Healthcare Systems

Introduction

Various healthcare systems have developed around the world. They all use, to a larger or smaller extent, elements of The Bismarck Model and The Beveridge Model. The Out-of-Pocket Model represents another possible approach.

Models of Healthcare Systems

NOTE: Universal health coverage, as defined by WHO, requires all people to have access to needed health services without the risk of financial hardship associated with accessing services.



The Bismarck Model

The Bismarck model is a social insurance model where it is compulsory for all citizens to belong to an insurance fund.

  • Insurance agencies have a high level of autonomy, which means that the finances cannot be used for other purposes than health care. They are run as non-profit organizations and are required to accept all citizens without discrimination.
  • Healthcare providers tend to be largely private.
Under the Commercial Model, the health insurance companies can be for-profit enterprises.

  • The system is based on the demand/supply basis with the possibility to freely choose among different insurance programmes.
  • The premiums are based on risk assessments and the insurances can also refuse the request for insurance.

National Health Insurance Model is a single-payer, state-run insurance programme, which is compulsory for all citizens.

  • Payroll contributions are often supplemented by general taxation or other public funds.
  • Predominantly private facilities and providers of health care



The Beveridge Model

In the Beveridge Model, health care is financed by the government (single-payer system) through tax payments.

  • Many healthcare facilities are owned by the government, and the healthcare workers are government employees.



The Out-of-Pocket Model

The Out-of-Pocket Model is based on direct payments from patients to healthcare workers at the time of treatment.

  • Such a system does not present a systematic approach that would assure health care to all citizens in need.



Malaysia: Health White Paper

The Health White Paper, which was first tabled in the Parliament on 14 June 2023, is a comprehensive proposal to revamp the country's healthcare system for a higher quality, more sustainable and resilient health system in stages over a 15-year period.

The policy paper depicted the existing health system gaps and challenges, which includes

  • Ageing population
  • Rising burden of non-communicable diseases
  • Hidden epidemic (mental health)
  • Persistent problem of communicable diseases (e.g. COVID-19, polio, measles)
  • Constraints in health funding
  • Constraints in human resources and infrastructures (e.g. old health facilities and equipment, shortage of health personnel)

The Health White Paper rests on 4 pillars.

Health White Paper

Reforms under these 4 pillars include

  • Setting up a national disease control centre.
  • Reviewing fees at all public hospitals and clinics.
  • Providing incentives to promote a healthy lifestyle.



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