Comparing health systems

Week 19

Comparative Sociology

Outline

• Macro factors in healthcare systems

• Health systems Ideal Types

• Pressures on health systems

Health care systems

• Health care systems deliver services to individuals

• They are also a major part of the economy

• They are subject to political battles– Between political parties– Between individuals and service

providers/political parties

Shaping Health Care Systems

Political factors include:

Extent of State Involvement Local/national divides How decisions over structure/entitlement are

made? Values underpinning decisions Form of organisations Power of professional groups

Shaping Health Care Systems

Social and Economic factors include

Historical Background

Social structures Social divisions, Employment patterns etc

Strength of national economy Budgets may go up or down Impact of the global economy

Shaping Health Care Systems

• Cultural factors

– How much a society values its health care system.

– Different nations value• Different levels of provision • Different types of provision• May respond differently to the same issues

Shaping Health Care Systems

• Demand for health care influenced by factors such as

– Population size

– Geographical distribution

– Age and Gender

– Normative expectations (eg number of children in a family)

Shaping Health Care Systems

• Epidemiological trends– In Developed Countries

• Reduction of rates of infectious disease

• Growing levels of chronic illness

• Emphasis (or not) on preventive services.

• Discuss with the people sitting next to you the factors you think might be most important.

Ideal Types of health care systems

• Considers the degree of government involvement

• Free market system vs. government monopoly

• But most countries have a mixture so models only used for macro comparisons

Models based on State Funding

• Three main types of health care systems emerge along this continuum

1. Private insurance (US)

2. Social insurance (Germany)

3. National Health Service. (New Zealand)

Private insurance

• Minimum state involvement in direct provision or funding– May have safety net provisions for vulnerable

groups

• Individuals/Employers purchase insurance • Health care providers are privately owned• Health Care best provided by free market• Outcome:

– Extreme inequality and high cost (people and money)

Social insurance

• Compulsory health insurance (non-profit)

• Funded by State, employer and individual contributions

• Service provision often private with some public ownership

• Outcome: Unequal financial burdens

National Health Service

• Universal coverage funded out of general taxation

• Equitable system assumptions of collective responsibility for health care

• Services owned or controlled by the State

• Outcome: – May fail to met demand

• Which system to you think is best? Why?

• Discuss this with you neighbour

Pressures on health care

• Recently, health care has become more of an issue in all developed nations.

• Reasons for this include:– Threats to national economy, health care

costs lots of money– Ageing population – older people more likely

to need care– Growth in medical technologies

• New drugs/inventions cost more money

Ideological Reform

• Ideological belief that competition in the ‘free market’ drives up standards and lowers costs

• Applied to healthcare in previously non-market models

• Wave of privatization and quasi-market based reforms

Health Care Reforms

• In National Health Care Systems – splitting purchasing and providing functions (PCT,

Hospitals)– making providers compete for the receipt of (largely

public) funds through negotiated contracts

• In countries where there was already a market structure:– Encouraging ‘smart’ purchasing – Opening more contracts to competition

Health Care Reforms

• But market strategies and competition did more always increase efficiency– Aims of New Zealand, Netherlands and US not

achieved– Germany reduce some costs, but distorted incentives– Sweden gains in efficiency and diversity of provisions,

but unclear if sustainable– UK some gains but competitive market impacted on

stability of providers and growing inequality in access

Health Care Reforms

• Managed Competition was seen as being able to fix a range of problems• But feasibility was not properly assessed

• Financing health care mainly through private insurance is neither equitable nor efficient

• Pressure on health care will

continue to grow

Summary

• Health Care Systems are developed in relation to multiple factors

• Their design and management are subject to political ideologies

• Health care pressures can lead to changes in priority – but market-based reforms are not necessarily the answer