This document discusses and compares various global healthcare systems models including the Beveridge model, Bismarck model, national health insurance model, and out-of-pocket model. It provides details on the characteristics of each model such as universal coverage, funding mechanisms, provider types, and coverage levels. Examples are given of countries that follow each model including the UK (Beveridge), Germany (Bismarck), Canada (national health insurance), and less developed nations (out-of-pocket). The document concludes that no single system is perfect and that many countries utilize hybrid approaches.

1. Global Healthcare Systems
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2. Learning Objectives
• By end of the lecture you will be able to:
– Know about universal healthcare & its various
models
– Understand Beveridge Model
– Understand Bismarck Model
– Understand the Canadian Model
– Know about Out of pocket systems
– Compare & Evaluate various healthcare models
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3. Health system
• A good health system delivers quality services to all
people, when and where they need them
• The exact configuration of services varies from country
to country, but in all cases requires;
– robust financing mechanism;
– well-trained and adequately paid workforce;
– reliable information on which to base decisions and
policies;
– well maintained facilities, logistics to deliver quality
medicines and technologies’ providing equitable access to
people-centred care
– an efficient governance mechanism.
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4. Universal Health Coverage
• Universal health coverage (UHC) means that
all people have access to the health services
they need, when and where they need them,
without financial hardship
• It is organized around providing a specified
package of benefits to all members of a
society with the end goal of providing;
– improved access to health services
(responsiveness)
– and improved health outcomes
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5. ..Universal healthcare
• Universal health coverage is the single most
powerful concept that public health has to
offer. (Margret Chan Former DG WHO)
• Most countries implement universal health
care through legislation, regulation, and
taxation
• The bulk of costs come from a combination of
compulsory insurance and tax revenues
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6. Health Insurance
• “Coverage that provides for the payments of
benefits as a result of sickness or injury”
• Health insurance is an insurance that covers
the whole or a part of the risk of a person
incurring medical expenses
• Health Insurance can be Compulsory or
Voluntary
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7. Four Basic models
• These systems tend to follow general patterns
however researchers identify Four basic
Health Care Models:-
• The Beveridge Model
• The Bismarck Model
• The National Health Insurance Model
• The Out-of-Pocket Model
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8. William Beveridge
• Born in Rangpur, BD
• Director London School of
Economics
• A social reformer
• Chairman of the
committee which
presented report to the
Parliament on Social
Insurance and Allied
Services in 1942, paving
way for NHS
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9. The Beveridge Model
• The founders of the Beveridge system of
health care, Lord William Beveridge and Nye
Bevan
• National Health Service (NHS) was, among the
world’s first tax-funded healthcare systems to
be completely free at the point of use
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10. Characteristics
• In this system, health care is provided and financed by the
government through tax payments, just like the police force or
the public library; healthcare being a public service
• Single payer system – Government being the single payer,
removes all the competition in the market to minimize
expenses and standardize benefits
• Majority hospitals are owned by the government; while most
of the GPs are not public employees but rather independent
contractors to the NHS, similarly at many places NHS buys
inpatient and other services from private providers
• 100% population is insured
• Nearly half (47%) of the NHS budget is spent on acute and
emergency care 11

11. characteristics
• The 3 founding principles of this system are:
– Meeting the needs of everyone
– Free at the point of delivery of care (now co
pay for prescriptions, dentures & dentistry)
– Based on urgency of care and not on the
patient’s ability to pay
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12. Bismarck Model
• Named after the German
statesman who dominated
European affairs from the
1860s to his dismissal in
1890
• He unified numerous
German states into a
powerful German Empire
under Prussian leadership,
then created a "balance of
power" that preserved
peace in Europe from 1871
until 1914
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13. Germany
• It uses Statutory Health Insurance; heavily
regulated, non-profit insurance called Sickness
Funds, financed jointly by employers and
employees through payroll deduction
• Unlike the insurance industry, Bismarck-type
health insurance plans have to cover everybody,
and they don't make a profit
• Health expenditure is around 11.5% of GDP
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14. • The law requires everyone living in Germany to be insured for
at least hospital and out-patient medical treatment
• 9O% Germans are insured with this compulsory health
insurance which includes complete coverage of most health
needs, the rest have private health insurance
• The compulsory health insurance is based on the monthly
fees which are not calculated by age and health status but by
personal income
• The compulsory payroll deduction is 15.5% of the pre-tax
income divided into 8.2% for the employee and 7.3% for the
employer
• The Federal Government provides Unemployment benefits to
those who are not working, however they receive 60% of the
benefits
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15. Characteristics
• Only middle- and upper-class can opt out of
compulsory insurance for Private insurance
• The Sickness funds provide healthcare both at Public
and Private hospitals
• The compulsory insurance holders have a choice to
move from one provider to another
• The compulsory health insurance covers inpatient in
the nearest hospital and OPD with a registered doctors
and basic dental care
• Practitioners are mostly private, they can open a
practice or join an existing practice. They may also
choose to work as salaried doctors at hospitals.
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16. 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 all citizens fund through a tax
• Essentially, the national health insurance
model is universal insurance that doesn't
make a profit
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17. ….characteristics
• Publicly funded universal health coverage (UHC)
systems, called Medicare
• All citizens and permanent residents receive necessary
hospital and physician services free at the point of use
• Role of government: The provincial governments have
primary responsibility for financing, organizing, and
delivering health services and supervising providers.
• Financing. Canada has a predominantly publicly
financed health system with approximately 70% of
health expenditures financed through the general tax
revenues of the federal, provincial and territorial (FPT)
governments
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18. Out of Pocket Model
• The out-of-pocket model is the most common model in less-
developed areas and countries where there aren’t enough
financial resources to create a medical system like the three
models
• In this model, patients must pay for their procedures out of
pocket.
• It is a market driven healthcare, put simply, anybody requiring
medical treatment must pay for it on the spot
• There is no universal insurance system and income taxes are not
raised to provide access to healthcare for all citizens
• This method is most common in developing countries
– WHO & World bank report 2017
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19. Which system?
• No system of health care is perfect
• There will always be a trade offs
– Longer waits
– Higher taxes or compulsory insurance
– Providers – private vs public
– Rich can always purchase the treatment of their choice
– Poor have to rely on social net works or only seek medical
care when they can come up with enough money to pay
for
• Many countries have a mixture of these basic models
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20. India
• Population of 1.2 Billion, fast growing
economy with some astounding progress in
Health sector
• India provides universal free outpatient and
inpatient care at government clinics and
hospitals
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21. Mixed System
• Nearly 100 million people in India live on less than 1.90
USD per day
• 44 percent of all children are malnourished
• Public Health spending varies between 1.1 to 1.6 per cent
of GDP while private spending is 3%
• Private healthcare providers currently treat 78 per cent of
outpatients and 60 per cent inpatients
• About 300 million are covered by Health Insurance, out of
which 243 Million are covered by various forms of Govt
sponsored schemes
• The new PM-JAY program is financed by taxes and enables
free secondary and tertiary care at private hospitals for the
500 Million poor
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22. The Health system
• For the 10 percent of the population who
have no health insurance, the Americans are
Cambodians or rural Indians, with access to a
doctor available only if they are able to pay
the bill out-of-pocket at the time of treatment
or if they are sick enough to be admitted to
the emergency ward at the public hospital
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23. • Deductibles: The amount you pay for covered
health care services before your insurance
plan starts to pay.
– With a $2,000 deductible, for example, you pay
the first $2,000 of covered services yourself.
• Coinsurance refers to a percentage of the
Medicare-approved cost of your health care
services that you're expected to pay after
you've paid your plan deductibles.
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24. Thank You
Questions & Comments
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25. References
• Healthcare models across the globe. A comparative analysis. Sibu Saha, MD, MBA
Professor of Surgery University of Kentucky
• Which country has the world's best healthcare system? The Guardian; 9 Feb 2016
• www.commonwealthfund.org/international-health-policy-
center/countries/canada
• Universal Health Coverage, WHO
• Canada Health system review Gregory P. Marchildon Sara Allin
• www.verawholehealth.com/blog/global-healthcare-4-major-national-models-and-
how-they-work
• Health Systems, Management, and Organization in Global Health. David Zakus,
Onil Bhattacharyya, and Xiaolin Wei
• An excerpt from T.R. Reid's book The Healing of America: A Global Quest for Better,
Cheaper, and Fairer Health Care, published by Penguin Press
• India's Healthcare System – overview and Quality Improvements
• Wikipedia
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