Insurance Models Used to Finance Health Sectors
Subject Area:Health Care
Private is where businesses, individuals or charitable organizations get involved in healthcare while the public is the involvement of government in health care. ("Role of Private Health Insurance in Mixed Systems of Health Care Funding," 2004, p. There are different levels of the two categories. Public sector category levels include Nation, Province/State, Region and Local. On the other hand, Private sector category levels include Corporate (for-profit), Small business (Entrepreneurial), Charity (Non-profit) paid employees or volunteers, Family (Personal) (Blanchette & Tolley, 2001, p. The shared concerns are access, cost, and quality. Different nations have chosen various systems to ensure they address the concerns, hence simplifying the International Health Care Systems comparative analysis. Private sector like the charitable organizations delivers health services but the responsibility is typically government delegated or provided by the public sector.
German government frequently regulates the involvement of private sector through the Sickness funds and additional funding. In the United States, the government subsidizes the healthcare model which is usually described to be private in the long run. "Virtually every country employs some combination of financing and delivery models, relying on various public-private combinations in various sectors of the health-care system or for various groups of the nation's population," (Deber, 1997, p. Mobilizing funds to assist in health care or payment for health care is health financing. There are two financing systems, public funding and private financing system. Public financing system refers to where the government gets involved in providing funds for health services. Public financing comprises of two major approaches; The Beveridge Model and The Bismarck Model.
Moreover, U. K uses a collection of contributions of the national insurance and the general taxation systems in funding the National Health Service. Countries such as Ireland, Italy, Scandinavia, Denmark, Cuba and Finland also uses Beveridge approach as the primary source of funding healthcare. In a country like Trinidad and Tobago, the public health-care model is government financed. Though it is a two-tier system, the Ministry of Health (MoH) is primarily responsible for leading the health sector. Sickness fund membership is mandatory, and the premium is to the wage percentage of an individual. The management of the funds is under various social associates such as employers, regions and professional groups. However, they are subjected to rigorous monitoring and regulation by the government.
Due to this, the model is at times called quasi-public financing and is applicable in countries such as Belgium, Germany, the Netherlands, Luxembourg, Austria, Japan, and France among others. The importance of the approach is that waiting time when receiving healthcare is little and citizens do not need to pay for expensive healthcare bills. Most of the population in these countries are covered by the plans. The model in these two countries is entirely in contrast to the one in Canada where the legislation of the province disallows National Health Insurance services covered under public healthcare insurance. However, for services such dental care, eye care and drugs provision is available in National Health Insurance since they are not publicly insured. National Health Insurance approach is very successful in Canada.
NHI has various pros and cons. In France and Sweden, user charges apply to drugs, dental care and services offered the physicians. Additionally, Japan charges for bills of physicians, pathology, all medical bills, x-rays and inpatient care as co-payments (Blanchette & Tolley, 2001, p. When there is little insurance to cover health services costs, out-of-pocket payments are sustainable hence the system is considered the most disorganized among the four models. The system applies to the majority of third world countries and developing countries such as Sudan, Nigeria, Kenya, Cambodia, Vietnam and Thailand among others. "Formal health insurance in developing countries is rare […] much of the borrowing and saving by households is informal in nature and reliant on the social capital of communities," ("WHO | Universal Health Coverage," n.
Community-based financing is a model based on the principles of local self-reliance, pre-payment and community cooperation. This form of funding is successful since it; receives support from outside individuals and organizations, able to adapt to a changing environment, funding diversity, ability to respond to other non-health development needs of the community and the institutional capacity and technical strength of the local group. Community-based financing is in a country like India. In India, community-based funding is categorized into insurance schemes such as voluntary, mandatory, NGO based and employer-based (Pradhan, 2013, p. The compulsory insurance CGHS and ESIS, financed from the taxes, contributions of employers and beneficiaries. (2013, November 15). Retrieved from http://www. medicarehelp. org/advantages-disadvantages-private-health-insurance/ Blanchette, C. B. Health Insurance Values and Implementation in the Netherlands and the Federal Republic of Germany.
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