Organizing and funding health care

Chapter 75 Organizing and funding health care


The organization and funding of health care affect patients as well as health care providers. Doctors, as health care providers, may be restricted in their actions owing to the existing organization of health care, or they may feel that their patients’ access to certain expensive tests or interventions is restricted.


Health care systems all over the world seem to be facing a funding crisis. The main issue is the allocation of scarce resources. This is not simply a question of money but also of political decision-making and priorities. In order to understand the current organization and funding of health care, we have to look at historical developments and the underlying political decision-making process.


We concentrate on three countries, the UK (with a predominantly state-run welfare system), the USA (with a predominantly free-market system), and Germany (with a mixed-health economy), representing the major ways health care is organized and funded (Table 1). Total expenditure per capita on health (including private and public health expenditure) in these three countries differs considerably, as does the proportion of the gross national product spent on health care.


Table 1 Three different ways of funding and organizing health care provision























UK USA Germany

image State-run national health service mainly funded through taxation
image Mainly private health insurance system with market-based health care provision
image National health insurance-based system with a market-based health care system

image Every citizen covered, but small fees paid on prescriptions
image 10% of the population not covered
image Every citizen covered, but small fees paid on use

image Per capita spending on health US$2428
image Per capita spending on health US$5711
image Per capita spending on health US$3204

image 8.0% of gross national product (GNP) spent on health services
image 15.2% of GNP spent on health services
image 11.1% of GNP spent on health services


UK


All citizens of the UK are included in the NHS. The NHS is a universal, tax-funded health care system. Doctors, nurses and hospitals are paid by the state. The NHS requires some additional payments from patients, for example, for prescriptions and dental check-ups, but the overwhelming majority of care provision is free of charge. Treatment is decided on (mostly) by doctors. GPs are gate-keepers in this system, selecting patients and referring patients to the appropriate specialist. Medical care is available to all, and is therefore without stigma or significant financial cost to the poor. However, there is a problem of waiting lists in certain areas (see pp. 154–155). This has stimulated an increase in the small but growing private health care sector. In the UK this includes sales of over-the-counter medicines and private payments for alternative therapies and hospital treatment. The latter is often provided by the same doctors in the same hospitals as the standard NHS care.



USA


The system in the USA is predominantly commercial insurance-based. Most people take out their own private health insurance, or are insured through their employer. These insurance companies reimburse doctors, hospitals and others for care provided. Most people have the freedom to go to the medical professional or hospital of their choice. A limited number of people are covered by state-organized schemes, such as Medicaid, which provides health care for the poor, but eligibility is incomplete and coverage usually excludes dental services and prescribed drugs, and Medicare, for all people over 65, which provides limited coverage. Over 45 million people are not insured or are seriously underinsured.

Related posts:

Intelligence The social implications of the new genetics Bereavement Complementary therapies Measuring health and illness Alcohol use

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 10, 2016 | Posted by in PSYCHOLOGY | Comments Off on Organizing and funding health care

Full access? Get Clinical Tree
Get Clinical Tree app for offline access