Health care system

A health care system is the organization by which health care is provided.^{[citation needed]}

Financing

There are generally five primary methods of funding health care systems:^[1][2]

1. direct or out-of-pocket payments,
2. general taxation,
3. social health insurance,
4. voluntary or private health insurance, and
5. donations or community health insurance.

Although some view health care from an economic perspective as being no different from other products or services, others believe it has many characteristics that encourage government intervention or regulation:

• The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—some treatments cost more than a typical family's life savings.
• Health care professionals are bound by law and their oaths of service to provide lifesaving treatment.
• People often lack the information or understanding to be able to choose rationally between competing health care providers when they need treatment, particularly in the event of the need of urgent or emergency treatment.

Health care systems models

• Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid).

• The other major models are public insurance systems:
  • Social security health care model, where workers and their families are insured by the State.
  • Publicly funded health care model, where the residents of the country are insured by the State.
  • Social health insurance, where the whole population or most of the population is a member of a sickness insurance company.

In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.

Examples

• In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications.
• Canada has a federally sponsored, publicly funded Medicare system. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors, with the entire fee paid for by the government at the same rate. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate - even to patients who are not covered by the publicly funded system - unless he opts out of billing the publicly funded system altogether. Other areas of health care, such as dentistry and optometry, are wholly private.
• Cuba has a wholly government-controlled system that consumes a large proportion of the nation's GDP. The system does work on a for profit basis in treating patients from abroad. Cuba attracts patients mostly from Latin America and Eastern Europe by offering care of comparable quality to a developed nation but at much lower prices. While the government system is free to all, patients frequently pay out-of-pocket for drugs that are in short supply in the public system.
• In Finland, the publicly funded medical system is funded by taxation and every citizen has state-funded health insurance. The system is comprehensive and compulsory, like in Sweden, and a small patient fee is also taken.
• In France, most doctors remain in private practice; there are both private and public hospitals. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the "universal health coverage". In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer.
• Germany has a universal multi-payer system with two main types of health insurance: "Compulsory health insurance" (Gesetzlich) and "Private" (Privat).^[3][4][5]
• In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care.
• In Hong Kong, both private and public clinics are common, while public hospitals account for the majority of the market.
• In Israel, the publicly funded medical system is universal and compulsory. Payment for the services are shared by labor unions and the government.
• In the Netherlands, a system of standardised and mandatory health insurance is in place, meant to encourage competition between healthcare providers and insurers. The insurance policies are paid for through a system of levies and subsidies as well as a premium paid by the insured, from which children under 18 are exempt.
• In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the curent Labour coalition governments, 1999 - present, there are plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card.
• In South Africa, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served.
• In Sweden, the publicly funded medical system is comprehensive and compulsory. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden.
• In 1948, the United Kingdom passed the National Health Service Act that provided free physician and hospital services to all people resident in the United Kingdom. Most doctors and nurses are on contracts, and receive salaries, a fixed fee for each patient assigned, and enhanced payments for specialized treatments or skills. The National Health Service has been amended from time to time, but is largely intact. Around 86% of prescriptions are provided free. Prescriptions are provided free to people who satisfy certain criteria such as low income or permanent disabilities. People that pay for prescriptions do not pay the full cost. For example, in 2004 most people in will pay a flat fee of £6.40 (€9.64, US$11.76) for a single drug prescription regardless of the cost (average cost to the health service was £11.10--about €16.70, US$20.40--in 2002). (Charges are lower in Wales, and the administration there is committed to their eventual elimination.) Funding comes from a hypothecated health insurance tax and from general taxation. Private health services are also available. Private health care continued parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a top-up to NHS services.

• The United States is alone among developed nations with the absence of a universal healthcare system. The U.S. health system does, however, have significant publicly funded components. Medicare for the elderly and disabled, with a historical work record and Medicaid, for indigents, provides taxation-financed coverage. This care is generally provided by privately owned hospitals or physicians in private practice, but public hospitals are common in older cities. Medicare is a federal government program providing coverage to people age 65 or older. Medicaid is a federal and state program providing coverage to low-income and disabled persons. The Department of Veterans Affairs directly provides health care to injured U.S. military veterans and current servicemen and women through a nationwide network of government hospitals (non-injured veterans are often not covered) The Indian Health Service provides public funded care for indigenous peoples. Employer benefit based health insurance remains quite common with larger employers. Workers injured on the job are covered by government mandated worker compensation insurance and wage replacement benefits. These benefits vary considerably state-to-state and employers bear the cost of this insurance. Businesses with considerable risks, such as bridge-building, mining, or meat processing face far higher worker compensation insurance costs than do office based clerical businesses.

A significant and growing number of people cannot obtain health insurance through their employer, or are unable to afford individual coverage. Currently, it is estimated that 17% of the U.S. population is uninsured. This number is growing rapidly as increasing numbers of employers cannot afford the ever-growing costs of the insurance. For those that continue to provide employer-based programs, the employee percentage share is increasing year by year. The cost of medicines is frequently not covered by insurances and it is common for U.S. citizens to travel to Canada and Mexico for drug purchases at prices far below those in their home areas. A few states have taken serious steps toward universal health care coverage, most notably Minnesota and Massachusetts.^[6] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy. It is typical for most forms of general liability insurance sold in the U.S., such as home, automobile, or business insurance to have a significant premium allocation for medical damages. The U. S. legal system, which has the highest number of attorneys per 100,000 population of any country in the world, is available to assist in proving liability and collecting the money for medical bills from such insurances.

• In Italy their public system has the unique feature of paying its doctors a fee per capita per year, a salary system, that does not reward repeat visits, testing, and referrals.^{[citation needed]}

References

See also

• Accident compensation
• Accident Compensation Corporation, a New Zealand state insurance agency
• Canadian and American health care systems compared
• Diagnosis-related group (DRG)
• Emergency services (see also Lifeline)
• Health care delivery
• Health care professionals
• Health care reform
• Health maintenance organization (HMO)
• Health insurance
• International aid organizations (e.g. World Health Organization)
• National Health Service (British system)
• Pharmaceutical company
• Social security

External links

• HRC/Eldis Health Systems Resource Guide provides access to free online research and other resources on health systems in developing countries
• Healthcare Research provides access to free online research on electronic health systems along with EHR vendor comparison.
• Health Decisions Comprehensive health insurance resource; with news, a learning center, and original content.
• Harvard University: Longevity Gap: Who, Where And Why Americans Live Longer Or Die Sooner

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