Health care system

Health Care System Overview

  • Date: 2024. 10. 07

  • Lecturer: Klára Boruzs

  • Concept:

    • Health systems are complex and involve multiple interacting components.

    • Defined by WHO as activities aimed at promoting or restoring health.

    • Encompasses both public and private systems, as well as allopathic and informal systems.

Functions of Health Systems

  • Deliver health care services

  • Implement interventions to maintain/improve health

  • Protect households from financial impacts of illness and health care costs

  • Economic functions within society

  • Establish societal norms and values

  • Roemer (1993) identifies four components for service delivery:

    1. Financing

    2. Production of inputs (personnel, facilities, pharmaceuticals)

    3. Organization and structure

    4. Management

Health System Categorization by OECD

  • Features:

    1. Prime Funding Source:

      • Voluntary

      • Compulsory

    2. Service Provision Models:

      • Direct ownership (government entities)

      • Contractual arrangements

      • Private providers (out-of-pocket payments)

    3. Payment Structures:

      • Prospective

      • Retrospective

Parts of Health Care Systems I

  • Public health services

  • Preventive services and health screenings

  • Emergency care

  • Patient transport and care

Parts of Health Care Systems II

  • Hospice care

  • Medical equipment supply

  • Pharmaceutical retail

  • Psychotherapy and clinical psychology

  • Rehabilitation services

  • Natural medicine

Health Sector vs. Health Care System

  • Concept of Health Care Sector:

    • Broader than health care system

    • Includes pharmaceutical production, medical equipment manufacture, and insurance benefits related to health conditions.

Basic Conflict in Hungary

  • Non-market healthcare system integrated into a market-driven health sector.

  • Healthcare expenditure impacts income generation within the health care sector.

Basic Models in Health Care

Beveridge Model

  • Origin: Beveridge Report, 1948

  • Funded through taxes; no insurance principle

  • State-owned infrastructure for inpatient care

  • Examples: National Health Services (NHS) in the UK

Tax-based Health Care Systems

  1. Centralized control systems (e.g., England, Ireland)

  2. Decentralized control systems (e.g., Nordic countries, Greece, Portugal, Spain)

Bismarck Model

  • Introduced in Germany, 1883

  • Health expenditure financed primarily through wage-based insurance, shared between workers (2/3) and employers (1/3).

  • Solidarity principle with mandatory membership.

Contribution-based Health Care Systems

  • Cost Reimbursement Model: Patient upfront costs reimbursed by insurer (e.g., France, Belgium)

  • Multi-payer Systems: Co-payments involved (e.g., Germany, Netherlands)

Healthcare in Russia

  • Funded by the Federal Compulsory Medical Insurance Fund and regulated by the Ministry of Health

  • Free healthcare guaranteed by the Russian Constitution since 1996

  • Composed of state and private systems post-Soviet Union.

Private Insurance-Based Systems

  • Individual risk-based, self-care principle, not mandatory

  • Users face high-quality care variability and access issues (USA context)

Global Variations in Health Care Funding Systems

  • Distinct health service buyers (single, multiple, non-profit/profit-driven)

  • Mixed systems are prevalent, although foundational models exist.

New Challenges in Health Care Systems

  • Challenges:

    • Economic problems, migration, climate change, human resource shortages, aging populations

Economic Crisis Effects on Health Care (2005-2013)

  • Increased expenditure during and after crisis in specific OECD countries

  • Public funding as a primary source; negligible growth post-crisis

  • Retail spending declined significantly.

Migration and Public Health

  • Migration-related health risks highlighted; need for standard definitions and responses across Europe.

Climate Change and Health

  • Impact on respiratory, infectious, gastrointestinal, cardiovascular diseases, and mental health due to environmental changes.

Human Resources Crisis in Health Care

  • Anticipated shortages of healthcare professionals in Europe, detailing potential impacts on care delivery.

Sustainability of Health Care Systems

  • Balancing rising costs with economic growth; conflict between rapid technological advances and financial restraints.

Conclusion

  • Ongoing health care challenges require dynamic responses, balancing efficiency, equity, and quality of services.