3. Healthcare System
What is ‘healthcare system’?
- System that considers;
1) How medical services are covered & Who pays for What when people are sick
2) How to make people healthy
3) How to make them affordable
Only the developed countries - about 40 of the world’s 200 countries - have
established healthcare systems.
4. Types of Healthcare Systems
Public Private
• Beveridge Model
- National single-payer
fully covers all the
service/cost by tax
- Key countries
UK, Spain, Italy, Sweden,
Denmark, Norway, New
Zealand, Hong Kong (part
of China), Cuba, etc.
• National Health
Insurance Model
- National single-payer
‘mainly' covers
service/cost
- Key countries
Japan, S. Korea, China,
Taiwan, etc.
• Bismarck Model
- Multi-payer (insurances)
covers service/cost for all
the people
- Key countries
Germany, France, Belgium,
Netherlands, Switzerland,
some Latin America, etc.
• Private Insurance
Model
- Multi-payer (insurances)
covers service/cost to
who are employed
- Key countries
United States (changing),
almost all other countries
where system is not
established.
5. Model Characteristics
Public Private
• Beveridge Model • National Health
Insurance Model
• Bismarck Model • Private Insurance
Model
Drawback
Dependency on Gov.
Inefficiency (e.g. waiting)
Strength
Low cost (Gov. control)
High quality care for all
Drawback
Gov. burden on control
Strength
Quality care
Relatively low cost
Efficiency
Drawback
Vacancy in population
6. Types of Payment Systems
1) FFS (Fee for Service)
- Provider reimbursed by Payer based on the service that are given to Patient
- Cost-Effectiveness Issue / Guideline
2) DRG (Diagnosis Related Group)
- Provider reimbursed by Payer as a single price for a Patient admission of specific disease
- Performance oriented reimbursement / Annual adjustment
- Treatment compromising & early discharge Issue
7. Types of Payment Systems (Cont’)
3) VBH (Value-Based Healthcare)
- Provider reimbursed by Payer based on the Patient value
- Value = Outcome / Cost
- Provider (or group of providers) in the region would receive a single payment to
cover all of the services their patients (population) need during a specific period of
time. (+ Incentive for the patient volume & severity)
- Patient-centered care / Preventive concept works
9. Healthcare Market Trend
# Patient-centered
# Precision Medicine
# Disruptive innovation
# Genomics
# Deep Learning
# Clinical Decision Support
# Data-driven
# AR/VR in surgery/training
# Robotic therapy
# Preventive Care
10. Discussion Point
1) Role of Government
2) Single vs. Multi Insurance
3) Cost-Effectiveness (Quality care at affordable cost)
- New Drug / Device / Equipment…?
4) Patient-centered / Preventive / Early diagnosis
