List of UGC CARE journals in Chemistry

Global Healthcare Systems

A healthcare system refers to the organization and method by which healthcare is delivered to individuals. These systems vary widely across countries, and not all healthcare is provided through a structured system. Comparing healthcare systems is the focus of health policy and research, generally based on how they are financed and managed.

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Goals of Healthcare Systems

According to the World Health Report (WHO, 2000), the primary goals of a healthcare system are:

1. Good health – Promoting the overall health of the population.
2. Responsiveness – Meeting the expectations of the population.
3. Fair financial contribution – Ensuring that costs are shared fairly across society.

Duckett (2004) proposed a two-dimensional approach to evaluating healthcare systems:

• Quality, efficiency, and acceptability on one dimension.
• Equity on the other dimension.

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Healthcare System Financing

Healthcare systems are generally financed through five primary methods:

1. Direct or out-of-pocket payments.
2. General taxation.
3. Social health insurance.
4. Voluntary or private health insurance.
5. Donations or community health insurance.

While healthcare is sometimes seen as a product like any other, many argue that it has unique features that require government regulation or intervention. These include:

• Human rights perspective: Access to critical healthcare is considered a basic human right, regardless of one's ability to pay.
• Life-saving obligations: Healthcare professionals are required by law and ethical standards to provide life-saving treatment, regardless of cost.
• Information asymmetry: In urgent or emergency situations, patients often lack the information to make informed decisions between competing providers.

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Models of Healthcare Systems

• Private healthcare systems are rare and usually exist for wealthy subpopulations in poorer countries.

• Public insurance systems include:

  • Social security healthcare model: Workers and their families are insured by the state.
  • Publicly funded healthcare model: The entire population is insured by the state.
  • Social health insurance model: Most or all of the population is insured through sickness insurance companies.

Most countries with government healthcare systems allow private healthcare to operate in parallel, often referred to as a two-tier healthcare system.

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Country-by-Country Examples

Australia

• Medicare, established in 1984, coexists with a private health system.
• Funded by a 1.5% income tax levy (with exceptions for low-income earners) and additional levies on high-income earners without private insurance.
• Pharmaceutical Benefits Scheme subsidizes prescription medications.

Canada

• A federally sponsored, publicly funded Medicare system.
• Services are provided by private doctors, and the government pays a set fee for services.
• Provinces negotiate rates with medical associations.

Cuba

• A government-coordinated system that guarantees universal coverage.
• Lower healthcare expenditure (7.3% of GDP) compared to more privatized systems.
• Universal health indicators in Cuba surpass those of some developed nations, including the U.S., in areas like infant mortality and immunization rates.

Finland

• Public healthcare is funded by 76% taxation, 20% patient fees, and 4% other sources.
• Annual caps on patient fees ensure affordable access to healthcare.
• The private sector accounts for 14% of healthcare spending.

France

• Social Security refunds 70% of healthcare costs, and 100% for long-term ailments.
• Supplemental private insurance is available for additional coverage.

Germany

• A universal multi-payer system with both compulsory (public) and private health insurance.

Ghana

• Most healthcare is provided by the government, with rural areas relying on traditional medicine or traveling for modern care.

India

• Healthcare is delivered through government hospitals, charitable trusts, and private organizations.
• Traditional medicine systems like Ayurveda and Unani are widely practiced alongside modern medicine.

Israel

• A universal and compulsory healthcare system funded by labor unions and the government.

Japan

• Healthcare is provided through public and private hospitals.
• Public insurance covers 70% of healthcare costs, with the remaining 30% paid by the patient (upper limits apply).

Netherlands

• Standardized and mandatory health insurance encourages competition among providers.
• Insurance is funded by levies, subsidies, and premiums, with children under 18 exempt from premiums.

New Zealand

• Public hospitals provide free healthcare to citizens and residents.
• Government subsidies exist for healthcare, and some pharmaceuticals are subsidized by PHARMAC.

South Africa

• Parallel public and private systems exist, with the public system underfunded and used by the majority of the population.

Sweden

• A comprehensive, publicly funded system where services are supported by taxation.

United Kingdom

• National Health Services (NHS) of Scotland, Northern Ireland, and England & Wales provide free healthcare.
• Private healthcare operates in parallel, used as a supplement to NHS services.

United States

• No universal healthcare system, but significant publicly funded programs like Medicare and Medicaid.
• Private insurance covers the majority of the population, but about 16% remain uninsured.

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Conclusion

Global healthcare systems differ widely in how they are structured, funded, and managed. Countries utilize a mix of public and private models, aiming to balance quality, equity, and efficiency in delivering care. The political and financial landscapes in each country shape the direction of healthcare policies and access to care.