The document compares the healthcare systems of France and the United States. It begins with an executive summary and overview of healthcare systems and models. France follows the Bismarck model with universal coverage funded through mandatory health insurance. The US has a fragmented system with both public and private components. While the US spends more on healthcare, France achieves better health outcomes at a lower cost. Both systems could benefit from each other by addressing issues like rising costs and ensuring access.
Chikitsa -Revamping The Health Sector of Maharashtra 2015Shyam Ashtekar
This is a systematic review of Maharashtra's ( A state in India) Health Sector, and a program for revamping this sector, with a 10 point agenda. The book is in Marathi, and this is an English Summary. I have dealt with public and private health sectors, as well as the global context of health system management.
India's Healthcare in a Globalised World: Healthcare Workers’ and Patients’ V...SLDIndia
India's Healthcare in a Globalised World: Healthcare Workers’ and Patients’ Views of Delhi’s Public Health Services
Society for Labour and Development
http://www.sldindia.org/
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
Chikitsa -Revamping The Health Sector of Maharashtra 2015Shyam Ashtekar
This is a systematic review of Maharashtra's ( A state in India) Health Sector, and a program for revamping this sector, with a 10 point agenda. The book is in Marathi, and this is an English Summary. I have dealt with public and private health sectors, as well as the global context of health system management.
India's Healthcare in a Globalised World: Healthcare Workers’ and Patients’ V...SLDIndia
India's Healthcare in a Globalised World: Healthcare Workers’ and Patients’ Views of Delhi’s Public Health Services
Society for Labour and Development
http://www.sldindia.org/
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
Health systems, goals of health system,
Leadership and Governance
Human Resource for Health
Health Financing
Medicines and Technologies
Service Delivery, and
Health Information System
These slides were used as part of a talk for Sheffield Health Watch on the idea emerging from NHS England that the future direction of NHS reform will be the creation of Accountable Care Organisations (ACOs)
Markets and Healthcare Services in Malaysia: Critical IssuesEyesWideOpen2008
An October 2011 academic paper by University of Malaya and Universiti Tun Abdul Razak. It calls for improvement of present system and increased federal funding. But it is ignored by the government in favour of 1Care's model.
Excerpt:
The arguments obviously call for Government funding of healthcare in Malaysia to be raised to around 10 per cent of overall government expenditure so that public hospitals will enjoy enough resources to provide service comparable to developed countries.
These resources should be targeted at raising remuneration of personnel, more medical equipment, greater access to pharmaceutical drugs and materials, as well as quality building support. In addition, the government should introduce and implement merit-based promotion personnel policies in public hospitals.
Health Economics and Health Finance :Jordan Health Policy Directions Musa Ajlouni
This presentation includes general introduction to health economics,the concept of market failure in health, health financing including health insurance and major challenges related to healthcare financing in Jordan and some policy directions to face these challenges.
About Healthcare system of Bangladesh: Health care delivery is a daunting challenge area of the Bangladesh’s healthcare systems. The Health
care system in Bangladesh falls under the control of the Ministry of Health and Family Planning. The
government is responsible for building health facilities in urban and rural areas.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Nachiket Mor IT for primary healthcare in indiaPankaj Gupta
An Approach Towards Health Systems Design in India,
Information technology for Primary Healthcare in India,
Johns Hopkins University,
March 2020,
13 citations - [Streveler and Gupta, 2019] - Health Systems for New India - Niti Aayog Book published in Nov 2019,
eObjects - eClaims, eDischarge, ePrescription, eEncounter, eReferral,
System of Health Accounts 2011: What is SHA 2011 and How Are SHA 2011 Data Pr...HFG Project
The SHA 2011 statistical manual improves upon the original by strengthening the classifications to support production of more detailed results and by introducing new classifications that expand the scope of the analysis and provide a more comprehensive look at health expenditure flows. The purpose of this brief is to present the main features of the SHA 2011 framework as well as discuss the process of its implementation and, ultimately, institutionalization within routine government operations.
Health systems, goals of health system,
Leadership and Governance
Human Resource for Health
Health Financing
Medicines and Technologies
Service Delivery, and
Health Information System
These slides were used as part of a talk for Sheffield Health Watch on the idea emerging from NHS England that the future direction of NHS reform will be the creation of Accountable Care Organisations (ACOs)
Markets and Healthcare Services in Malaysia: Critical IssuesEyesWideOpen2008
An October 2011 academic paper by University of Malaya and Universiti Tun Abdul Razak. It calls for improvement of present system and increased federal funding. But it is ignored by the government in favour of 1Care's model.
Excerpt:
The arguments obviously call for Government funding of healthcare in Malaysia to be raised to around 10 per cent of overall government expenditure so that public hospitals will enjoy enough resources to provide service comparable to developed countries.
These resources should be targeted at raising remuneration of personnel, more medical equipment, greater access to pharmaceutical drugs and materials, as well as quality building support. In addition, the government should introduce and implement merit-based promotion personnel policies in public hospitals.
Health Economics and Health Finance :Jordan Health Policy Directions Musa Ajlouni
This presentation includes general introduction to health economics,the concept of market failure in health, health financing including health insurance and major challenges related to healthcare financing in Jordan and some policy directions to face these challenges.
About Healthcare system of Bangladesh: Health care delivery is a daunting challenge area of the Bangladesh’s healthcare systems. The Health
care system in Bangladesh falls under the control of the Ministry of Health and Family Planning. The
government is responsible for building health facilities in urban and rural areas.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Nachiket Mor IT for primary healthcare in indiaPankaj Gupta
An Approach Towards Health Systems Design in India,
Information technology for Primary Healthcare in India,
Johns Hopkins University,
March 2020,
13 citations - [Streveler and Gupta, 2019] - Health Systems for New India - Niti Aayog Book published in Nov 2019,
eObjects - eClaims, eDischarge, ePrescription, eEncounter, eReferral,
System of Health Accounts 2011: What is SHA 2011 and How Are SHA 2011 Data Pr...HFG Project
The SHA 2011 statistical manual improves upon the original by strengthening the classifications to support production of more detailed results and by introducing new classifications that expand the scope of the analysis and provide a more comprehensive look at health expenditure flows. The purpose of this brief is to present the main features of the SHA 2011 framework as well as discuss the process of its implementation and, ultimately, institutionalization within routine government operations.
Learn how to cope with the emotions of diabetes. This guide helps you learn to deal with stress, depression and accepting that you have diabetes.
Liberty Medical
3.1 INTRODUCTION
When the health community makes reference to patients having access to care, the reference is
generally limited. The concept of access is too often described as individuals getting to and from
health services and having the ability to pay for the services either by virtue of a third party or
out-of-pocket. We believe access to be much more than this and suggest that a redefinition of
access is long overdue. True access means being able to get to and from health services, having the
ability to pay for the services needed, and getting your needs met once you enter the health system.
This text introduces a framework for assessing the strengths and weaknesses of selective healthcare
systems, and determining if the system is providing true access to health care. The framework is
called “The Eight Factor Model.”
The comparison of health systems is made by utilizing The Eight Factor Model, which was
developed by the authors, and has “true access” as the driving value. As illustrated in Figure 3-1 ,
the model has true access at its core, and eight surrounding factors that are important for health
systems to demonstrate in order to provide that true access. A solid directional arrow from the
factor to the core depicts a system that has demonstrated evidence to support that it is providing
true access. A broken directional arrow from the core to the factor suggests the system is not
providing true access, and much work must be done to achieve it. Table 3-1 (a format for assessing
true access) provides a template for learners to formulate their own opinions about the extent to
which countries discussed in this text provide true access. Table 7 in Chapter 16 , The Eight Factor
Model for True Access, summarizes author observations regarding the extent to which each of the
11 countries discussed in the “Health Care in Industrialized (Developed) Countries and “Health
Care in Developing Countries” sections of this text have addressed true access. This will hopefully
enable the learner to briefly review it against the Eight Factor Model illustrated in Figure 3-1 . Table
7, The Eight Factor Model for True Access, which appears at the end of Chapter 16 (Comparative
health perspectives) should be fully reviewed as the l ...
Unintended Consequences of Health Care ReformThe PPACA of .docxgibbonshay
Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of
THREE
scholarly references from the list of required readings below. Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING).
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3 ...
HCA 4303, Comparative Health Systems 1 Course LearninMargaritoWhitt221
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit II
Upon completion of this unit, students should be able to:
1. Outline the eight major factors that determine a country’s true access within a healthcare system.
Reading Assignment
Chapter 3: The Eight Factor Model for Evaluating True Access
Chapter 9: The Healthcare System in Italy
Unit Lesson
In this unit, we will explore Chapter 3 of the Lovett-Scott and Prather (2014) textbook. This chapter provides
an introduction to the eight factors that serve as a framework to define whether or not true access to health
care exists in a country or culture. Leaders and scholars have discussed this question for many years and
tend to define access more narrowly than Lovett-Scott and Prather. Typically, access to care is determined by
the ability to pay for the care through personal funds or by a third party payer (healthcare insurance, federal
funding, etc.).
Other writers include the ability to see a physician in a reasonable amount of time. Occasionally, the term
“provider” is used instead of physician to denote the inclusion of physician extenders, such as advanced
practice nurses and physician assistants. Regardless, the concept of true access to care extends further than
the ability to obtain and pay for time with a licensed medical provider.
The major elements of each factor are listed below:
1. Historical
- Traces how health and access to services have been defined historically
- Describes how the healthcare system emerged
- Defines the role of emergency room services
- Observes the clinics and health centers providing care
2. Structure
- Defines the type of delivery system
- Observes the health system’s infrastructure
- Reviews health policies, roles, and responsibilities of medical professionals
- Examines supply versus demand for services
- Identifies the presence or absence of various structural barriers to services
3. Financing (Most difficult factors to address)
- Examines a nation’s ability to fund healthcare services
- Describes the nation’s fiscal responsibilities and financing priorities
- Determines where the majority of healthcare budget is spent
- Includes a critical examination of long-term care, maternal care, and child care
- Discusses technology and research, and emphasizes a system on curative care
- Determines if the funding is private or public
- Reviews the government’s role and provider’s compensation
UNIT II STUDY GUIDE
Evaluating True Access to Care
Using the Eight Factors Analysis
HCA 4303, Comparative Health Systems 2
UNIT x STUDY GUIDE
Title
4. Interventional
- Determines the focus of care; primary care, acute care, restorative care, etc.
- Observes if most care is provided in hospitals or community clinics
- Reviews outcome-based systems for requirements and compensation
- Determines the role of family and the community is healthcare delivery ...
WEEK 2 DISCUSSIONUnintended Consequences of the Individual Manda.docxcelenarouzie
WEEK 2 DISCUSSION
Unintended Consequences of the Individual Mandate
I chose the individual mandate which is a requirement of all Americans, unless exempted, to have basic coverage of health insurance. It is a healthcare reform that came into law in 2010 and was known as Obamacare or the Affordable Care Act. The legislation calls for a tax penalty for those who fail to have the insurance coverage (Laureate Education, 2011).
Positive Results of the Individual Mandate
Just like any other insurance policy, health insurance creates risk pools among policyholders. The individual mandate resulted in having many healthy people paying premiums which helped pay for health costs for those who got sick and could not afford the medical costs on their own. The risk pool becomes wide enough when more people, especially the healthy, and this lowers the premiums for everybody including those with expensive medical requirements. Thus, healthcare is more affordable and accessible to more Americans. Therefore, the individual mandate reduced the number of Americans who did not health insurance and lowered the insurance premiums. It also reduced the government’s cost of subsidizing the insurance coverage for those who are newly insured (Blumental, Abrams & Nuzum, 2015).
Unintended Consequences of the Individual Mandate
However, there were negative consequences that came with the individual mandate. Critics saw it as a financial burden and an unconstitutional violation against personal liberty. Opponents argued that citizens have the right to make their own health decisions and live without the government interfering with their social matters. Further, the individual mandate became less popular as people opposed the penalties imposed on them if they failed to pay for their health insurance. The matter was actually taken to the Supreme Court to determine whether the mandate was a constitutional exercise of the government to exercise its taxing power (Blumental et al., 2015). A significant number of Americans believe that the legislation has done more harm than good to state residents. Among these are those opposing government meddling in their personal health matters and forcing them to have insurance. Others are those opposing the tax penalties imposed for failure to pay for the health insurance.
Issues to be considered by Organizations and Nursing Profession
There are a number of factors that my organization have to consider with the individual mandate. To begin with, the nursing profession need to keep up with the Affordable Care Act changes and fully comprehend the nature and complexity of health insurance. This way, they can educate and inform health consumers who come to the hospital about their health insurance requirements and coverage (Bodenheimer & Grumbach, 2016). Further, even with the increased health coverage enabled by the individual mandate, organizations are still facing some challenges that they need to handl.
The following resources have been provided to help you learn mor.docxarnoldmeredith47041
The following resources have been provided to help you learn more about important concepts covered this week. Look for ways to apply these resources to this week’s activities and assignments. Ensure you:
· Read “Price Transparency Needed From All Stakeholders, HFMA Task Force Says” from Modern Healthcare.
https://www.modernhealthcare.com/article/20140416/NEWS/304169931/price-transparency-needed-from-all-stakeholders-hfma-task-force-saysCHAPTER 3
Current Operations of the Healthcare System
LEARNING OBJECTIVES
The student will be able to:
■ Identify the stakeholders of the U.S. healthcare system and their relationships with each other.
■ Discuss the importance of healthcare statistics.
■ Compare the United States to five other countries using different health statistics.
■ List at least five current statistics regarding the U.S. healthcare system.
■ Discuss complementary and alternative medicine and its role in health care.
■ Define OECD and its importance to international health care.
DID YOU KNOW THAT?
■ According to the Bureau of Labor Statistics, the projection for job growth in the healthcare industry over a 10-year period is 9.8 million jobs by 2024.
■ Most healthcare workers have jobs that do not require a four-year college degree but health diagnostic and treatment providers are the most educated workers in the United States.
■ Healthcare employment is found predominantly in large states such as California, New York, Texas, and Florida.
■ Approximately 40% of U.S. adults use some form of nontraditional medicine.
■ The healthcare industry and social assistance industry reported more work-related injuries than any other private industry.
■ Life expectancy and infant mortality rates are an indication of the health of a population.
▶ Introduction
The one commonality with all of the world’s healthcare systems is that they all have consumers or users of their systems. Systems were developed to provide a service to their citizens. However, the U.S. healthcare system, unlike other systems in the world, does not provide healthcare access to all of its citizens. It is a very complex system that is comprised of many public and private components. Healthcare expenditures comprise approximately 17.5% of the gross domestic product (GDP). Health care is very expensive and most citizens do not have the money to pay for health care themselves. Individuals rely on health insurance to pay a large portion of their healthcare costs. Health insurance is predominantly offered by employers. The uninsured rate remains at an all-time low with 9.1% of under 65 uninsured as of the end of 2015 according to CDC.Gov data. Generally, 2016 saw a rough increase of all the 2015 numbers. (Obamacare enrollment, 2016). The government believes this is the result of the universal mandate for individual health insurance coverage.
In the United States, in order to provide healthcare services, there are several stakeholders or interested entities that participate in the indust.
A Career in Public Health Essay examples
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1. University of Paris- Dauphine
Managing
Healthcare
A comparative study between the healthcare system in
France and US
Teja Mysore
6-9-2016
2. 1
Executive Summary
Healthcare is a very complex issue involving many stakeholders and it requires a smooth
functioning between all these players to make the system work. Throughout history, there have
been many significant authorities in determining the over-arching model of healthcare. As such,
different countries have adopted different models and have tailored them to the needs of their
population.
US and France can be called two sides of the same coin. There are many similarities
between the two systems, but there are also significant differences. Ultimately, it would
behoove the two nations to learn from each other’s’ successes and challenges.
This paper first delves into the various players in the healthcare industry and gives an
overview of the goals of various nations and WHO-World Health Organization. We then look at
how France and US healthcare systems stack up against each other.
3. 2
Contents
Executive Summary......................................................................................................................... 1
1. Introduction ............................................................................................................................ 3
2. Basic Overview of Healthcare................................................................................................. 4
Components of Healthcare Industry........................................................................................... 4
Building Blocks of a Health System ............................................................................................. 6
3. Healthcare Models.................................................................................................................. 8
The Beveridge Model .................................................................................................................. 8
The Bismarck Model.................................................................................................................... 8
The National Health Insurance Model ........................................................................................ 8
The Out-of-Pocket Model............................................................................................................ 9
4. The French System.................................................................................................................. 9
5. The US System....................................................................................................................... 10
6. France v/s USA ...................................................................................................................... 11
Distribution of Funding Sources for Personal Health Care ....................................................... 12
7. Conclusion............................................................................................................................. 14
References .................................................................................................................................... 15
Table of Figures
Figure 1: Pictorial depiction of various aspects of Healthcare (Cognizant, 2014).......................... 4
Figure 2: Inter-relation between the components of Healthcare industry (Vellanki, 2016).......... 6
Figure 3: The six building blocks and their interaction (Organization, 2007)................................. 7
Figure 4: Table comparing the 4 healthcare models (Reid, We're Number 37!, 2009) ................. 9
Figure 5: Distribution of Funding Sources for Personal Health Care (Kervasdoué, 2000) ........... 12
4. 3
1. Introduction
Healthcare, also sometimes referred to as health care system or health system, is the
organization of people, institutions, and resources that deliver health care and related services
to meet the needs of people.
The World Health Organization defines health systems as follows:
A health system consists of all organizations, people and actions whose primary intent is
to promote, restore or maintain health. This includes efforts to influence determinants of health
as well as more direct health-improving activities. A health system is therefore more than the
pyramid of publicly owned facilities that deliver personal health services. It includes, for
example, a mother caring for a sick child at home; private providers; behavior change
programmes; vector-control campaigns; health insurance organizations; occupational health
and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging
the ministry of education to promote female education, a well-known determinant of better
health. (Eva A Rehfuess, 2009)
As human population continues to make great strides in healthcare, humans are living
longer than ever and are able to reproduce at a much faster rate than ever in history. This
brings us to the cusp of issues that face us today- providing adequate healthcare to all sections
of the population, and by corollary, should the rich pay for the healthcare of the poor.
These aspects make healthcare management a very complex issue involving many
stakeholders and it is imperative to understand the workings of different models and see where
value can be maximized and identify trends and larger industry movement in the healthcare
5. 4
field. This report aims to give a brief overview of the various players in the healthcare industry,
compare and contrast the system and hence challenges in the French and US healthcare.
2. Basic Overview of Healthcare
As a consumer of healthcare, one is exposed to a very limited aspect of the entire industry.
There are many moving pieces that make the entire system work
Figure 1: Pictorial depiction of various aspects of Healthcare (Cognizant, 2014)
Components of Healthcare Industry
In very broad strokes, there are 3 main components of the healthcare industry:
1. Provider: defined as a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor,
clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social
worker who is authorized to practice by the State and performing within the scope of
their practice as defined by State law, or a Christian Science practitioner. A health care
6. 5
provider also is any provider from whom the University or the employee's group health
plan will accept medical certification to substantiate a claim for benefits.
E.g.: Doctors, Hospitals, Clinicians, etc.
2. Payer: defined as entities other than the patient that finance or reimburse the cost of
health services. In most cases, this term refers to insurance carriers, other third-party
payers, or health plan sponsors
E.g.: Insurance companies, Employers
3. Patient (Consumer): defined as any actual or potential recipient of health care, such as a
patient in a hospital, a client in a community mental health center, or a member of a
prepaid health maintenance organization. (Vellanki, 2016)
E.g.: You and me, sections of populations
There one other major stakeholder in this equation
4. Government: the role of government varies from country to country and is an evolving
entity. Some of the possible roles that exist around the world are: Minimal Role, Safety
Regulator, Purchaser and Partial Provider of Health Care Services, Marketplace
Regulator, Primary or Sole Provider of Health Care, or some combinations of these roles
There are certainly other important constituents, such as pharmacy benefits managers
(PBMs) or benefits managers, but these four groups are the tent poles that define the
healthcare industry.
7. 6
Figure 2: Inter-relation between the components of Healthcare industry (Vellanki, 2016)
Building Blocks of a Health System
In order to compare and try to improve a system, one must first analyze the current
systems. WHO has laid out 6 guiding principles, called the building blocks, on the basis of whose
performance, various systems are compared. A health system consists of all organizations,
people and actions whose primary interest is to promote, restore or maintain health.
1. Good health services are those which deliver effective, safe, quality personal and non-
personal health interventions to those who need them, when and where needed, with
minimum waste of resources.
2. A well-performing health workforce is one which works in ways that are responsive, fair
and efficient to achieve the best health outcomes possible, given available resources
and circumstances. I.e. There are sufficient numbers and mix of staff, fairly distributed;
they are competent, responsive and productive.
8. 7
3. A well-functioning health information system is one that ensures the production,
analysis, dissemination and use of reliable and timely information on health
determinants, health systems performance and health status.
4. A well-functioning health system ensures equitable access to essential medical products,
vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and
their scientifically sound and cost-effective use.
5. A good health financing system raises adequate funds for health, in ways that ensure
people can use needed services, and are protected from financial catastrophe or
impoverishment associated with having to pay for them.
6. Leadership and governance involves ensuring strategic policy frameworks exist and are
combined with effective oversight, coalition-building, the provision of appropriate
regulations and incentives, attention to system-design, and accountability. (WPRO,
2016)
Figure 3: The six building blocks and their interaction (Organization, 2007)
9. 8
3. Healthcare Models
All over the world, there are four main healthcare models
The Beveridge Model
Health care is provided and financed by the government through tax payments, just like
the police force or the public library. Most doctors are government employees. Even the few
private doctors get paid by the government.
You never get a doctor 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.
The Bismarck Model
It uses an insurance system — the insurers are called “sickness funds” — usually
financed jointly by employers and employees through payroll deduction. health insurance plans
have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be
private.
The National Health Insurance Model
This system 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
10. 9
The Out-of-Pocket Model
Most of the nations on the planet are too poor and too disorganized to provide any kind
of mass medical care. The basic rule in such countries is that the rich get medical care; the poor
stay sick or die. (Reid, We’re Number 37!, 2009)
The Beveridge
Model
The Bismarck
Model
The National
Health Insurance
Model
The Out-of-
Pocket Model
single payer national
health service
non-profit “sickness
funds” or a “social
insurance model”
single payer national
health insurance
“market driven”
health care
UK, Spain, New
Zealand, Hong Kong,
Cuba
Germany, France,
Belgium, the
Netherlands, Japan,
Switzerland, Latin
America.
Canada, Taiwan,
South Korea
Sweden, in some
aspects. Rural
regions of Africa,
India, China and
South America
Figure 4: Table comparing the 4 healthcare models (Reid, We're Number 37!, 2009)
4. The French System
The French system boasts of features such as: There are very short wait times. There is
significant assurance of quality care while keeping the costs relatively low, and simplified
administration. There is also very tight regulation of insurance, often sold on a non-profit basis,
not a necessary condition though. All claims paid. Period. There is no concept of challenging a
claim. And perhaps the most significant factor, there is no exclusion for pre-existing conditions,
11. 10
a change that Obamacare tried to bring. The state fixes prices for most procedures but there is
encouragement of private hospitals and physician practices.
On the flip side, because of embracing a socialized system, there are greater costs and much
less efficiency. While physicians benefit from a free education, and have virtually no
administrative overhead costs, and (very significantly) are rarely sued, they also earn less than
their American counterparts.
5. The US System
The US has elements of all 4 basic healthcare models in the very fragmented national health
care apparatus. When it comes to treating veterans, the US is Britain or Cuba. For Americans
over the age of 65 on Medicare, US is Canada. For working Americans who get insurance on the
job, Germany.
For the 15 percent of the population who have no health insurance, the United States is
Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill
out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the
emergency ward at the public hospital.
The United States is unlike every other country because it maintains so many separate
systems for separate classes of people. All the other countries have settled on one model for
everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.
12. 11
6. France v/s USA
France USA
Disability-Adjusted Life Expectancy 3 24
Distribution of Health in the Population 12 32
Fairness in Health Care Financing 6 54
Responsiveness 16 1
Health Care Spending per capita 4 1
Overall Rank 1 37
The WHO rankings, however, do not mean that the French system is unequivocally superior
to the American. In fact, both systems could profit from an understanding of the other’s
strengths.
France and US have the same basic principle of medical care- the idea of Private Health Care.
Other similar principals are:
- Patient choice of physician
- direct access to specialists
- patient payment of fees (with subsequent reimbursement)
- physicians’ freedom of diagnosis and prescription
- fee for service
- ultrahigh levels of medical confidentiality
13. 12
Distribution of Funding Sources for Personal Health Care
Figure 5: Distribution of Funding Sources for Personal Health Care (Kervasdoué, 2000)
U.S. private insurers account for nearly three times the share of total expenditures than
their French counterparts do (35% versus 12%) and Americans pay more out of their own
pockets than the French (17% versus 13%) for personal health care spending. The federal and
state governments in the U.S. play a substantial role in health care, mostly through Medicare
and Medicaid (43%). But even this large fraction is dwarfed by France’s quasi-public insurance
funds, which account for almost three-quarters of total health care spending.
14. 13
Access constitutes the most striking difference between the American and French health
care systems. 16% of the U.S. population lacks health insurance altogether and many possess
insurance with such high deductibles that they forego medical needs for financial reasons. A
large number of uninsured puts additional strains on a health care system. In order to
recuperate the costs of uncompensated care, providers raise the price of services for the
insured, thereby creating a vicious cycle, since higher insurance premiums ultimately lead to
more uninsured patients. (Dutton)
15. 14
7. Conclusion
Despite significant differences in the nature of the systems and the over-arching aim of the
medical field, the US and French systems share several common principles. The two nations
must leverage these similarities and foster an atmosphere of sharing of ideas and policy.
French insurance companies and government officials should seek the latest innovation and
technological advancement in medicine and the business of medicine. They must also focus on
efficient provider management tools. Holding down doctor’s fees, an aspect of the system that
France is so dependent on, is not a sustainable model.
The US senate can be inspired by the successes of France- reduction of administrative and
operational costs, particularly of insurance and France’s achievement of universal coverage for
its citizens.
Incredible breakthroughs in science and especially pharmacology, have ushered a new
era of human life expectancy and lifestyle in the world, especially in the western world.
However, the advancements will not translate into ground reality without effective measures to
contain the ever-increasing medical costs.
16. 15
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