● a lack of data on the patient (allergies, symptoms not all taken into account, multiple pathologies),
● an under-estimation of drug interactions,
● and self-medication.

Between 30% and 50%+ of iatrogenesis could be avoided (French Ministry of Health, July 2010).

Better information systems could play a part in cutting this figure. This reduction is one of the goals of the
Personal Medical File.

Healthcare fraud is also a significant challenge.

Just think about it.

● I​ n the United States, between $75 billion and $250 billion, according to the FBI, are lost to fraud. In
2021, $4 trillion was dedicated to healthcare spending.
● On average, around 6% to 10% of spending in the healthcare sector is lost to fraud, according to the
European Healthcare Fraud and Corruption Network (EHFCN). Europe spent €1.5 trillion on
healthcare in 2019. Over €150 billion were lost in that year alone.
 Feedback from interviewees in a study we conducted indicated that the higher EHFCN fraud figure (10%) is
closer to the problem's actual cost.

2. Focusing the work of Healthcare professionals on patient health

Most programs in this area aim to facilitate information exchanges, helping healthcare professionals concentrate
on care and treatment rather than management.

This attempt to reorganize the relationships between patients, healthcare professionals, and administration is
much helped by introducing new digital technology for exchanges between healthcare or insurance
organizations and creating health cards. These factors can often lead to drastic improvements.

In France, with the universal health care SESAM Vitale program, for example:

● Patients are now reimbursed after five days rather than after 2-3 weeks (due to paperwork).
● ​1.207 billion electronic claim forms were used in 2020; 93% of all claim forms with administrative
productivity and treatment costs were divided by 6 for the claims in question.
● 12% of the French population has a Shared Electronic Medical Record ( smart EMR) in January
2021".

"Carte Vitale" is a card with an embedded microcontroller certifying health insurance entitlement.

There's more.

The introduction of electronic claim forms and the cut-statement sheets means that 3,6 billion A4 sheets of
paper are saved annually.

They are no longer produced, printed, distributed, stored, or destroyed.

Thales provides electronic health card solutions to several countries worldwide and contributes to more efficient
national healthcare systems to benefit patients, health insurance, and health professionals.

3. Coordinating and optimizing information-sharing

Ambition: optimize the use of medical data. Patient's Electronic Medical Records (smart EMR) ensure that
healthcare professionals can access all their medical information whenever and wherever.

This record, therefore, cuts errors and hesitancy in emergencies and improves the quality of services provided. It
also enhances cooperation between healthcare workers, pooling all available patient information into a
centralized file.

Electronic Medical Records streamline healthcare systems.

Smart EMRs limit the number of medical interventions and ensure that patient care is consistent. There are also
advantages to government health policy: a well-treated patient does not have to keep coming back.

Telemedicine also presents fantastic opportunities. The term refers to any situation where information is passed
between healthcare professionals electronically (general practitioners or specialists, care workers, pharmacists,
etc.).

This information could be messages, letters, signals, results, images, administrative data, complete files, or
monitoring for diagnosis, therapy, or monitoring.
 Benefits of smart mart cards in healthcare

Using smart cards speeds up the transition to paperless electronic procedures and data exchanges, three
formidable catalysts for systems modernization.

In terms of administration, the results obtained are impressive.

Yet this technology is often under-used in areas where it will produce excellent results.

Now:

● Strong identification and authentication (ID verification) for patients and healthcare professionals are
critical features of computerized cards and should be implemented in the healthcare sector. Yet this is
not the case in many countries.
● Implementing health care cards with an identification number and PIN or biometric authentication
would enable creating personalized online services, a quintessentially «patient-centric» approach. Yet,
these initiatives are still in the development stages.
● The ability to verify benefits, expiration dates, and multiple uses is underused.
● Thus far, the benefits of paperless, electronic medical data exchanges have not been fully tapped. Yet
cards have a crucial role in creating consistent databases, automatic data reading, and temporary or
permanent confidential local storage of additional data such as blood groups, allergies, chronic
diseases, and associated treatments.

Electronic services that have already been implemented in European countries for universal health care schemes
and in the rest of the world—with identification systems, electronic signatures, and electronic authentication -
clearly show:

A modern healthcare system's key elements (microchip cards, public key infrastructure, authentication, etc.) can
rely on robust technology to rise to the challenges presented by fraud, abuse, and errors.

The best part?

This robust technology can strike at the heart of fraud mechanisms, often with minimal infrastructure
investment and without significant changes for patients and healthcare professionals.

Smart card technology is an invaluable asset to combat healthcare fraud and errors in the interest of all.​

Thales – a significant healthcare systems provider

Thales provided technical services and products while implementing 11 national electronic healthcare systems,
including the German Gesundheitskarte (picture above) or Chifa card, an eHealthcare solution in Algeria.

Our contribution to these electronic healthcare projects provides an excellent overview of the technology
involved, its applications, the quality of information systems, and the social context of its use.

Furthermore, our experts have supported national debates on improving systems to fight fraud and reduce
errors.

Finally, Thales is an active collaborator in European and global standardization organizations and in mHealth.​