Healthcare facilities in a country are directly linked to the development and progress of its people since only an efficient healthcare system can ensure a healthy workforce for the nation and lead to national development. This makes it an important sector for the government to frame policies. Its significance has also led to unique healthcare systems in different countries.
Based on the role of the government, there are generally four majorly classified healthcare systems in the world.
In this system, the government is the primary supplier and provider of healthcare. Healthcare in such countries is like ‘public good’ distributed by the government promising equity and efficiency. In U.K. the healthcare service is free to be used, but everyone is taxed a certain amount in return, while in Cuba it is available at cheap and subsidised rates. This system has worked wonders for a third-world country like Cuba since they have achieved numbers at par with U.K., a far superior and a developed nation.
Statistics – An infant mortality rate of 4.2 per thousand births in Cuba compared with a rate of 3.5 in the UK in 2015, the life expectancy of 77 years for men and 81 years for women in contrast to U.K.’s 79 years for men and 83 years for women. A doctor to patient ratio of 1:150, which surpasses many developed nations, U.K.’s ratio from the latest World Bank data is 1.4 doctors per 500 patients.
This model of healthcare which is originated in Germany requires a compulsory social insurance like a ‘sickness fund’ created through monetary contribution by both employee and employer. These funds can be bought from different private companies. And while it is regulated by the government, the latter does not pay for anyone, instead ensures the financial ability of the citizens to pay for their own healthcare. The most important point here is that ‘sickness funds’ are just like insurance funds. The non-profit generating, fixed priced procedure and compulsory insurance cover the salient features of the Bismarck model.
National Health Insurance Scheme
Countries like Canada, Taiwan, and South Korea use this scheme, wherein instead of multiple, private players setting up funds, the government sets up just one universal healthcare insurance. Every citizen compulsorily contributes to this national fund, and costs of healthcare service received by individuals are drawn from this fund. In the former, while someone who isn’t a part of the funds isn’t benefitted, while in the later when the non-contributors can reap the advantage.
In this system, the government plays no role at all except for being ‘one of the many’ providers of healthcare. Either due to lack of funds or infrastructure or due to instability, the governments are unable to provide for a uniform stable system. This is the situation in most of the third-world and developing (India) countries. These countries make up the rest of the 200 countries, excluding the 40 which have some sort of national healthcare systems and are also developed.
The healthcare statistics of such countries aren’t bright either. Examples include India, The Democratic Republic of Congo, Sri Lanka, Pakistan, Cambodia.
India specifically has general tax revenue financing with limited role of private insurance (substitutive coverage for the upper-class urban population) and some government-funded health insurance schemes for the poor and vulnerable. According to WHO India’s life expectancy for men is of 67 years and of 70 years for women. The value for Mortality rate, under-5 (per 1,000 live births) in India was 43.00 as of 2016. A lot of government initiatives and policies like Intensified Mission Indradhanush for immunisation and Rashtiya Swasthya Bima Yojana assuring social security and healthcare are implemented to ensure better health care services to the rural poor.
Which of these is the most effective/affordable? And why?
The most basic observation from this classification is that the healthcare of the countries in which governments have clearly defined roles is easily available to the general public, is affordable and the quality of the services is regulated. This means that Governments should at least play some kind of role, preferably larger in the control of a country’s healthcare to better the health of its citizens.
As to what it can be, policy makers and advisers of the Governments can always chart up health care plan suiting the country’s needs by borrowing certain positive elements from all the healthcare systems mentioned above. Exactly like the U.S. has. In the U.S. it’s the Beveridge system for the veterans, Bismarck for the working class and National Health Insurance for the elderly, while people who can’t afford an insurance due to unstable income have to pay for their medical care. While this kind of system is not uniform and is a little complicated, it still tries to ensure fairness.
However, the most efficient healthcare comes when integrated with social care, understanding payer’s capacity and still providing them with their basic necessity. Given proper coverage for the elderly through a standardised process and a simplified system for best of the entire population can essentially fulfill all the requirements of an intelligent healthcare system.