Management and Governance Paradigms in Health (SGHMANGOV) - Health System Model

Classification of Health Systems based on Organization or Institutional Context (OECD)

• Private Insurance model (Consumer Sovereignty model):

• Least state involvement in funding or provision

• Characterized by purchase of private health insurance financed by employers and/or individuals

• Largely based on private ownership of health care providers and the factors of production

• Funding and provision of health care are generally left to market forces

• Social Solidarity model:

• Characterized by universal health insurance coverage

• Generally funded by a combination of employer and individual contribution through non-profit insurance funds

• Provision of health services may be private or public

• National health insurance – a variation of the model with funding jointly coming from payroll taxes, government subsidies and individual premiums

• National Health Service model (Beveridgean model):

• Characterized by universal coverage funded out of general taxation

• Generally open-ended access to all needed health care services given free at the point of use

• Provision of health care services is administered by the state which either owns or controls the factors of production and delivery

• Examples: British health system, Russia

Classification of Health Systems based on Role of State in Financing, Service Provision, and Regulation (Wendt et al. 2009)

• Country health system model:
• Financing: State, Societal, Private
• Service Provision: State, Societal, Private
• Governance and Regulation: State, Societal, Private

Description of Health Sub-Systems

Financing

• Raising and allocating funds
• Control of resources

Provision

• Means of delivery of health services
• Range of services
• Levels of choice
• Types of providers (public or private, profit or non-profit)
• Mix of providers

Governance and Regulation

• Modes of coordinating health systems and stakeholders/actors (public or private, central or local)
• Government capacity and authority

Classification of Health Systems based on Organization or Institutional Context (OECD)

• Private Insurance model (Consumer Sovereignty model):

• Least state involvement in funding or provision

• Characterized by purchase of private health insurance financed by employers and/or individuals

• Largely based on private ownership of health care providers and the factors of production

• Funding and provision of health care are generally left to market forces

• Social Solidarity model:

• Characterized by universal health insurance coverage

• Generally funded by a combination of employer and individual contribution through non-profit insurance funds

• Provision of health services may be private or public

• National health insurance – a variation of the model with funding jointly coming from payroll taxes, government subsidies and individual premiums

• National Health Service model (Beveridgean model):

• Characterized by universal coverage funded out of general taxation

• Generally open-ended access to all needed health care services given free at the point of use

• Provision of health care services is administered by the state which either owns or controls the factors of production and delivery

• Examples: British health system, Russia

Classification of Health Systems based on Role of State in Financing, Service Provision, and Regulation (Wendt et al. 2009)

• Country health system model:
• Financing: State, Societal, Private
• Service Provision: State, Societal, Private
• Governance and Regulation: State, Societal, Private

Description of Health Sub-Systems

Financing

• Raising and allocating funds
• Control of resources

Provision

• Means of delivery of health services
• Range of services
• Levels of choice
• Types of providers (public or private, profit or non-profit)
• Mix of providers

Governance and Regulation

• Modes of coordinating health systems and stakeholders/actors (public or private, central or local)
• Government capacity and authority

This quiz covers the classification of health systems based on organization or institutional context by OECD, including private insurance models and consumer sovereignty.