Health System Types
There are several classification systems, each describing multiple types. We will consider a few classifications here.
One classification describes four types of health systems in industrialized countries:
- Beveridge model
- Bismarck model
- National Health Insurance or Tommy Douglas model
- Out-of-pocket model
Beveridge model: Health care is provided to all citizens and is financed by the government through tax payments. This is also called “socialized medicine” model, and is currently found in
- Great Britain
- New Zealand
Bismarck model: This is characterized by a private insurance system often jointly financed by employers and employees through payroll deductions. All citizens are covered by health insurance plans. Although doctors and hospitals tend to be private, health insurance plans do not make a profit. This model is currently found in
- The Netherlands
National Health Insurance model: This has characteristics of both Beveridge and Bismarck models. It uses private-sector providers, but financing is from a government-run insurance program that all citizens fund through a premium or tax. The insurance programs tend to be not-for-profit and have lower administrative costs than for-profit insurance plans. The classic National Health Insurance model is found in Canada.
Out-of-pocket model: This is the commonest model at the global level and is used in countries too poor or disorganized to provide a national health care system. Even if a national health care system exists, it is likely to be dysfunctional. Here, those who can pay for health care get it, and the rest remain sick or die. Among industrialized nations, the USA is probably the only country to have this model. (In fact, the US has elements of all four models and provides different types of care and coverage for different sectors of the population, making it disjointed and costly.)
Although the above typology describes industrialized countries, the four models may be extended to developing countries also.