DNP 835 Topic 3 Discussion Question Two
DNP 835 Topic 3 Discussion Question Two
Two major models of care exist, for-profit and not-for-profit? Does one or the other provide more ethical care? Why or why not?
There are four major models for health care systems: the Beveridge Model, the Bismarck model, the National Health Insurance model, and the out-of-pocket model. While in theory these categories have distinct policy separations, in reality most countries have a blend of these approaches, though they generally have a single health care system that is uniform for most citizens. These distinctions are effective at differentiating schools of thought on health care policy, but the policies of each country should be analyzed when
determining potential improvements.
The Beveridge Model: single-payer national health service
Examples: the United Kingdom, Spain, New Zealand, Cuba
Relevance to the US: similar to the Veterans Health Administration
The Beveridge Model was first developed by Sir William Beveridge in 1948. Established in the United Kingdom and spreading throughout many areas of Northern Europe and the world, this system is often centralized through the establishment of a national health service. The government acts as the single-payer, eliminating competition in the market and generally keeping prices low. Funding health care through income taxes allows for health care to be free at the point of service – after an appointment or operation, the patient does not have to pay any out-of-pocket fees because of their contribution through taxes. Under this system, a large majority of health staff is composed of government employees. A central tenant of this model is health as a human right. Thus, universal coverage is guaranteed by the government and anyone who is a citizen has the same access to care.
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With the government as the sole payer in this healthcare system, costs can be kept low and benefits are standardized across the country. However, a common criticism of this system is the tendency toward long waiting lists. Because everyone is guaranteed access to health services, over-utilization of the system may lead to increasing costs. There are fears that adoption of a single-payer national health service in the US would lead to an increase in demand for all procedures, even medically unnecessary ones because citizens would not pay upfront costs for these services. However, other analysts argue against this problem, stating that current American practices waste a similar amount of money covering the uninsured.
Another practical concern is the government response to crisis. In the case of a precarious national emergency, such as war or a health crisis, funding for health services may decline as public revenue decreases, exacerbating the financial burden inherent in a large influx of patients. Such a situation would require careful allocation of emergency funding before the crisis.
The Bismarck Model: social health insurance model
Examples: Germany, Belgium, Japan, Switzerland
Relevance to the US: similar to employer-based health care plans and some aspects of Medicaid
A more decentralized form of healthcare, the Bismarck model was created near the end of the 19th century by Otto von Bismarck. Employers and employees fund health insurance in this model – those who are employed have access to “sickness funds” created by compulsory payroll dedications. In addition, private insurance plans cover every employed person, regardless of pre-existing conditions.
Health providers are generally private institutions, though the Social Health Insurance funds are considered public. In some countries, there is a single insurer (France, Korea); other countries may have multiple, competing insurers (Germany, Czech Republic) or multiple, non-competing insurers (Japan). Regardless of the number of insurers, the government tightly controls prices while insurers do not make a profit. These measures allow for the government to exercise a similar amount of control over prices for health services seen in the Beveridge model.
The requirement of employment for health insurance provides benefits and causes problems. These measures ensure that employed people will have the healthcare needed to continue working and ensure a productive workforce. Because it was not initially established to provide universal health coverage, the Bismarck model focuses resources on those who can contribute financially. With a shift in mindset from health as a privilege for employed citizens to a right for all citizens, the model faces a number of concerns, such as how to care for those unable to work or those who may not be able to afford contributions. More immediate practical concerns include how to contend with aging populations, with an uneven number of retired citizens compared to employed citizens, and how to stay competitive in attracting international companies that may prefer locations without these required payroll dedications.
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