Health Systems

Lesson Plan Aims and Objectives: To define the health care system and state its goals To describe the different methods of health care financing To list the different health care models in use

Health Care Systems

A health care system is an organization to deliver health care. There are many variations of health care systems around the world.

The goals for health systems, according to the World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.

There are generally five primary methods of funding health care systems:

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

One recent study published by the National Bureau of Economic Research found no systematic relationship between the cost efficiency of health care systems and the type of financing used. The author concluded "that almost all financing choices are compatible with efficiency in the delivery of health care."

Health care has the following characteristics:

• 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.
• Asymmetric information
• High risk level

Health care models include:

• 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.

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