Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Introduction and History of Modern Health Care in the U.S.
Lecture:Components of Health Care Delivery and Finance
Slide content:Reids Four Systems and Their U.S. Analogs (2010) Name Description Countries U.S. Analog Beveridge Provided and financed by government Great Britain, Hong Kong, Cuba Veterans Administration (VA) Bismarck Regulated private insurance must cover all Germany, France, Switzerland Employer-provided health insurance National health insurance Private system with government-run insurance Canada, Taiwan, South Korea Medicare, Medicaid Out-of-pocket Pay as you go Most poor countries U.S. uninsured Reid, 2010 14
Slide notes:In his analysis of comparative health care systems, Mr. Reid comes up with four basic systems or models. He has names for these, describes them, points out the countries that use them, and shows that each of these models is used in different segments of the U.S. health care system. The first of these is the Beveridge model, which was developed in Great Britain and has health care that is provided and financed by the government. We all know the British National Health Service. This approach is also used in Hong Kong, an example of a capitalist country, and in Cuba, an example of a socialist country. In the U.S., this model is used in the Veterans Administration, or VA system, where care is provided and financed by the government. The second model is the Bismarck system. This is a system where there is highly regulated private insurance. There are usually rules that everyone must be covered and that pre-existing conditions must be covered as well. Often times, the coverage is tied into employment, and the major example of the Bismarck model is Germany, where Bismarck was from, although France, Switzerland, and many other European countries use this model. While we don't have this model exactly in the U.S., the employer-provided health insurance that most who are employed have is the closest example of the Bismarck model in the U.S. The third model is the national health insurance model. This is a private health care system with government-financed insurance. Canada is probably the best known model of this approach, although other countries like Taiwan and South Korea use it. The closest analog in the U.S. is Medicare, and Medicaid to some extent. The final model is out-of-pocket health care, where individuals pay as they go. Most poor countries around the world that cannot afford a comprehensive health care system use this approach, which basically ends up having those who have wealth being able to get health care and those who don't have wealth not being able to get it. There are many citizens in the U.S. who function under this model, namely those who lack health insurance. One point that Reid wanted to make was that there are different models and the U.S. has within its system people who are covered by the approach of each of these four models. 14