Health Care Systems

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Introduction

A health system consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services.

Rehabilitation is an essential health service, alongside prevention, promotion, treatment and palliation. However, in many countries, individuals do not have access to the rehabilitation services they need. The best way to ensure that rehabilitation services reach all those who need them is by integrating rehabilitation across all levels of the health system, as part of universal health coverage. A well-functioning health system working in harmony is built on having trained and motivated health workers, a well-maintained infrastructure, and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans and evidence-based policies. Health Care Systems differ from nation to nation depending upon the level of economic development and the political system in place. Health care is a priority and source of concern worldwide. Every country irrespective of its private, public or mixed health care system faces challenges with regard to quality, delivery and cost of services.

Inadequate healthcare is prevalent globally, and no country has a perfect healthcare system. Health is a basic human right, and improvements in healthcare should be a goal of every country. Healthcare systems present in different countries are strongly influenced by the norms and values prevalent with the respective societies, and often reflect deeply rooted social and cultural expectations and norms. Although these fundamental values are generated outside the formal structure of the healthcare system, they often define its overall character.

Models

The Beveridge Model

The Beveridge Model of Health Care, named for William Beveridge, the social reformer who designed Britain’s original National Health Service, is provided and financed by the government through tax payments, like other public services such as the police force or the public library. In this system healthcare facilities can be owned by the Government or privately. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge. Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge­style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

The Bismarck Model

Named for the 19th Century Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany. Predominantly funded jointly by employers and employees through payroll deductions, it is a mixed model health system that incorporates a mix of private and public providers, and allows more flexible spending on healthcare.

The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private­ sector providers, but payment comes from a government­run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American­ style for­profit insurance. The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated. The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

The Private Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die. In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home­brewed remedies that may or not be effective against disease. In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care. These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out­of­pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.

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Resources

• Health Care Systems - Four Basic Models.pdf
• Healthcare Systems Around the World.pdf
• Transforming Health - Shifting from Reactive to Proactive and Predictive Care

References