1. What is the difference between universal health coverage and single-payer health system? Provide examples of countries that have adopted each model. - Universal health coverage (UHC) is a policy goal that aims to ensure that all people have access to essential health services without facing financial hardship. UHC does not necessarily imply that the government is the sole payer or provider of health care, but rather that it ensures adequate funding, regulation, and coordination of the health system. Single-payer health system is a specific way of achieving UHC, in which the government collects taxes and pays for all health care services through a single public fund. Examples of countries that have adopted UHC include Germany, Japan, and Thailand. Examples of countries that have adopted single-payer health system include Canada, Taiwan, and the United Kingdom. - Rationale: This question tests the students' understanding of the concepts and implications of different health financing models, as well as their knowledge of global examples. 2. What are the main advantages and disadvantages of decentralizing health care decision-making to subnational levels of government? - Decentralizing health care decision-making to subnational levels of government can have several advantages, such as increasing responsiveness to local needs and preferences, enhancing accountability and transparency, fostering innovation and experimentation, and improving coordination and integration of services. However, decentralization can also pose several challenges, such as creating inequities across regions, reducing economies of scale and scope, weakening national standards and regulations, increasing administrative costs and complexity, and creating potential conflicts and duplication of functions. - Rationale: This question assesses the students' ability to analyze the benefits and drawbacks of different levels of governance in health care delivery, as well as their awareness of the trade-offs involved. 3. What are the main types of health insurance systems and how do they affect the behavior of consumers and providers? - The main types of health insurance systems are social health insurance, private health insurance, and community-based health insurance. Social health insurance is a system in which workers and employers contribute to a public fund that covers a defined package of benefits for all or most of the population. Private health insurance is a system in which individuals or groups purchase coverage from private insurers that compete in the market. Community-based health insurance is a system in which members of a community pool their resources to provide mutual protection against health risks. Health insurance systems affect the behavior of consumers and providers through various mechanisms, such as moral hazard, adverse selection, risk pooling, risk adjustment, cost-sharing, provider payment methods, and quality assurance. - Rationale: This question evaluates the students' comprehension of the main features and functions of different health insurance systems, as well as their ability to apply economic concepts to explain their effects on health care utilization and provision. What is informed consent and why is it important for ethical health care? Provide an example of a situation where informed consent is required and explain how it should be obtained. Answer: Informed consent is the process of obtaining voluntary agreement from a patient or a surrogate decision-maker to undergo a specific medical intervention, after providing adequate information about the benefits, risks, alternatives and consequences of the intervention. It is important for ethical health care because it respects the patient's autonomy, dignity, values and preferences, and promotes trust and communication between the patient and the health care provider. An example of a situation where informed consent is required is when a patient needs to undergo a surgery. The health care provider should explain to the patient the nature, purpose, expected outcomes, potential complications, available options and possible consequences of the surgery, and answer any questions or concerns that the patient may have. The patient should then sign a written consent form to indicate their understanding and agreement. What are the four principles of biomedical ethics and how can they be applied to health care decisionmaking? Provide an example of a clinical scenario where these principles can be used to guide ethical reasoning. Answer: The four principles of biomedical ethics are respect for autonomy, beneficence, non-maleficence and justice. Respect for autonomy means respecting the patient's right to make their own decisions about their health care, based on their values, beliefs and preferences. Beneficence means acting in the best interests of the patient and promoting their well-being. Non-maleficence means avoiding or minimizing harm to the patient and preventing unnecessary suffering. Justice means treating patients fairly and equitably, and distributing health care resources according to need, merit and efficiency. These principles can be applied to health care decision-making by weighing them against each other and considering the context, consequences and stakeholders involved in each situation. An example of a clinical scenario where these principles can be used to guide ethical reasoning is when a patient with terminal cancer refuses further treatment that may prolong their life but also cause significant side effects. The health care provider should respect the patient's autonomy and honor their decision, while also ensuring that they are fully informed and competent to make such a choice. The health care provider should also balance the benefits and harms of the treatment for the patient, as well as the implications for other patients who may benefit from the same treatment. What is confidentiality and what are some exceptions to it in health care? Provide an example of a situation where confidentiality may be breached and explain the ethical justification for doing so. Answer: Confidentiality is the duty of health care providers to protect the privacy of their patients and not disclose any information about them without their consent or authorization. It is based on the principle of respect for autonomy and the value of trust in health care relationships. Some exceptions to confidentiality in health care are when there is a legal obligation or a public interest to disclose information, such as when reporting child abuse, infectious diseases or criminal acts; when there is a risk of serious harm to the patient or others that can be prevented by disclosure, such as when a patient is suicidal or homicidal; or when there is a valid consent from the patient or their surrogate decision-maker to share information with others, such as family members or other health care providers. An example of a situation where confidentiality may be breached is when a patient with HIV/AIDS does not inform their sexual partner about their status and continues to engage in unprotected sex. The health care provider may have an ethical justification to disclose this information to the partner, based on the principle of non-maleficence and the duty to protect others from harm.