The Beveridge model Bismarck model National Health Insurance model The out-of-pocket model

1. Shiva Ram Khatiwoda
Health System Models
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2. Goals of Health System
• There are about 200 nations on our planet,
and each nation devises its own set of
arrangements for meeting the three basic
goals of Health care system:
– I. Keeping people healthy
– II. Treating the sick
– III. Protecting families against financial ruin from
medical bills.

3. Health System Models
Healthcare delivery (Health System) models :
1. The Beveridge model
2. Bismarck model
3. National Health Insurance model
4. The out-of-pocket model
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4. The Beveridge (NHS) Model
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5. The Beveridge (NHS) Model
• Named after William Beveridge, the daring social reformer
who designed Britain’s National Health Service (NHS).
• In this system, health care is provided and financed by the
government through tax payments,
• Many, but not all, hospitals and clinics are owned by the
government; some doctors are government employees,
but there are also private doctors who collect their fees
from the government.
• In Britain, you never get a doctor’s bill.
• These systems tend to have low costs per capita, because
the government, as the sole payer, controls what doctors
can do and what they can charge.
• Example – UK, Spain, New Zealand
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The Bismarck Model

7. The Bismarck Model
• Named after the Prussian Chancellor Otto von
Bismarck, who invented the welfare state as part of the
unification of Germany in the 19th century.
• Usually financed jointly by employers and employees
through payroll deduction.
• Bismarck-type health insurance plans have to cover
everybody
• Non-profit making insurance
• Doctors and hospitals tend to be private in Bismarck
countries.
• Examples –Germany, France, Belgium, Netherlands,
Switzerland, Japan
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The National Health Insurance
Model

9. The National Health Insurance Model
• Has elements of both Beveridge and Bismarck.
• It uses private-sector providers, but payment comes
from a government-run insurance program that every
citizen pays into.
• Since there’s no need for marketing, no financial
motive to deny claims and no profit, these universal
insurance programs tend to be cheaper and much
simpler administratively
• The classic NHI system is found in Canada, but some
newly industrialized countries - Taiwan and South
Korea, for example - have also adopted the NHI model.
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10. The Out-of-Pocket Model
• Only the developed, industrialized countries - perhaps
40 of the world’s 200 countries - have established
health care systems.
• In other countries they have out of pocket model.
• The basic rule in such countries is that the rich get
medical care; the poor stay sick or die.
• Most of the nations on the planet are too poor and
too disorganized to provide any kind of mass medical
care.
• Hospitals and doctors are mostly private 10

11. The Out-of-Pocket Model
• Example – Many underdeveloped countries
of Africa, South America and Asia including -
Nepal, India, and China
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12. Mixed models
• Some elements of different models may be
included in some countries.
• This may also be a in transitional phase.
• For example – some services provided free,
some with subsidies, some social/national
insurance, and some out-of-pocket.
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13. Another way of categorization of
Health system model
1. Free market –
2. Welfare state –
3. Socialist state -
4. Underdeveloped -
5. Transitional –

14. Thank You
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