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 in all countries, 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.

Components of Health Systems

A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health. The key components of a well-functioning health system should include:

Leadership and Governance

Leadership and governance involves assurance that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability.

Service Delivery

Service delivery can be defined as the way inputs are combined to allow the delivery of a series of interventions or health actions.

Human Resources

A health workforce works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff; fairly distributed; they are competent, responsive and productive).

Essential Medical Products and Technologies

Equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.

Health Information Systems

Ensure the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.

Health Financing

Raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.

Health System Models

While globally each country has some variation in their health care systems, overall they tend to follow general patterns with four main models forming the basis for most health care systems globally;

The Beveridge Model

The Beveridge Model of Health Care, named for William Beveridge, the social reformer who designed Britain’s original National Health Service. Like other public services such as the police or education systems, this model of health care is both provided and financed by the government through tax payments. In this system healthcare facilities can be owned by the Government, but may also be privately owned with Government funding, with the majority of health staff in this model composed of government employees. These systems tend to have low costs per capita, because the government, as the sole payer, controls what healthcare providers can do and what they can charge with benefits generally standardized across the country.

Health as a human right, ia a central tenant of this model, with universal health coverage and equal access to care guaranteed by the government. Primary criticism of this system is the tendency toward long waiting lists with everyone guaranteed access to health services, often leading to over-utilization and risk of increasing costs.

Countries using the Beveridge Model or variations on it include its Great Britain where the Beveridge Model was developed, Spain, most of Scandinavia and New Zealand. Hong Kong has its own Beveridge­ style health care system, which remained in place after the Chinese took over that former British Colony in 1997, while Cuba represents the extreme application of the Beveridge approach with total government control over the healthcare system.

The Bismarck Model

The Bismark Model of Health Care, also referred to as a "Social Health Insurance Model" was named for the 19th Century Prussian Chancellor, Otto von Bismarck, who developed a welfare state with compulsory insurance for all working individuals as part of the unification of Germany in 1883. It is a health insurance plan that in principle must include all citizens, and is non profit in nature, although in practice tends to be available only to the working population with allocation of resources to those who contribute financially, so as such does not provide universal health coverage. It is predominantly funded jointly by employers and employees through payroll deductions. Generally it is a mixed model health system that incorporates a mix of private and public providers, and allows more flexible spending on healthcare. Providers and hospitals are generally private, while insurers are generally public, and in some countries like France or Korea have a single insurer, while in other countries like Germany have multiple competing insurers although pricing is controlled by the government as is also seen with the Beveridge Model. This model is found in Germany, France, Belgium, the Netherlands, Japan, and Switzerland.

Significant drop in mortality was shown in Germany with the introduction of the original Bismarck system , thought to be due predominantly to the prevention of communicable disease. As a whole Bismark Models of Health Care generally have significantly higher accessibility, lower waiting times and often higher quality and more consumer-oriented healthcare, thought to be as a result of competition between healthcare providers. The primary criticism of the Bismarck model is how to provide care for those who are unable to work or can't afford contributions, including aging populations and the imbalance between retirees and employees.

The National Health Insurance Model

This system combines elements of both the Beveridge and Bismarck Models of Healthcare. Generally funding comes from a government­ run insurance program that every citizen pays into, as we see in the Beveridge Model, but it predominantly uses private­ sector providers. This model provides a universal insurance that doesn't make a profit or deny claims and as such with no no requirement for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than For Profit or Private Insurance Models.

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, which is the primary criticism of these models. The potential for long waiting lists and delays in treatment, can be considered a serious health policy issue. This model is found Canada, Taiwan and South Korea, and the Medicare Model is the United States of America are based on this model.

The Private Model

Disparities in health care due to socioeconomic status and ethnicity are found in all countries. Currently there are a limited number of countries globally that have established national health care systems, with the majority countries providing ad hoc national medical care, which are provided on a private or pay for treatment basis. This typically means that those with access to money get access to health care, while those that do not have money do not have health care access. In many isolated or rural regions of the world, hundreds of millions of people can go their whole lives without ever accessing health care services. In this type of model Healthcare is still driven by income. This model of healthcare is found predominatly in isolated communities and is particularly seen in rural areas in India, China, Africa, South America, and among uninsured or underinsured populations within the United States of America.

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.

Conclusion

The concerns faced by each country when attempting to construct a system for health care delivery can be very different based on their needs impacted by a wide variety of factors including economics, climate, population size etc.. No health care system is completely alike, and none are completely free of problems and as such a method that works for one country will not be completely transferrable to another due to different health concerns, priorities, and mindsets.

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