Public Health System: Definition and Types

Another typology proposes six types of health systems for OECD countries:

National Health Service (NHS): Here, regulation, financing and provision of care are ruled by the state. Alternative nomenclature used for this type include ‘state-led’ and ‘command and control’. State dominance is the highlight of this model. The state has the responsibility to govern the relation with respect to access of patients to services since there is some leeway for choice of providers. Public provision of services through state-owned hospitals and salaried physicians in public facilities is the prevailing modality. Countries with this type include:

  • Denmark
  • Finland
  • Iceland
  • Norway
  • Sweden
  • UK
  • Portugal
  • Spain

National Health Insurance (NHI): This combines NHS regulation structures and tax financing with the dominance of private actors to provide services. While the state takes responsibility to regulate the relation between providers, payers, and patients, there is some leeway for patients to choose GPs or hospitals. Countries with this model include:

  • Canada
  • New Zealand
  • Australia
  • Ireland
  • Italy

Social Health Insurance (SHI): This type represents a dominating role of societal actors in healthcare regulation and financing but services are mainly delivered by private for-profit providers. Social security contributions cover over 70% of health expenditure and state authorities often only have a supervisory role. Public and private not-profit service provision is limited to the hospital sector while the other sectors are in the hands of for-profit providers. Countries with this type include:

  • Austria
  • Germany
  • Luxembourg
  • Switzerland

Etatist Social Health Insurance (ESHI): This is characterized by a clear hierarchy of three dimensions: the state is responsible for regulating the system while financing is organized by societal actors and provision of services has been given to private hands. Insurance contributions make the greatest share of health expenditure and taxes play only a minor role. Countries with this type include:

  • Czech Republic
  • Estonia
  • Hungary
  • Poland
  • Slovakia
  • Japan
  • South Korea
  • Belgium
  • France
  • Israel
  • The Netherlands

Private Healthcare System: This is characterized by a dominance of private market actors in the coordination of the healthcare system, funding from private sources such as insurance premiums or out-of-pocket payments, and services performed by for-profit providers. This type is currently found only in the USA. Although private nature is dominant in the US healthcare system, it tends to more toward more public funding and stronger state regulation.

The Special Case of Slovenia: Here, societal actors are in charge of regulation and financing, but service provision lies predominantly in the hand of state actors.

Useful Links:

Link to previous article:

Link to WHO’s Health System Strengthening Glossary:

Link to Chapter 7 of World Health Report 2003:

Link to Document classifying OECD countries:

Link to article describing what a Health System is:

1 thought on “Public Health System: Definition and Types

  1. Pingback: Health Systems Analysis: A brief overview | communitymedicine4all

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