CGriggs HCA347 case study comparing health care systems

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Western Kentucky University *

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347

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Finance

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Feb 20, 2024

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HCA 347 – Fall 2023 Case Study: Comparing Health Care Systems Around the World Crystal Griggs Fall Case Study Professor Dolby September 29, 2023 This case study is an examination of the US Healthcare System compared to other systems worldwide. 1. First, identify/name at least four major healthcare system models and give examples of countries that use each of these different healthcare systems. There are four major healthcare models: the Beveridge model, the Bismarck model, national health insurance, and the out-of-pocket model. Although each model has its unique characteristics, most countries do not strictly follow a single model. Instead, they create their own combinations that incorporate features of several models. The Beveridge Model The Beveridge model, developed in 1948 by Sir William Beveridge in the UK, is a centralized national health service where the government acts as the single-payer. Funded by taxes, this model provides free access to everyone without any out-of-pocket fees. However, criticisms include the potential risk of overutilization and funding during a state of national emergency. This model is used by several countries, including the UK, Spain, New Zealand, Cuba, Hong Kong, and the Veterans Health Administration in the US. The Bismarck Model Otto von Bismarck created the Bismarck model of healthcare as a decentralized alternative to existing healthcare systems. Employers and employees jointly fund the healthcare system by contributing to "sickness funds" through payroll deductions. Private insurance plans are available to all employed individuals, irrespective of pre-existing conditions, and providers and hospitals are usually private, while insurers are public. The government regulates pricing, but the model does not provide universal health coverage. Countries such as Germany, Belgium, Japan, Switzerland, the Netherlands, France, and some US employer-based healthcare plans use the Bismarck model. The National Health Insurance Model The national health insurance model is a blend of the Beveridge and Bismarck models. In this model, the government acts as the single payer for medical procedures while providers are private. It's a universal insurance system that doesn't make a profit or deny claims. Since there's no need for marketing, profit, or complex policies, it's cheaper and simpler to navigate. However, long waiting lists and delays are a major issue. It's used by Canada, Taiwan, and South Korea and is similar to Medicare in the US.

HCA 347 – Fall 2023 Case Study: Comparing Health Care Systems Around the World The Out-of-pocket Model This is the most common model in less-developed areas and countries where there are not enough financial resources to create a medical system, such as the three models above. Patients must pay for their procedures out of pocket. The reality is that the wealthy receive professional medical care and the poor do not unless they can somehow come up with enough money to pay for it. However, healthcare is still driven by income. It is used by rural areas in India, China, Africa, and South America, and uninsured or underinsured populations in the U.S. 2. Select the model (or is similar to) that is used in your assigned country and give a detailed explanation of that system and how it works in your country. The Czech healthcare system started with the Bismarck model, took a Soviet Semashko detour during communism, and ultimately circled back to its Bismarck roots after the Velvet Revolution in 1989. It is characterized by mandatory health insurance and is also known as being universal. All residents, including foreigners with long-term or permanent residences, were required to have health insurance. Mandatory Health Insurance ensures that every resident in the Czech Republic, whether employed or self-employed, contributes to the public health insurance system. They typically share contributions between the employees and employers. Non-Czech Republic residents must obtain private health insurance to accompany their visa or residency applications. A visa or residency may not be approved without the documentation of health insurance. Some private health insurance policies are available for people who want to travel or are long-term residents. Universal Coverage ensures that all residents have access to the essential medical services. Services include general and specialized healthcare, hospital care, prescription drugs, and preventive care. Citizens and permanent residents are automatically enrolled in the public health insurance system. However, dental care is outside its coverage. A combination of state-owned and private providers provides health care services. This mix allows for the choice of healthcare providers, who are typically preferred for routine and non- emergency care. The government regulates and monitors healthcare quality and standards. Patients in the Czech Republic are free to choose primary care physicians and specialists. They can also change their primary care providers and insurance companies annually. As a patient, you have the right to choose your healthcare provider and contribute to the public health insurance. The Czech healthcare system is built on principles of reputation, unity, and equal opportunities. Every resident has access to healthcare with contributions based on income. Regardless of their contributions, everyone is entitled to the same range of basic services.

HCA 347 – Fall 2023 Case Study: Comparing Health Care Systems Around the World 3. Explain how the system of your assigned country differs from the US healthcare system. The most important difference is that the Czech Republic has universal healthcare coverage, whereas the United States does not. In the US, healthcare coverage is often tied to employment, and millions of Americans are uninsured or underinsured. This means that it is funded through a combination of private health insurance, government-funded programs, such as Medicare and Medicaid, and out-of-pocket payments. The Czech Republic primarily finances its health care system through mandatory health insurance contributions and government funding. The US has a more complex and split healthcare system with various private insurance providers, leading to administrative complications and high costs. The Czech Republic's system is more straightforward because of mandatory universal health insurance. Comparing these two countries, the United States has a more intricate and fragmented healthcare system with a more significant role in the private sector, while the Czech Republic has a more integrated and government-regulated system following the Bismarck model. This comparison can be extended to analyze healthcare outcomes, costs, and accessibility in both nations. 4. What are the strengths and weaknesses of these two healthcare systems (your assigned country and the USA)? Czech Republic Strengths: Universal Coverage: Ensures access to healthcare for all residents. Government Regulation: Helps control costs and maintains quality. Freedom of Choice: Patients can select healthcare providers. Weaknesses: Funding Challenges: Ensuring sustainable funding as the population ages is a concern. Waiting Times: Some patients may experience waiting times for specialized treatment. United States Strengths: Innovation: The US is a leader in medical research and innovation. Choice: Patients have a wide choice of healthcare providers and treatment. Weaknesses: Lack of Universal Coverage: Millions of Americans lack essential health care coverage. High Costs: Healthcare in the US is expensive, and the system faces challenges related to cost control and affordability.

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