1.1. Describe models and systems of health care

This guide will help you answer 1.1. Describe models and systems of health care.

Health care is a broad term that refers to the provision of services to maintain or improve physical and mental health. Throughout the world, various models and systems are designed to deliver health care services. In the UK, understanding these models and systems helps ensure efficient delivery and access to care. This guide will cover the main models, systems, and structures within health care.

Models of Health Care

Health care models explain the frameworks and principles used to organise, deliver, and fund health services. Each model reflects different cultural, political, and social principles. Let’s take a look at the main models used globally and how they work.

The Beveridge Model

This model, developed by William Beveridge, forms the foundation of the National Health Service (NHS) in the UK. It is based on the principle that health care should be accessible to everyone, free at the point of delivery, and funded through taxation.

Features of the Beveridge Model include:

• Health services are publicly owned, meaning hospitals and health professionals often work for the government.
• Care is provided to all residents regardless of their ability to pay, creating equal access.
• Funding comes directly from tax contributions.

Benefits of this model include universal coverage with no direct costs for patients, equity of access, and a focus on preventative care. However, challenges can include funding pressures and waiting times due to high demand.

The Bismarck Model

The Bismarck model originated in Germany and focuses on insurance-based health care systems. This model ensures health care is accessible by requiring both employees and employers to contribute to health insurance funds.

Key features:

• Health insurance is mandatory, and contributions are split between individuals and their employers.
• Care providers may be privately or publicly owned.
• The government regulates care to ensure equitable access and cost control.

In this model, care is often delivered quickly, but it is heavily reliant on insurance contributions. Those who are unemployed or unable to pay may need government subsidies to access care.

The Private Insurance Model

In this model, health care services are funded through private insurance schemes. Patients pay directly for insurance plans, which then cover the cost of treatment. The USA is one example of a country that follows this model.

Characteristics include:

• Providers (e.g., hospitals and specialists) operate privately and independently.
• Individuals choose and pay for insurance plans themselves.
• Access to care and quality of care can vary based on the insurance policy one holds.

This model often provides quicker access to treatment and more choice. However, people without insurance or with low-quality insurance may face difficulties accessing care.

The National Insurance Model (Hybrid System)

The National Insurance Model is a combination of elements from both tax-funded public services and insurance-based funding. For example, countries like Canada use this hybrid approach.

Features include:

• Funding mainly comes from taxes, ensuring universal health care.
• Privately employed care providers deliver services, but their fees are paid by the government via public insurance.
• People typically don’t pay directly for services.

This approach ensures universal coverage while allowing flexibility over how care is delivered. However, there may still be costs for individuals for additional non-essential services.

Systems of Health Care

Health care systems define the organisation of health services within a country. These systems include how care is delivered, how it is funded, and how it is managed. Below are the main systems used in different parts of the world.

Universal Health Care (UHC) Systems

Universal health care ensures that all individuals have access to essential health services without financial hardship. This is the primary system used in the UK through the NHS.

Features:

• Care is free or affordable for the entire population.
• Funding typically comes through taxation or national health insurance.
• Governments regulate and oversee the system to ensure equity.

The goal is accessibility and fairness. Everyone, regardless of income, gender, age, or background, receives the care they need.

Private Health Care Systems

In a private system, individuals or companies pay directly for health services. Treatment is often quicker, but not all members of society can afford care. This system is more common in wealthier nations or as a supplement to a public system.

Key points about private systems:

• Patients pay for services out of pocket or through private insurance.
• Care providers are privately owned, creating competitive markets.
• Often associated with wider choice for patients (e.g., selecting specialists).

Examples include private hospitals or clinics offering services not always accessible through public systems, such as cosmetic surgery or private physiotherapy.

Mixed Health Care Systems

Some countries combine public and private systems to deliver a balance between universal access and private sector efficiency. For example, in the UK, private health care coexists with the NHS, allowing individuals to access additional or faster treatment by paying for it.

Features include:

• A baseline of publicly-funded care complemented by private care options.
• Governments regulate private health providers to prevent inequality.
• Individuals may choose to pay for private treatment for quicker access.

The NHS incorporates this system, as people can pay for private care or use insurers such as Bupa for optional enhancements.

How the NHS Operates

The NHS is one of the most well-known examples of a public health care system based on the Beveridge model. Here’s a description of its structure to help you understand its delivery.

Roles in the NHS

1. Primary Care
   Primary care is the first point of contact for patients. It includes services like GP appointments, dental treatment, and opticians. Primary care providers refer patients to specialists where necessary.
2. Secondary Care
   This is specialist care. It may involve treatment in a hospital, diagnostic tests like x-rays, or specialist advice from consultants. Access usually requires a referral from a GP.
3. Tertiary Care
   Tertiary care involves highly specialised treatment, such as cancer specialists, neurosurgery, or advanced cardiac care. It is often provided in specific centres of excellence.

NHS Funding

The NHS is publicly funded through taxes. This provides free-at-the-point-of-use services, meaning patients usually do not pay for consultations, prescriptions (except set fees), or surgeries. This keeps services accessible for all.

Benefits and Limitations of the NHS System

Benefits of the NHS include equitable access, reduced financial barriers to care, and emphasis on prevention. Limitations can include long waiting times, restricted choice, and funding shortfalls in some areas.

International Comparisons

Understanding models and systems in different countries highlights variations in health care access.

1. Sweden: Uses a tax-funded system similar to the UK but is more decentralised, with regions managing health budgets.
2. USA: Operates primarily on a private insurance system. Free care is limited to emergency services or government-funded schemes like Medicare (for older adults) or Medicaid (for low-income individuals).
3. Japan: Provides access to health care through mandatory health insurance. Patients share costs, but the government regulates fees to keep services affordable.

Impact on Practice

Health and social care workers must understand these models and systems. It affects how they deliver care, advocate for service users, and contribute to improving local services. For example:

• Workers in the NHS must follow procedures for equity and safeguarding public funds.
• Care workers in private care homes might assist residents in making insurance claims or financial contributions toward care.
• Social care practitioners may advise service users about accessing universal services such as benefits.

Conclusion

By understanding health care models and systems, workers contribute to equitable, efficient care delivery. The Beveridge model ensures fairness in the UK, while mixed systems allow flexibility. Each system has strengths and weaknesses. Workers should focus on aligning their practices with the values and resources of the system they work within. Familiarising yourself with different models can help improve quality of care and outcomes for everyone involved.