A health care system is an organization to deliver health care. An organization (or organisation &mdash see spelling differences) is a social arrangement which pursues collective goals which controls its own performance and Health care is the prevention treatment and management of illness and the preservation of mental health through the services offered by the medical, Nursing There are many variations of health care systems around the world.

Contents 1 Goals of Health Care Systems 2 Financing 3 Health care systems models 4 Examples in different countries 4.1 Australia 4.2 Canada 4.3 Cuba 4.4 Finland 4.5 France 4.6 Germany 4.7 Ghana 4.8 Hong Kong 4.9 India 4.10 Ireland 4.11 Israel 4.12 Italy 4.13 Japan 4.14 Netherlands 4.15 New Zealand 4.16 South Africa 4.17 Sweden 4.18 Taiwan 4.19 United Kingdom 4.20 United States 5 See also 6 References 7 Books 8 External links

Goals of Health Care Systems

The goals for health systems, according to the World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.

Financing

There are generally five primary methods of funding health care systems:^[1][2]

1. direct or out-of-pocket payments,
2. general taxation,
3. social health insurance,
4. voluntary or private health insurance, and
5. donations or community health insurance. Out-of-pocket expenses are direct outlays of cash which are not reimbursed Social health insurance (SHI is a method for Financing Health care costs through a (governnment-mandated social insurance program based on the collection The term health insurance is generally used to describe a form of Insurance that pays for medical expenses A donation is a gift given typically to a cause or/and for charitable purposes

One recent study published by the National Bureau of Economic Research found no systematic relationship between the cost efficiency of health care systems and the type of financing used. The National Bureau of Economic Research (NBER is a private nonprofit research organization dedicated to studying the science and empirics of Economics, especially the The author concluded "that almost all financing choices are compatible with efficiency in the delivery of health care. "^[3]

Health care has the following characteristics:

• The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—some treatments cost more than a typical family's life savings. Human rights refers to the "basic Rights and freedoms to which all humans are entitled
• Health care professionals are bound by law and their oaths of service to provide lifesaving treatment. A health care provider or health professional is an organization or person who delivers proper Health care in a systematic way professionally to any individual in
• Asymmetric information
• High risk level

There is a debate whether these characteristics necessitate public ownership or increased government regulation of the health care industry. In Economics and Contract theory, information asymmetry deals with the study of decisions in transactions where one party has more or better Information

Health care systems models

• Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid). This article refers to Medicare, a United States health insurance program Medicaid is the United States health program for eligible individuals and families with low incomes and resources

• The other major models are public insurance systems:
  • Social security health care model, where workers and their families are insured by the State. Social security primarily refers to a Social insurance program providing social protection or protection against socially recognized conditions including poverty old
  • Publicly funded health care model, where the residents of the country are insured by the State. Publicly funded health care, or publicly funded healthcare, is Health care that is financed entirely or in majority part by citizens' tax payments instead of through This article deals with personal residence in a given place For other uses see Residency (disambiguation and Resident.
  • Social health insurance, where the whole population or most of the population is a member of a sickness insurance company. Social health insurance (SHI is a method for Financing Health care costs through a (governnment-mandated social insurance program based on the collection

In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. Two-tier health care is a form of national Health care system. The scale, extent, and funding of these private systems is very variable.

For the application of health care systems in schools see school health services. School Health Services are services from medical teaching and other professionals applied in or out of school to improve the health and well-being of children and in some cases whole families

Examples in different countries

Australia

In Australia the current system, known as Medicare, was instituted in 1984. For a topic outline on this subject see List of basic Australia topics. This article describes the Australian universal health scheme Medicare Year 1984 ( MCMLXXXIV) was a Leap year starting on Sunday (link displays the 1984 Gregorian calendar) It coexists with a private health system. Medicare is funded partly by a 1. 5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. The Pharmaceutical Benefits Scheme or PBS is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia

Canada

Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page This article refers to medicare a name for Canada's publicly-funded health insurance system for hospital and physician services Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors, (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Single-payer health care is an American term describing the payment for doctors hospitals and other providers of health care from a single fund Most all family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate - even to patients who are not covered by the publicly funded system - unless he opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private. Dentistry' is the "evaluation diagnosis prevention and/or treatment (nonsurgical surgical or related procedures of diseases disorders and/or conditions of the oral cavity Optometry is a health care profession concerned with Eyes and related structures as well as vision, Visual systems and vision information

Cuba

Healthcare in Cuba consists of a government-coordinated system that guarantees universal coverage and consumes a lower proportion of the nation's GDP (7. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the Health care of its citizens 3%) than some highly privatised systems (e. g. USA: 10. 2%) (UNDP 2006: Table 6). The system does charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated freely in Cuban hospitals. Cuba attracts patients mostly from Latin America and Europe by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10)

Finland

In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and by others 4%. Finland, officially the Republic of Finland ( is a Nordic country situated in the Fennoscandian region of northern Europe. Patient access charges are subject to annual caps. For example GP visits are (11€ per visit with annual 33€ cap), hospital outpatient treatment (22€ per visit), a hospital stay, including food, medical care and medicines (26€ per 24 hours, or 12€ if in a psychiatric hospital). After a patient has spent 590€ per year on public medical services, all treatment and medications thereafter are free. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA. Finland also has a much smaller private medical sector which accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. Dentistry' is the "evaluation diagnosis prevention and/or treatment (nonsurgical surgical or related procedures of diseases disorders and/or conditions of the oral cavity However, private sector health care is mainly in the primary care sector. There are virtually no private hospitals, the main hospitals being either municipally owned (funded from local taxes) or run by the teaching universities (funded jointly by the municipalities and the national government).

France

In France, most doctors remain in private practice; there are both private and public hospitals. This article is about the country For a topic outline on this subject see List of basic France topics. In Economics, the private sector is that part of the economy which is both run for private Profit and is not controlled by the State. Public is of or pertaining to the people relating to or affecting a nation state or community opposed to private; as the public treasury a road or lake A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. A non-profit organization ( abbreviated "NPO" also "not-for-profit" is a legally constituted Organization whose objective is to support or engage Mutual insurance is a type of Insurance where those protected by the insurance (policyholders also have certain "ownership" rights in the organization. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the "universal health coverage". Lionel Jospin (born 12 July 1937 is a French politician who served as Prime Minister of France, during the third " cohabitation " In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer. Insurance, in Law and Economics, is a form of Risk management primarily used to hedge against the Risk of a contingent loss

France is largely known for providing one of the leading health care systems in the world. In the film Sicko, which portrays the flaws with American health care and emphasizes the success of Canadian, British, Cuban, and French health care, the successes of the French system are noted. Sicko is a 2007 Documentary film by filmmaker Michael Moore that investigates the American health care system, focusing on its Health care, including dentistry and other forms of medicine are completely free at the point of need. In fact, the French hospitals pay their patients back the amount they paid to get to the hospital, such as the cost of fuel or taxis. If a woman has a newborn baby, a government nurse will come to the house daily to do the laundry and cook - for free. Also for a minimal price, the nurse will clean the whole house, so that the mother simply has more time to bond with her baby.

Germany

Germany has a universal multi-payer system with two main types of health insurance: "State health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and "Private" (Private Krankenversicherung). Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. ^[4][5][6] Compulsory insurance applies to those below a set income level is provided through private non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. Provider compensation rates are negotiated in complex corporatist social bargaining among specified autonomously organized interest groups (e. Historically corporatism (corporativismo refers to a political or Economic system in which power is held by civic assemblies that represent Economic g. physicians' associations) at the level of federal states (Länder). Germany (Deutschland is a Federal Republic consisting of sixteen States, known in German as Länder (singular The sickness funds are mandated to provide a wide range of coverages and cannot refuse membership or otherwise discriminate on an actuarial basis. Small numbers of persons are covered by tax-funded government employee insurance or social welfare insurance. Persons with incomes above the prescribed compulsory insurance level may opt into the sickness fund system, which a majority do, or purchase private insurance. Private supplementary insurance to the sickness funds of various sorts is available.

Ghana

In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. The Republic of Ghana is a country in West Africa. It borders Côte d'Ivoire (Ivory Coast to the west Burkina Faso to the north Togo to the Some for profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care.

Hong Kong

In Hong Kong, both private and public clinics are common, while public hospitals account for the majority of the market. Hong Kong ( officially the Hong Kong Special Administrative Region, is a territory located on China 's south coast on the Pearl River Delta, and borders

India

In India, the hospitals are run by government, charitable trusts and by private organizations. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country The government hospitals in rural areas are called the primary health centre(PHC)s. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Unani systems are in practice throughout the country. Ayurveda ( Devanāgarī: आयुर्वॆद the 'science of life' is a system of Traditional medicine native to India, and practiced in other Unani IPA: (in Arabic, Hindi, Persian, Pashtu, Urdu, etc means " Greek " PHC's are non existent in most places, due to poor pay and scarcity of resources. Patients generally prefer private health clinics. These days some of the major corporate hospitals are attracting patients from neibouring countries like Pakistan, Middle East and some european countries by providing quality treatment at low cost. Pakistan () officially the Islamic Republic of Pakistan, is a country located in South Asia, Southwest Asia, Middle East and The Middle East is a Subcontinent with no clear boundaries often used as a synonym to Near East, in opposition to Far East.

Ireland

For Ireland, see Health care in Ireland. Ireland ( Irish: Éire, ˈeːrʲə is a country in north-western Europe. "Health care in Ireland" redirects here For health care in Northern Ireland see Health and Care NI The public Health care system

Israel

In Israel, the publicly funded medical system is universal and compulsory. For a topic outline on this subject see List of basic Israel topics. Payment for the services are shared by labor unions and the government. A trade union or labour union is an organization of workers who have banded together to achieve common goals in key areas such as wages hours and working conditions forming

Italy

In Italy the public system has the unique feature of paying its doctors a fee per capita per year, a salary system, that does not reward repeat visits, testing, and referrals. Italy (Italia officially the Italian Republic, (Repubblica Italiana is located on the Italian Peninsula in Southern Europe, and on the two largest ^[7] Italy has one of the highest doctor per capita ratio's at 3. 9 doctors per 1,000 patients. ^[8]

Japan

In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without referral. For a topic outline on this subject see List of basic Japan topics. Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the rest of 30% (upper limits apply). Insurance system is funded by tax(40%), insurance premium from each household (35%) and from employer (25%). Monthly insurance fee is 0-50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the copayments or non-covered cost, and usually makes fixed payment per days in hospital or per surgery performed, rather than per actual expenditure.

Netherlands

Health care in the Netherlands, has since January 2006 been provided by a system of compulsory insurance backed by a risk equalization program so that the insured are not penalized for their age or health status. Health care in The Netherlands is financed by obligatory Health insurance and all insurance companies are obliged to provide a package with a defined set of insured treatments Risk equalization is a way of equalizing the risk profiles of insurance members in order to reduce premium differences to some predetermined extent This is meant to encourage competition between healthcare providers and insurers. Children under 18 are insured by the government and special assistance is available to those with limited incomes.

New Zealand

In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. New Zealand is an Island country in the south-western Pacific Ocean comprising two main landmasses (the North Island and the South Island District Health Boards (DHBs in New Zealand are organisations established by the New Zealand Public Health and Disability Act 2000 responsible for ensuring the provision of Under the current Labour coalition governments, 1999 - present, there are plans to make primary health care available free of charge. The New Zealand Labour Party is a New Zealand political party Primary health care, often abbreviated as PHC ( Primary Health Centre) and PC is "essential health care based on practical scientifically sound At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card.

South Africa

In South Africa, parallel private and public systems exist. The Republic of South Africa (also known by other official names) is a country located at the southern tip of the continent of Africa The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. This division in subtantial ways perpetuates racial inequalities created in the pre-apartheid segregation era and apartheid era of the 20th century.

Sweden

In Sweden, the publicly funded medical system is comprehensive and compulsory. "Sverige" redirects here For other uses see Sweden (disambiguation and Sverige (disambiguation. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden. A County Council, or Landsting, is an elected assembly of a County in Sweden.

Taiwan

The current health care system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. Taiwan ( Taiwanese: Tâi-oân/Tāi-oân (historically 大灣/台員/大員/台圓/大圓/台窩灣 is an Island in East Asia. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care dollars. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. ^[9] NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.

United Kingdom

In the United Kingdom there are three separate but co-operating National Health Services of Scotland, Northern Ireland and England & Wales. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The National Health Service is the name commonly used to refer to the four Publicly-funded healthcare systems of the United Kingdom collectively or individually (although History The Roman occupation of Britain was the first period in which the area of present-day England and Wales was administered as a single unit (with the exception They provide free physician and hospital services to all permanent residents of the United Kingdom. Hospital staff are salaried employees according to nationally agreed contracts, whilst primary care is largely provided by independent practices, who are paid, again via a nationally agreed contract, according to the number of patients registered with them and the range of additional services offered. Around 86% of prescriptions are provided free. Prescriptions are provided free to people who satisfy certain criteria such as low income or permanent disabilities. People that pay for prescriptions do not pay the full cost. For example, in 2007, most people will pay a flat fee of £6. The Pound Sterling ( symbol £; ISO code: GBP) subdivided into 100 pence (singular penny) is the Currency 85 (€10. Please update other articles as well to avoid contradiction within Wikipedia e 16, US$13. The United States dollar ( sign: $; code: USD) is the unit of Currency of the United States; it has also been 76) for a single drug prescription regardless of the cost (average cost to the health service was £11. 10--about €16. 70, US$20. 40--in 2002). (Charges have been abolished as a matter of government policy in Wales. ) Funding comes from general taxation. Private health services are also available. Private health care continues parallel to the NHS, paid for largely by private insurance. Accident and emergency (U. S. emergency room) services are only available on the NHS.

United States

The United States is alone among developed nations with the absence of a universal health care system. Health care in the United States is provided by many separate legal entities Universal health care is health care coverage which is extended to all eligible residents of a governmental region ^[10][11] Healthcare in the U. S. does, however, have significant publicly funded components. Medicare covers the elderly and disabled with a historical work record, Medicaid is available for some, but not all of the poor,^[12] and the State Children's Health Insurance Program covers children of low-income families. This article refers to Medicare, a United States health insurance program Medicaid is the United States health program for eligible individuals and families with low incomes and resources The State Children’s Health Insurance Program (SCHIP is a United States federal government program that gives funds to states in order to provide Health insurance The Veterans Health Administration directly provides health care to U. Veterans Health Administration (VHA is the component of the United States Department of Veterans Affairs (VA that implements the medical assistance program of the VA through S. military veterans through a nationwide network of government hospitals; while active duty service members, retired service members and their dependents are eligible for benefits through TRICARE. TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services ( CHAMPUS) is the Managed care component of the United Together, these tax-financed programs cover about 27% of the population^[13] and make the government the largest health insurer in the nation. In 2001, only the governments of Iceland and Norway spent more per capita on healthcare. Iceland, officially the Republic of Iceland ( ( Ísland or Lýðveldið Ísland ( Norway ( Norwegian: Norge ( Bokmål) or Noreg ( Nynorsk) officially the Kingdom of Norway, is a Constitutional ^[14] This care is generally provided by privately owned hospitals or physicians in private practice, but public hospitals are common in older cities. Just under 60% of Americans receive health insurance through an employer, although this number is declining and the employee's expected contribution to these plans varies widely and is increasing as costs escalate. A significant and growing number of people cannot obtain health insurance through their employer or are unable to afford individual coverage. Currently, the U. S. Census Bureau estimates that 16% of the U. S. population, or 47 million people, are uninsured. More than a third of the uninsured are in households earning $50,000 or more per year. ^[13] Some uninsured are people under age 30 who don't believe they need to purchase health care; others are eligible for Medicaid but have not applied. The cost of medicines is frequently not covered by insurance, and it is common for U. S. citizens to travel to Canada and Mexico for drug purchases at prices far below those in their home areas. A few states have taken serious steps toward universal health care coverage, most notably Minnesota and Massachusetts, with a recent example being the Massachusetts 2006 Health Reform Statute. Minnesota ( Native Americans demonstrated the name to early settlers The Commonwealth of Massachusetts ( is a state located in the New England region of the northeastern United States. Massachusetts health care reform law was enacted in 2006 It requires nearly every resident of Massachusetts to obtain health insurance coverage ^[15] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy. In the United States, charity care (also known as uncompensated care is Health care provided for free or at reduced prices to low income patients New Jersey ( is a state in the Mid-Atlantic and Northeastern regions of the United States. It is typical for most forms of general liability insurance sold in the U. S. , such as home, automobile, or business insurance to have a significant premium allocation for medical damages. The U. S. legal system, which has the highest number of attorneys per capita of any country in the world, is available to assist in proving liability and collecting the money for medical bills from such insurances.

The Indian Health Service provides public funded care for indigenous peoples. Indian Health Service (IHS is an Operating Division (OPDIV within the U Native Americans in the United States are the indigenous peoples from the regions of North America now encompassed by the continental United States Employer benefit based health insurance remains quite common with larger employers. Workers injured on the job are covered by government mandated worker compensation insurance and wage replacement benefits. These benefits vary considerably state-to-state and employers bear the cost of this insurance. Businesses with considerable risks, such as bridge-building, mining, or meat processing face far higher worker compensation insurance costs than do office based clerical businesses. Although the Medical colleges and research institutes form a backbone structure for providing healthcare, the private hospitals and nursing homes also are becoming an increasingly necessary part of the healthcare structure in the country.

See also

1993 Clinton health care plan Aurora Health Care Consumer driven health care Health Health care in Australia Healthcare in India Health care in Nigeria Health care in the United Kingdom Health care in the United States Health insurance

Hospital network National health insurance Primary care Primary health care Publicly-funded health care Single-payer health care Social insurance Socialized medicine SSM Health Care Two-tier health care Universal health care

References

Books

• Robin Means, Sally Richards and Randall Smith (2008) Community Care: Policy and Practice, Palgrave MacMillan. ISBN 0230006744

External links

• Health Decisions Comprehensive health insurance resource; with news, a learning center, and original content.
• HRC/Eldis Health Systems Resource Guide provides access to free online research and other resources on health systems in developing countries
• The Not So Short Introduction to Health Care in US (305 KiB PDF file) by Nainil Chheda. A kibibyte (a contraction of ki lo bi nary byte) is a unit of Information or Computer storage, established by the International
• Tishchenko P. D. The Individual and Healthcare in the New Russia

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