Classify healthcare systems – Prof. Monika Steffen EUHEALTH

Summary

The transcript discusses various healthcare systems, categorizing them into three main types: National Health Service (NHS), social health insurance, and commercial health insurance. It explains the differences in governance, funding, regulation, and service delivery for each system. The NHS, found in countries like the UK, is government-run and funded through taxes, providing free or low-cost services. Social health insurance, like in Germany, involves compulsory contributions based on income, while commercial systems, such as in Switzerland, are profit-driven and depend on premiums based on individual health risks. The distinctions highlight the varying roles of government and private actors in healthcare systems.

Takeaways

• 😀 National Health Service (NHS) systems are government-managed, where the state oversees regulation, funding, and service distribution, such as in the UK.
• 😀 Social health insurance systems, inspired by Bismarck's model, rely on income-based contributions, with coverage being compulsory for all citizens.
• 😀 Commercial health insurance systems are profit-driven, where individuals pay premiums based on their health risk, often excluding those with pre-existing conditions.
• 😀 NHS systems are funded through taxes, making the service free or low-cost for users, with minimal out-of-pocket expenses.
• 😀 Social health insurance systems involve contributions that are typically split between employers and employees, and coverage is mandatory for all workers.
• 😀 Commercial health insurance systems target healthy individuals who can pay higher premiums, while avoiding high-risk individuals like the elderly or chronically ill.
• 😀 In social health insurance systems, the government sets contribution rates and regulates the functioning of the health insurers, ensuring fair coverage for all.
• 😀 In NHS systems, medical care is free for citizens, with only small out-of-pocket payments for some services, such as prescriptions in some countries.
• 😀 Commercial health insurance systems are generally more expensive to manage due to the need for marketing, customer acquisition, and profit-making goals.
• 😀 Social health insurance systems are typically more affordable to manage than commercial systems, with lower administrative costs and a focus on equitable coverage.

Q & A

What is the main focus of system analysis when discussing health care systems?

The main focus is on who is regulating and governing the system, and what the rules are, rather than distinguishing between public and private systems. It involves understanding the roles of government, regulations, and various actors in governance like employers and trade unions.

What is the role of government in National Health Service (NHS) systems?

In NHS systems, the government manages all three functions: regulation, distribution, and funding of health services. It organizes the system entirely through public administration, using tax revenues to fund health services.

How does a social health insurance system differ from a commercial health insurance system?

A social health insurance system aims to cover the population using the contributions it receives, regardless of health status. A commercial health insurance system, on the other hand, focuses on making profits by insuring healthier individuals who pay higher premiums and avoiding high-risk groups like the elderly or chronically ill.

What are the key distinctions between National Health Service (NHS) and social health insurance systems?

In NHS systems, the government organizes and finances health services directly through taxation, and the service is usually free at the point of use. In contrast, social health insurance systems involve multiple actors (public and private) managing insurance coverage, with contributions based on income, and health coverage is often mandatory.

What role does the government play in social health insurance systems?

The government sets the major rules for the system, such as the contribution rates that health insurances can charge, and ensures that health insurance coverage is compulsory for everyone, making sure that individuals cannot avoid health insurance and that premiums are proportionate to income.

How does a commercial health insurance system work in terms of coverage and premiums?

In commercial health insurance systems, clients voluntarily choose their coverage, and premiums are based on individual risk factors, such as age, health history, and lifestyle. Insurers aim to minimize risks and maximize profits by avoiding high-risk individuals, leading to higher premiums for those with health issues.

Why are administrative costs higher in social health insurance systems compared to national health service systems?

Social health insurance systems are often more expensive to manage due to the involvement of multiple insurers, each with its own staff, buildings, rules, and operations. In contrast, NHS systems are more centralized, which leads to lower administrative costs, as the government organizes everything within a single framework.

What is the impact of compulsory health insurance on commercial health insurance systems, such as in Switzerland?

In Switzerland, the government made health insurance compulsory for all residents, which led to the regulation of private insurers. The government ensures that everyone has insurance, but private companies manage the actual policies. This creates a mixed system where private insurers must follow government regulations.

How does the financing of social health insurance systems work?

Social health insurance systems are financed through compulsory contributions based on income. Both employers and employees contribute, usually in equal parts, to fund the system. These contributions are automatically deducted from employees' wages.

How do private health insurance companies assess risk and determine premiums?

Private health insurance companies assess risk by considering factors such as an individual's age, health status, pre-existing conditions, lifestyle, occupation, and family medical history. Based on these factors, insurers set premiums that reflect the perceived risk of needing extensive medical care.