Different Designs of Health Care Systems

Updated: Jun 16, 2021

The design of a national health care system involves providing medical services of quality, monitoring and controlling medical costs, and providing different ilk of health insurance options to citizens of a country.(1) This can be accomplished via political, economic and medical decisions.(1) With American Exceptionalism playing a role in our fragmented health care system(1), many Americans find displeasure in the idea that we might learn valuable and/or beneficial policy ideas from other countries, such as nationalizing the concept “socialized medicine”.(1)

The U.S. chooses to believe that the private sector can run a medical system for less money than government can whilst all the evidence from around the world suggests the opposite.(1) The United States is the only industrialized nation that does not provide universal healthcare to its citizens and our reasoning behind this is: “We cannot afford it”.(3) When we look at health care systems internationally, there are different countries with health systems that, if we were to adapt as a health care system in the U.S, would provide better qualitative care, national health coverage and lower medical costs. This comparative health policy analysiswill point to three better organized healthcare models overseas, that if adopted in the US, would insure coverage for everyone and cut costs in our disadvantageous healthcare system.(1)

In the fragmented American health care system, different “providers” send medical bills to various payers.(1) (There is a health system exclusively for Americans over 65, another health system for military personnel, a different system for people with end-stage renal failure, a health system for Americans under 16 living in poor families and a different one for people over 26 in poor families).1In the US, approximately 80 percent of adults receive health insurance through their jobs, with the employer paying part of the premium and the worker paying the rest of the premium out-of-pocket.(1) Economists agree that this is about the most expensive possible way to pay for a nation’s health care.(1) The monthly premium goes towards paying the worker’s medical bills(2), but the insurance firms take out large portion of the premium fee to cover marketing costs, administrative costs and profit.(1) US health care expenditures are far higher than those of other developed countries, our results are no better.(3) Many American health insurance plans limit a patient’s choices of doctors, hospitals and treatments in order to save money with their “provider networks” and “approved formularies”.(1) Millions of Americans who are underinsured or uninsured are at risk of financial ruin due to medical and pharmaceutical bills, in addition to the risk of disability or death due to disease.(1)

Although it still left 23 million Americans uninsured(1), after the Health Care Reform Act, the number of Americans who didn’t have health insurance decreased to 23 million people from 45 million.(1)There is nothing wrong with paying more for better performance, but Americans buy inferior treatment than people in other countries.(1)Another disadvantage of the American health care system, are our outrageously expensive administrative costs, which is the highest of any health care payer in the world.(1)According to the Securities and Exchange Commission, 20 cents of every dollar people pay in premiums for health insurance goes to healthcare administrative costs instead of health care.(1) Half of health care spending is used to treat just 5% of the population.(5)

Great Britain, the Beveridge Model:

In Great Britain, the Beveridge Model is adapted by the National Health Service (1) to provide and pay for medical services.(1) In Britain, the providers of healthcare are private, but the payer is a government-ran insurance plan that collects monthly premiums via tax payments and pays medical bills.(1) Unlike the US, the British have a single-payer healthcare system that covers everybody, consolidating the National Health Service’s market power to negotiate for lower prices (drug prescriptions, medical fees, etc).(1) The National Health Service’s controls medical costs by limiting the medical services they will pay for by delaying treatment to patients.(1)Although the National Health Service let patients go wherever they want (in the country) for health coverage(1), British patients have the option to use private insurance to get an earlier appointment with a specialist and avoid the long waiting times of the NHS.(1)

All health care professionals in Great Britain are employed by the government and work in government-owned health facilities, even private doctors collect their fees from the government.(1) Since the government is the sole payer of the National Health Service, the government essentially controls what doctors can or can’t do, along with what doctors can or cannot charge.(1) In American health care, doctors, nurses, hospitals and drug companies have higher incomes than their international colleagues overseas, however; American patients pay higher pharmaceutical and medical fees them.(1) When Americans fill a prescription, the price is usually twice as much that a British medical patient would pay, for the same prescription pills made in the same factory.(1)

France, the Bismark Model:

The healthcare system in France, the National Health Ministry, is steered by the Bismark model.(1) French workers don’t have a choice of which health insurance plan they get stuck with for the rest of their lives, which is usually based on their job or their geographic area.(1) The National Health Ministry essentially dictates what providers can charge for most types of medical treatment and what price will be paid for each prescription. (1) In France, every health facility is an “in -network” facility, so patients can seek medical attention in any French health facility they want.(1)The National Health Ministry pays the medical fees that it’s patients rack upalong with making it free for patients to call an ambulance to take them to the doctor.(1) In the rare instance that a patient does have to pay for a medical bill, that patient would (fully or partly) be reimbursed in a matter of days by the National Health Ministry.(1)

Unlike American patients, French patients are informed upfront about the medical fees they’ll be charged along with how much money they will receive in reimbursement.(1) To limit the cost of burden on any individual, the National Health Ministry caps patients to pay up to $100 a day, no matter how much treatment a patient utilizes.(1)The National Health Ministry spends $3,165 per capita each year, which isn’t that bad when compared to the US who spends more than $7,000 per capita and yet still leaves millions of Americans uninsured.(1)This could be due to the fact that Americans are the top consumers of prescription drugs. (4)

Similar to the US, France’s National Health Ministry does have a “Gatekeeper” system, where patients need to get a referral from a general practitioner before they can go and schedule any appointment with any specialist.(1) The waiting times in France are usually about the same as those for people with insurance in the United States with the exception of pediatricians, who are in short supply in France.(1) Although French hospitals generally have more doctors and nurses per patient than an American hospital, they have 67 percent fewer administrative personnel to organize and maintain medical paperwork.(1)

In France, the ‘Carte Vitale’digitizes a patient’s medical records.(1) Everybody in France over age fifteen has this card, a child’s medical records are maintained on his mother’s card.(1) This could explain why France spends under 10 percent of its GDP on healthcare (with coverage for everyone in France). (1) The United States spends about 17 percent of GDP on healthcare, still leaving people without coverage.(1) A study by Bank of America in 2006 concluded that if we Americans could get health care spending down to the French level, we would save about $600 billion annually. (1) In the U.S. system, saving $600 billion annually could mean meeting the basic health care needs of all uninsured Americans. (1)

Canada, the National Health Insurance Model:

Canada’s healthcare system is guided by the National Health Insurance model, offering universal healthcare coverage and medical treatment to its citizens.(1) Canadians pays for their healthcare via payroll taxes and corporate income taxes.(1) In Canada, the National Health Insurance would rather keep patients waiting for medical services, as long as everybody waits at the same time for equal medical treatment.(1) In the U.S, both the Medicare system and health care system for the Dialysis Community are organized very similarly to this single-payer, government-ran NHI system.(1) One of the advantages of the National Health Insurance model is, asides from being a single-payer system that covers all Canadians, is its impactful market power to negotiate for lower prices.(1) In Canada, the National Health Insurance controls costs by restraining the medical services they will pay or delaying treatments for patients.(1) The U.S. Government Accountability Office concluded that if the country could get the administrative costs of its medical system down to the Canadian level, which is about 3 percent, 1the money saved would be enough to pay for health care for all the Americans who are uninsured.(1)

  1. (n.d.). (2010). The healing of America: A global quest for better.

  2. Fernandez, B.. (n.d.). Health

  3. Berwick, D. M., & al, E.. (n.d.). The Triple, 759.

  4. (n.d.). Retrieved from https://meps.ahrq.gov/data_files/publications/st359/stat359.shtml

  5. L, S. D.. (n.d.). Delivering Health Care in,

#healthinsurance #healthpolicy #publichealth #healthcaresystem #healthcaresystems

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