The Bismarck model (also referred as "Social Health Insurance Model") is a health care system in which people pay a fee to a fund that in turn pays health care activities, that can be provided by State-owned institutions, other Government body-owned institutions, or a private institution. [1] The first Bismarck model was instituted by Otto von Bismarck in 1883 and focused its effort in providing cures to the workers and their family. [2] Since the establishment of the first Beveridge Model in 1948, where the focus was into providing healthcare as a human right to everyone with funding through taxation, nearly every Bismarck system became universal and the State started providing insurance or contributions to those unable to pay. [3] [4]
After the formation of the German Empire in 1871, Chancellor Otto von Bismarck experienced opposition from German Democratic Socialists. In response, anti-socialist legislation was passed in 1878, and Bismarck made the decision to incorporate social protection schemes into his budgetary planning. [5] Three major pieces of legislation that established state social insurance [6] were the Compulsory Insurance Act of 1883, the Accident Insurance Act of 1884 and a pension system that was enacted in 1889 and began in 1891. [5] [7] [8]
Unlike single-payer healthcare, the state does not directly insure the population through a single publicly-owned insurance provider. Instead, all residents are mandated to enroll in one of several publicly- or privately-managed insurance funds to ensure universal coverage. Community rating protects insurance applicants from sale and price discrimination, while risk equalization subsidizes providers that are forced to insure high-risk individuals. Governments will also use all-payer rate setting to fix prices at private healthcare providers.
States such as Germany, Austria, Switzerland and Czech Republic have Bismarck healthcare, while states such as South Korea [9] and the Netherlands, [10] while having a basic state insurance, have a much stronger private presence in the healthcare providers and insurance systems. [11]
In Europe, countries like France, Hungary and Slovakia, while theoretically Beveridge system, have some degree of Bismarck politics in their laws. [12] Some in Italy argue that the Lombard socio-health system, which prescribes equality between the private and public sector and payment by performance, has some typical characteristic of a Bismarck system. [11]
The Euro health consumer index calls the statement "Bismarck beats Beveridge" a "permanent feature" since 2014. Bismarck systems usually have significantly higher accessibility, lower waiting times and, thanks to the competition between operators, higher quality and more consumer-oriented healthcare. [13]
Studies show that the introduction of the Bismarck system in Germany led to a significant drop in mortality. [14]
Since in the Bismarck health system the core financing are contributions, people in poverty can't pay and get limited coverage. In some countries, like Switzerland, the cost of insurance is high and continues to grow, leading part of the population to be under-insured. [15]
Another criticism is that since institutions are paid by performance some isolated localities may have little hospital coverage. [1]
While primary care is significantly faster to get in a Bismarck system than in a Beveridge system some argue that some elective care may be slow to get even in a Bismarck system than in a free-market healthcare, like the US. [1]
Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
Single-payer healthcare is a type of universal healthcare, in which the costs of essential healthcare for all residents are covered by a single public system. Single-payer systems may contract for healthcare services from private organizations or may own and employ healthcare resources and personnel. "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not a private authority, nor a mix of both.
National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service and South Korea's National Health Insurance Service, contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where an NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.
The Medicare for All Act, also known as the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with 38 co-sponsors. In 2019, the original 16-year-old proposal was renumbered, and Pramila Jayapal (D-WA) introduced a broadly similar, but more detailed, bill, HR 1384, in the 116th Congress. As of November 3, 2019, it had 116 co-sponsors still in the House at the time, or 49.8% of House Democrats.
Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2020, Israel's health system was ranked third most efficient in the world. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.
Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.
Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 ; 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2019 was averaged at 81 years.
Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of Health and Welfare to which South Koreans of sufficient income must pay contributions in order to insure themselves and their dependants, and the Medical Aid Program, a social welfare program run by the central government and local governments to insure those unable to pay National Health Insurance contributions. In 2015, South Korea ranked first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea was rated as the second most efficient healthcare system by Bloomberg. Health insurance in South Korea is single-payer system. The introduction of health insurance resulted in a significant surge in the utilization of healthcare services. Healthcare providers are overburdened by government taking advantage of them.
Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is a New York Times bestseller from journalist T. R. Reid. Reid compares health care systems in a half-a-dozen wealthy nations with the health care models followed in the United States, in a straightforward, easy to read narrative. The countries whose systems are discussed are: France, Germany, Japan, the United Kingdom, Canada and a specific example from India. Reid visited all these countries personally and claims to have chosen them since they exemplify specific kinds of health-care system models. The book also discusses transitions in the health care systems of Taiwan and Switzerland.
Social security in Germany is codified on the Sozialgesetzbuch (SGB), or the "Social Code", contains 12 main parts, including the following,
Examples of health care systems of the world, sorted by continent, are as follows.
Government-guaranteed health care for all citizens of a country, often called universal health care, is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at broadly extending access to health care and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.
The Beveridge model is a health care system in which the government provides health care for all its citizens through income tax payments. This model was first established by William Beveridge in United Kingdom in 1948. Under this system, most hospitals and clinics are owned by the government; some doctors and health care professionals are government employees, but there are also private institutions that collect their fees from the government. With the government as the single-payer in this health care system, it eliminates competition in the health care market and helps to keep the costs low. Using income tax as the main funding for health care allows for services to be free at the point of service, and the patients' contribution to taxes covers for their health care expenses.