1. DESCRIPTION OF TWO HEALTH CARE MODELS : 1. The Beveridge health service 2. Bismarck health insurance ONCOLOGY TRACK : NUYOMUGABO CYRILLE MHOKA MWANGA

2. INTRODUCTION Health systems ‘encompass both personal and population services, as well as activities to influence the policies and actions of other sectors to address the social, environmental and economic determinants of health’ (Smith PC, Yip W. 2016) Objectives of Health System is to improving health, protecting people from the financial consequences of ill-health, promoting associated equity objectives and minimizing inefficiency associated with the pursuit of these objectives

3. Introduct….. Health Care system (HCS) is organizational arrangements and processes through which a society makes choices concerning the production, consumption, and distribution of health care services. Better health care System leads to better health care. Every nation have its own set of arrangements for meeting the three basic goals of Health care system which are, keeping people healthy, treating the sick and protecting families against financial ruin from medical bills.

4. INTRODUCTION Health System: All the activities whose primary purpose is to promote, restore or maintain health (WHR 2000, WHO) There are different health care delivery system(model): 1.The Beveridge model 2.Bismarck model 3.Out of Pocket Model 4.National health Insurance (Or Z, Cases C, 2010) In this assignment, will discuss first two models, (1&2)

5. The Beveridge (NHS) Model It is named after William Beveridge, a social reformer, Britain’s National health care Services(NHS). in 1948 Where the health care is provided and financed by the government through tax payments, Many, but not all, hospitals and clinics are owned by the government, some doctors are government employees, but there are also private doctors who collect their fees from the government. (Light DW. 2003)

6. The Beveridge (NHS) Model These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge. Example – UK, Spain, New Zealand Many healthcare service agencies are owned by government and some private providers get fees from government. Cuba is the example of extreme application of the Beveridge approach

7. The Beveridge Model--Characteristics Medical treatment is a public service Providers can be government employees Lows costs because of the control of government over costs [Gov. act as sole payer] Healthcare is provided and financed by the government, through tax payments There are no medical bills (Mihalache IC, 2018)

8. The Bismarck Model Named after the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Usually financed jointly by employers and employees through payroll deduction. Bismarck-type health insurance plans have to cover everybody Non-profit making insurance Doctors and hospitals tend to be private in Bismarck countries. Examples –Germany, France, Belgium, Netherlands, Switzerland, Japan. (Tjernberg M. 2010)

9. The Bismarck Model The Bismarck Model also referred as Social Health Insurance Model) is a limited health care system, in which people pay a fee to a fund that in turn pays health care activities, that can be provided by either state-owned institutions, other Government body-owned institutions, or a private institution The focus on low costs and efficient care means there are less health care services available for citizens living in rural areas. (Tjernberg M. 2010)

10. Bismarck Model Mandatory employment taxes are high in order to keep health care affordable. There are longer waiting times for patients to receive elective secondary and tertiary services. Benefit package for all members either fully or partially cover. Countries: France, Germany, Belgium, Japan, Switzerland, Netherlands (Tjernberg M. 2010)

11. Bismarck Model--Characteristics Providers and payers are private Private insurance plans financed jointly by employers and employees through payroll deduction The plans cover everyone and do not make a profit. Tight regulation of medical services and fees (cost control) (Mihalache IC. 2018)

12. ADVANTAGE OF BISMARCK SYSTEM Bismarck systems usually have significantly higher accessibility, lower waiting times and, thanks to the competition between operators, higher quality and more consumer-oriented healthcare. Studies show that the introduction of the Bismarck system in Germany led to a significant drop in mortality (Bauernschuster S, 2020)

13. Bismarck Model Strengths: – More resources in the system – Less dependence on budget negotiations – High redistributive dimension (cross subsidies) Weaknesses: – Possible exclusion of the poor – Negative economic impact on payroll contributions – Complex and expensive to manage – Poor coverage of chronic diseases and preventive care – Not aimed at Universal Coverage (Jakab, M. and Krishnan, C., 2001.)

14. References 1.Smith PC, Yip W. The economics of health system design. Oxford Review of Economic Policy. 2016 Jan 1;32(1):21-40. 2.Or Z, Cases C, Lisac M, Vrangbaek K, Winblad U, Bevan G. Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems. Health Economics, Policy and Law. 2010 Jul;5(3):269-93. 3.Light DW. Universal health care: lessons from the British experience. American journal of public health. 2003 Jan;93(1):25-30. 4.Tjernberg M. The economy of undocumented migration: Taxation and access to welfare. European Journal of Migration and Law. 2010 Jan 1;12(2):149-71. 5.Mihalache IC, Tomaziu-Todosia MI, Apetroi FC. Economic models of financing health services in European Union. European Financial Regulation-EUFIRE. 2018:211-24. 6.Bauernschuster S, Driva A, Hornung E. Bismarck’s health insurance and the mortality decline. Journal of the European Economic Association. 2020 Oct;18(5):2561-607. 7.Jakab, M. and Krishnan, C., 2001. Community involvement in health care financing: A survey of the literature on the impact, strengths, and weaknesses. 8.http://www.annfammed.org/content/11/1/84.1.fullhttp://www.annfammed.org/content/11/1/84.1.full 9.https://www.sciencedirect.com/science/article/abs/pii/S0733863505701650https://www.sciencedirect.com/science/article/abs/pii/S0733863505701650 10.applications.emro.who.int/docs/em_RC46_tech_disc_1_en.pdf

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