And what are our healthcare “system” choices? There are four major models for health care systems:
- Beveridge National Health Service Model
- Bismarck Model
- National Health Insurance Model
- Out-of-Pocket Model. (1)(2)
I will discuss them one at a time. In this blog post, we will examine the Beveridge Model.
The Beveridge Model:
A single-payer national health service that was first developed by Sir William Beveridge in 1948.
Examples: United Kingdom, Spain, New Zealand, Cuba.
Relevance to the U.S.: similar to the Veterans Health Administration.
This form of single-payer is most similar to the National Health Service of the United Kingdom and typically has physicians directly employed by the national government. Most primary care physicians in Great Britain remain privately organized but carry national contracts while the government employs specialists (THE FIRST PARTY). The funding for healthcare comes through income taxes, meaning that healthcare is free at the point of service (THE THIRD- PARTY PAYOR is the government). The closest version of this in the United States would be the way care is organized within our Veterans Administration, where both primary and specialty care physicians are employed directly by the VA system (government). But even this format has been modified in the United States with a “Choice” program where the private sector fills in the appointment (ACCESS) gap. The central tenant of the Beveridge Model is that healthcare is a right.
“The National Health Service (NHS) in England, which provides mostly free, universal care, imposes a global budget that cannot be exceeded. The budget has been largely flat in recent years, although demand has been rising. The result has been ‘some deterioration in quality of care — notably waiting time targets,’ according to a 2016 Commonwealth Fund report.” (3)
It starts with a GLOBAL BUDGET
Underneath that global budget (see above), the FIRST PARTY or provider payment occurs through a mixture of three payment types. The first is payment type is capitation. This covers essential services- about 60% of income. (see capitation diagram below).
The second payment type in the mix is an optional fee-for-service payments for additional services such as vaccines for at-risk populations. About 15% of payments are made in this fashion (see fee-for-service diagram below).
An optional performance-related scheme is also in play. About 10% of all payments are through this method (see Pay For Performance diagram below). (4)
Next time we will talk about the Bismarck Model.
Keep an eye out for my soon to be published book: Earthquake: How America’s Ever-changing Healthcare System Victimizes Americans
- Chung, Mimi, “HEALTH CARE REFORM: LEARNING FROM OTHER MAJOR HEALTH CARE SYSTEMS,” 2 Dec. 2017, Princeton Public health Review, /pphr.princeton.edu/2017/12/02/unhealthy-health-care-a-cursory-overview-of-major-health-care-systems/
- Weisbart, ED MD, CPE, FAAFP, Chair, MO Chapter of Physicians for a National Health Program
- Serafini, Marilyn, “Why Clinicians Support Single-Payer — and Who Will Win and Lose,” New England Journal of Medicine, Catalyst, 17 Jan. 2018, catalyst.nejm.org/clinicians-support-single-payer-win-lose/
- Thorlby, Ruth and Sandeepa Arora, “The English Health Care System,” The Commonwealth Fund, International health Care Systems Profiles, international.commonwealthfund.org/countries/england/