Healthcare delivery system models are popular and are influenced by several factors, including financing, efficiency levels, and the significance of healthcare. These models have the objective of enabling citizens to receive quality healthcare services at a cost-effective rate. There are four major healthcare delivery models: the national health insurance model, the Bismarck model, the Beveridge, and out of the pocket model (Baier et al. 6). The goal of the research paper is to compare and contrast healthcare delivery models in three countries: Germany, the United Kingdom, and the U.S.
United Kingdom: Beveridge Model- Single-Payer National Health Service
The United Kingdom uses the Beveridge model of healthcare delivery, a centralized model that was developed by Sir William Beveridge. This type of model is where the government’s healthcare system is fully funded and made available to all citizens. The major tenant of the model is that health is a human gift, and thus universal coverage is guaranteed to have access to the same healthcare. In this model, the government acts as the single-payer, thus removing the competition in the marketplace (Pickup et al. 20). This model allows for standardized benefits and lowers costs.
The United Kingdom provides its permanent citizens access to public healthcare. The taxes fund the healthcare delivery model, and therefore there are no fees incurred by the patient, thus eliminating cost-sharing. About 20% of the income tax goes towards funding healthcare in the country (Pickup et al. 15). Every tax-paying citizen is entitled to access healthcare with no medical bills incurred. However, citizens can opt for private health insurance coverage at a fee. This private healthcare sector is funded by the employer or can be paid by the customer directly to companies such as BUPA, Aviva, and AXA.
Before 1946, healthcare in the country was only made available to wealthy citizens. The country currently has a system referred to as the National Health Service (NHS), which is government-sponsored and comprises publicly funded healthcare systems. One of the goals of NHS is to provide quality and safe healthcare services. In the United Kingdom, the national health service controls what providers can do and the amount they charge (Kirchhof 202). It provides comprehensive covers to hospital covers, preventive care, mental health care, and pharmaceuticals. These services are free at the point of use, and 90 percent of the population has access to Medicare.
The NHS provides special services to patients with terminal illnesses and home nursing. The country has a department of health that is responsible for improving the health wellbeing of its citizens. It has the Primary Care Trusts established to improve the local population’s health and work collaboratively with partner agencies to develop community care services. The Strategic Health Authorities have the responsibility of ensuring the national health priorities are integrated.
However, the system has a potential drawback of overutilization, resulting in increasing operation costs and taxation. Since there is no limitation, the free access nature of the model allows patients to demand healthcare services that are wasteful and unnecessary. To curb this problem, the models should have a mode of regulation to manage the waste of resources.
The inability of the government to fund healthcare during national crises or emergencies is another major challenge. The government response in cases of war could lead to funding insufficiencies and financial burdens due to the large influx of patients (Baier et al. 10). This puts the healthcare system at risk as revenue decreases, and spending is increasing. Other common challenges noted are long waiting lines and decreasing quality of healthcare provided in hospitals.
Germany- Social Health Insurance Model
Germany’s healthcare system is based on mutual aid societies that were founded in the early nineteenth century. The country uses the Bismarck model, a decentralized healthcare delivery model created by Otto von Bismarck. Within this model, citizens are responsible for funding their healthcare insurance through payroll deductions (Kirchhof 203). Bismarck expanded the insurance funds to cover all workers from low-paying occupations. This concept is based on the system of social insurance, which is embodied in the principle of solidarity. The concept holds the belief that Germany’s government is obliged to provide its citizens with social benefits, including Medicare, unemployment insurance, maternity benefits, pensions, and social benefits.
The country has a sickness fund which is a not-for-profit insurance company and is a privately owned entity. Therefore, the insurance fund is self-regulating and independent of outside forces. It pays the provider of the insurance directly and negotiates individually with the hospitals. Hospitals are paid on a prospective basis, whereas ambulatory services are paid on a fee per service given. This fund is required by the law to give its citizens a set of benefits. These benefits include hospital care, nursing home care, physician ambulatory care, and health spa visits. With this model, patient cost-sharing is minimal. The sickness fund also provides additional cash payments to unemployed citizens when ill.
All the population in sixteen provinces in Germany has access to Medicare, and every individual in the country is required to have health insurance. Almost 80% of Germany’s population has joined the sickness fund, whereas the 20% is covered by private insurance (Cruppé and Max). The healthcare premiums for employees are calculated based on their income rather than the number of dependents or age. These premiums are collected through payroll tax reduction, which is approximated to be 13% of the worker’s gross salary (Busse et al. 890). Those from low-income families are required to register for sickness health funds. Citizens who earn above-average have the option of choosing private health insurance covers.
There are several competing insurance providers in this country, unlike in other countries where there is only a single insurer. In this model, the insurers are public, and the hospitals and providers are private. The insurance plans are non-profit-based and cover every employed citizen regardless of pre-existing conditions. The coverage does not provide universal coverage, and employment is a requirement for health insurance. The benefits are therefore allocated to those on payroll or those who contribute financially.
In Germany, decentralization is becoming extensive with the intervention of government increasing exponentially. The central arm of government passes legislative policies and jurisdiction. The state government has a role in hospital planning, supervision, and managing sickness funds. The local governments have a role in managing public health programs and local level hospitals. Germany has reformed policies and healthcare acts to bring changes to cost-sharing. These reforms cut expenditures on capital used, thus reducing costs. For example, the health care Reform Act of 1993 changed the hospital payment system from per-service payment to DRG’s prospective basis (Kirchhof 202). Through this reform, it has managed costs and established a direct trade-off between price and volume. This is to means when utilization is higher, fees incurred are lowered proportionally.
However, the system has flaws in several areas, including public service and psychiatric service departments. One primary drawback of the model being used is it cannot provide insurance coverage to those who cannot afford the contribution or those unemployed (Busse et al. 882). These problems bring the system into question and whether it is best positioned to cover the long-term medical costs of its citizens. A major challenge being its over-reliance on third-party payment. The consumers have no incentive to limit their demand, and the medical providers also heighten their supply.
The country’s inability to use resources efficiently discourages the provision of personal service and promotes invasive care provision. This causes an increased number of Germans visiting doctors, and there are increased rates of hospital admissions. Furthermore, German healthcare is facing a rapidly aging population, resulting in demographic changes. A larger percentage of Germany’s population consists of older people, which puts additional pressure on the country’s healthcare (Baier et al. 8). This challenge puts a lot of pressure on healthcare programs of the system.
United States Healthcare Model
The United States has no single mode of healthcare insurance delivery. The U.S. neither has a uniform healthcare system nor universal healthcare coverage. The United States uses the national health insurance model, which blends both aspects of the U.K. and German system. It can best be described as a hybrid of the U.K. and Germany’s system. The U.S. government plays a crucial role as the single-payer for medical care (Emanuel 983-985). This model therefore used in the U.S., is universal because every citizen pays into it; however, the government does not make any profit.
The United States healthcare delivery model is heavily dependent on private insurance plans and direct fees system. In the country, insurance covers are purchased from either private healthcare insurers or provided to certain groups by the government. Private insurers drive a larger portion of this model, and the coverage is purchased from nonprofit insurers or profit-making companies. A larger percentage of the coverage is employment-based plans purchased through an employer (Selladurai and Roshini 10). The employers sponsor insurance plans voluntarily, and their premiums fund the firm’s health insurance. The company contracts a third party to administer the health insurance program.
A larger percentage of the insurance is private and accounts for two-thirds of the population, while public insurance plans cover the rest. These public insurance plans include Medicaid, Medicare, and veterans’ programs. Medicare covers people over the age of sixty-five and individuals with disabilities (Papanicolas et al. 1024). Medicare covers marginalized groups, including low-income families. This balance between public and private insurers gives hospitals more freedom without complicating insurance policies.
This model has heavily been criticized for contributing to high rates of the uninsured population, increased costs of healthcare, and health issues. A major reason is that the healthcare sector is based on for-profit insurance systems. The United States faces issues such as the shortage of primary caregivers, and when the issues are not addressed, they lower the effectiveness and quality of healthcare. Despite the disadvantages of the model, the lack of a universal healthcare system has improved the health outcomes of the country. The health sector in the country performs exceptionally in metrics such as life expectancy, infant mortality, and treatment of diabetes, which has proven to be a challenge in other countries with universal coverage.
Comparison Between Germany’s Healthcare Delivery System to United States’ System
Germany has a universal multi-player system where people from certain levels of income have access to health insurance. In contrast, Americans continue to struggle with limited access to care because of their complex and the disorganized healthcare system. While Germany relies on a mandated healthcare coverage which is a requirement of the law, the Americans do not have this privilege. In the United States, many citizens and insurers reach agreements without the government’s intervention (Selladurai and Roshini 16). A major difference is that there is competition in healthcare provided with the German decentralized healthcare delivery model. The United States models limits competition since the government is the sole payer to healthcare providers rather than operating a national health service.
In Germany, the coverage is made available through several small and independent plans. The similarity with that of the U.S. is that the providers are private and independent of the government’s intervention (Papanicolas et al. 1024). A major similarity lies when negotiating prices and aggregating demand. Both countries use a Diagnosis Related Groups (DRGs) mechanism that controls costs for the payments of covers. This is a system that standardizes payment to hospitals, thus encouraging cost containment initiatives.
Comparison Between United Kingdom Healthcare Delivery System to United States’ System
The Beveridge model of healthcare delivery used in the U.K. is similar to that used in the U.S. since both systems cover most of the procedures regardless of the level of income of the recipients. The models may reduce the costs incurred since the government process all claims. When the two models of healthcare delivery systems are compared, they have world-class health outcomes, although the U.S. system is expensive.
The models in the U.K. cover most of its population, whereas, in the U.S., public health insurance covers 28% of its population. The model used in the U.S. has age and income requirements for Medicare and Medicaid, whereas that of the U.K. is made available to all citizens regardless of age and income. The healthcare system of the U.S. has the highest spending when the two models are compared. According to a study, 15% of U.S. GDP is spent on healthcare, whereas the U.K. only spends 8% on healthcare (Selladurai and Roshini 18). The U.S. model uses private-based financing, whereas the U.K. uses a national tax-based system that has a lower cost compared to that of the U.S. (Gordon et al. 600). The U.S. healthcare system has the largest private sector compared to the U.K., which has the largest public sector. A large population believes that the U.S. system needs to be rebuilt completely and express dissatisfaction. In contrast, a higher proportion of the U.K. population believes their model is the best. This suggests that clinical excellence in the United States does not match that in the United Kingdom.
Comparison Between United Kingdom Healthcare Delivery System to Germany’s Healthcare System
The U.K. healthcare system is fully funded by general taxation, while the German health system receives its funding from social insurance contributions and cost-sharing. In the United Kingdom, the NHS provides care for all permanent residents, whereas in Germany, healthcare is provided to those employed (Pickup et al. 12). A significant difference is that in Germany, ambulatory care is provided by self-sponsored doctors, whereas, in the United Kingdom, it is provided by salaried doctors in outpatient units. When it comes to governance, the government has a huge role in regulating healthcare in the United Kingdom compared to Germany. Germany spends a higher amount of revenue on healthcare as compared to the United Kingdom.
A similarity in both countries is that self-employed doctors provide primary care. Both healthcare systems offer their population health coverage(Gordon et al. 596). The two countries face the similar challenge of an aging population, which puts increased demand on healthcare services. Although Germany offers a social insurance fund, it does not guarantee high levels of customer satisfaction.
The three countries have unique modes of healthcare delivery, and when the systems are compared, it could be said that they are complete opposites. The three systems differ with respect to financing, governance mechanisms, and service provision arrangements. Ensuring that citizens have access to public healthcare and insurance coverage has proven to be a significant issue in many countries. Different countries experience various challenges, and each attempt to design a model that is more likely to lessen their problems. A healthcare delivery model in Germany is not likely to be transferrable to another country like the U.K., depending on the priorities and concerns of the country. Therefore, countries need to consider various models before implementing one that is fair and just to its citizens.
From the research, it can be noted that the systems in Germany and U.K. are more effective than the U.S. model. This is attributed to lower costs, more services are provided to its citizens, and lack of financial barriers. Americans have inadequate insurance protection, and the costs are extremely high. The performance of the three models provided by the countries shows contrasting opinions. The survey shows that many Germans and British are satisfied by their models compared to many Americans.
Works Cited
Baier, Natalie, et al. “Emergency and Urgent Care Systems in Australia, Denmark, England, France, Germany and the Netherlands – Analyzing Organization, Payment and Reforms.” Health Policy, vol. 123, no. 1, 2019, pp. 1–10. Crossref, doi: 10.1016/j.healthpol.2018.11.001.
Busse, Reinhard, et al. “Statutory Health Insurance in Germany: A Health System Shaped by 135 Years of Solidarity, Self-Governance, and Competition.” The Lancet, vol. 390, no. 10097, 2017, pp. 882–97. Crossref, doi:10.1016/s0140-6736(17)31280-1.
Cruppé, Werner de, and Max Geraedts. “Hospital Choice in Germany from the Patient’s Perspective: A Cross-Sectional Study.” BMC Health Services Research, vol. 17, no. 1, 2017. Crossref, doi:10.1186/s12913-017-2712-3.
Emanuel, Ezekiel J. “The Real Cost of the U.S. Health Care System.” AMA, vol. 319, no. 10, 2018, p. 983. Crossref, doi:10.1001/jama.2018.1151.
Gordon, Adam L., et al. “Optimal Healthcare Delivery to Care Homes in the U.K.: A Realist Evaluation of What Supports Effective Working to Improve Healthcare Outcomes.” Age and Ageing, vol. 47, no. 4, 2018, pp. 595–603. Crossref, doi:10.1093/ageing/afx195.
Kirchhof, Paulus. “A tale of two countries: how decentralized organization and long-term investment- build resilient healthcare systems.” European Heart Journal-Quality of Care and Clinical Outcomes, vol.6, no.3, 2020, pp. 201-203. doi: 10.1093/ehjqcco/qcaa036.
Papanicolas, Irene, et al. “Health Care Spending in the United States and Other High-Income Countries.” JAMA, vol. 319, no. 10, 2018, p. 1024. Crossref, doi:10.1001/jama.2018.1150.
Pickup, Laura, et al. “The Dichotomy of the Application of a Systems Approach in U.K. Healthcare the Challenges and Priorities for Implementation.” Ergonomics, vol. 61, no. 1, 2017, pp. 15–25. Crossref, doi:10.1080/00140139.2017.1306632.
Selladurai, Raj, and Roshini Selladurai, Raj, and Roshini Isabell Selladurai. “An Enhanced Healthcare Delivery System Model for the U.S.: Adaptation of Principles from the Best.” Evaluating Challenges and Opportunities for Healthcare Reform. IGI Global, 2020, pp. 1-20. doi: 10.4018/978-1-7998-2949-2.