John Howell reads Health System
06. The different health systems
29 September 2010, 12:35 am
There are no two social security systems in the world whose organization, financing and range of services are the same. Nevertheless, three basic models are essentially used.
Tax financed model
The Beveridge model of a public health system is named after the British Sir William Beveridge. In 1942 he created a national health service that was financed and operated by the state through taxes. Doctors and pharmacists should be employed by public employers. After the end of the war, this plan was implemented and the National Health Service (NHS) was founded. Later Ireland, the Scandinavian countries, and Spain and Portugal also introduced similar public health systems.
Social security system
The Bismarck model started in 1881 with the "Imperial Embassy" initiated by Chancellor Prince Otto von Bismarck, in which the establishment of social insurance was announced. Bismarck tried to curb the enormous influx of the lower classes to socialist movements. The basis is a social security system that is financed through income-related compulsory contributions from employees and / or employers. The services are provided under state supervision, mostly by private providers. In addition to Germany, almost all Central European countries and Japan opted for the Bismarck model. Switzerland can also be included in this model, although financing there is organized through a flat rate per capita.
In the market model, the state largely withdraws from the health system. All health services are provided by private service providers. It is also privately financed. State control and supervision is reduced to a minimum, for example in the USA.
The UK National Health Service (NHS) is largely government funded through tax revenues. Only a small part is covered with social contributions. All citizens are insured. The medical services are largely free of charge. With private insurance, patients can receive faster treatment and additional medical services. General practitioners have a central function because only they can refer patients to specialists.
The advantage of the British system is the central position of the NHS. This makes it possible, for example, to implement preventive medical measures more quickly. Breast cancer screening is very good in the UK. However, state welfare also has disadvantages: Patients have to wait many months or even years for non-essential surgery appointments.
In our neighboring country there has been a national health insurance in which all citizens are insured since the beginning of the 1990s. The insurance is financed by employees and employers. The state pays the contributions for people without an income. In addition, he bears the investment and operating costs of the medical facilities and compensates for deficits in the insurance. Thus there is a mixed system in Hungary. All medical services are covered by the national health insurance. However, additional payments must be made for medication, aids and dentures. About 300 of the most important drugs used to treat the 60 most common diseases are covered by 90 percent of the insurance. For all other drugs, patients have to pay between 30 and 50 percent of the price themselves.
The needy and the chronically ill are excluded from this rule.
The US system is shaped by private insurance companies. They are mainly financed by contributions from employers. As a result, there are gaps in insurance coverage for the unemployed or even employees in small companies. There is state insurance for the elderly and the poorest. Even so, more than ten percent of the population have no insurance coverage at all. Due to the enormous cost pressure in private insurance, however, innovative models are being developed in the USA in which the focus is on quality aspects and the treatment outcome for the patient.
Statutory health insurance is financed jointly by employees and employers. In addition, there is additional income, for example from alcohol tax and a levy on alcoholic mixed drinks. Pharmaceutical advertising also pays health insurance fees. Because health insurance, as in other European countries, is struggling with financing problems, benefits are being cut more and more. At the same time, the deductible increases. For example, one third of the treatment costs must be borne by yourself. Many medications are no longer reimbursed. The French, on the other hand, also take out private insurance. In terms of quality and supply, however, the French system is considered to be the world leader.
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