Top global healthcare models

Right now, innovation in healthcare is a hot topic. The COVID-19 pandemic has exposed major flaws and deficiencies in the current healthcare system. Primary care practices are struggling to survive. Opinions on the best way often include discussions of national healthcare models, and unsurprisingly, representatives differ widely on the approach they view as the best.

The talks about the model change will continue and now is the best time to better understand global coverage systems. By becoming aware of the problems we face and the solutions that other nations around the world are using, there is a greater chance that innovation in healthcare will take place around the world.

In broader terms, there are four main health care models: Beveridge model, Bismarck model, national health insurance, and the out-of-pocket model. Although each model is different in itself, most countries do not strictly adhere to a single model. Rather, most create their own hybrids that have many characteristics.

Developed by Sir William Beveridge in the United Kingdom in 1948, the model is often centralized through the establishment of the National Health Service. 

Basically, the government acts as the sole payer, eliminating all competition in the market to keep costs down and standardize profits. As the sole payer, the National Health Service controls what providers can do and what they can charge.

Financial assistance is provided through taxes, there are no out-of-pocket costs or cost-sharing for patients. All tax-paying citizens are guaranteed equal access to care and no one will receive a medical bill.

One criticism of this model is the potential danger of overuse. Without restrictions, free access could potentially allow patients to request healthcare services that are unnecessary or wasteful. 

There is also criticism around funding during national emergencies. Whether it is a war or a health crisis, increased spending or declining public revenues could jeopardize the government’s ability to provide health care. 

The Bismarck model was developed by Otto von Bismarck in the late 19th century as a more decentralized form of healthcare.

Within the Bismarck model, employers and employees are responsible for financing their health insurance system through sickness funds created through pay cuts. Private insurance plans also cover all employees, regardless of pre-existing conditions, and the plans are not profit-oriented.

Providers and hospitals are usually private, although insurers are public. In some cases, there is only one insurer (France and Korea). Other countries, such as Germany have several competitive insurers. However, the government controls prices.

Unlike the previous model, the Bismarck model does not offer universal health coverage. You need employment for health insurance. The main criticism of this model is how to care for people who cannot work or cannot afford to participate, including the elderly population and the imbalance between retirees and employees.

Some employer-based health plans are used in Germany, Belgium, Japan, Switzerland, the Netherlands, France, and the United States.

The National Health Insurance model combines different aspects of both the Beveridge model and the Bismarck model. First, the government acts as the sole payer for medical procedures; however, the providers are private.

The model of national health insurance is operated by private insurers and payments are received from government-operated insurance programs. The main criticism of the national health insurance model is the possibility of long waiting lists and delays in treatment, which is considered a serious health policy problem.

The out-of-pocket model is used in countries where medical systems are not in a place like the previous models.

In this model, patients have to pay out of pocket for their procedures. The fact is, the rich get professional health care and the poor do not unless they have enough money to pay for it. Medical care is still based on income.


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