The World Health organization defines a health system as follows “A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently (“WHO | Q&As: Health systems”, 2018).
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2. HEALTHCARE SYSTEM OF FRANCE
• France provides universal health care.
• In the year 2000, The World Health Organization rated France as providing ‘the best overall healthcare’ in the world
• Healthcare expenditure is 11.5% of the GDP.
• The average French male lives 79 years and a woman lives 85.
• The state reimburses 70% to 100% of medical costs. There is 100% coverage for low income (home, system & BV, 2018).
2.2 QUICK FACTS
• Population covered by health insurance: 96%
• Number of pharmacies: 22,000
• Number of hospitals: Approx. 2,700 (“Healthcare in France: A guide to the French healthcare system”, 2018)
2.3 THE HEALTHCARE SYSTEM IN FRANCE
? Partly funded by citizens through compulsory contributions, usually deducted from salary.
? The government funds the rest of the cost.
? The Patient has to pay a small fraction of the cost
? If you are referred by your designated GP, 70% of the doctors’ fees, and 80% of hospital charges will be reimbursed.
? To meet the remaining 30% cost, many take a private health insurance.
? In an emergency, there is no need for a GP referral to access the emergency room of the nearest hospital.
2.4 FRENCH HOSPITALS
There are both state and privately run hospitals. Most private hospitals are state approved and work for the National Health Service. Hospital referral can be done either by a specialist or a GP.
2.5 ADVANTAGES AND DISADVANTAGES
• Affordable due to fees being stipulated by the state
• Ease of access. Patients can also choose their own doctors.
• Ranked as the best overall healthcare provider by the WHO in 2000
• High health status of the citizens, and high rates of satisfaction regarding the system.
• High taxes to employed citizens to maintain the system.
• Decision making is highly centralized and conducted by the ministry of health.
3 HEALTHCARE SYSTEM OF CANADA
• Publicly funded socialized health insurance plans which provide Universal Health Care
• Guidelines set by federal government.
• Administered on a provincial or territorial basis, and healthcare control is decentralized.
• Canada Health Act – The legislation that governs the funding for health services. It has five principles
1. Public administration – Provincial health insurance is administered by a public authority on a non-profit basis.
2. Comprehensiveness – Health insurance must cover all necessary health services, hospitals, physicians and also dental services.
3. Universality – Same level of care for all insured citizens
4. Portability – Coverage continues during a minimum waiting period if the person moves to a different province or leaves the country.
5. Accessibility – reasonable access to health care services is assured for all insured persons (“Canadian Health Care”, 2018).
• In addition to the basic coverage in the Canada Health Act, each province decides what else is covered under healthcare.
• Approximately 9.5% of GDP is spent on health care.
• Approximately three quarters of funding of healthcare is from public sources and the remainder is from private sources and private insurance.
3.3 HOW THE HEALTHCARE SYSTEM OF CANADA WORKS
? Funding is at both provincial and territorial levels.
? Taxation of both personal and corporate income taxes. Some provinces also charge health premiums.
? Funds are distributed to provinces and territories by the Canadian health and Social transfer.
PUBLIC HEALTH CARE PROVIDERS –
? Consist of both primary care doctors and specialists. Access to specialist is by a referral from the GP.
? Hospital access is also by GP referral, but direct access is granted in emergency situations
PRIVATE CLINICS –
? By law they are not allowed provide services included in the Canada Health Act.
? Advantage – reduced waiting times.
? They are more useful to people with better income and upsets the equity in the sytem.
? Reliance on private insurance to meet cost
PROVINCIAL HEALTH CARD –
? Contains the health information of the individual.
3.4 ADVANTAGES AND DISADVANTAGES
• High standard of care with 100% coverage
• Most of the medical needs are covered with the exception of dental and vision.
• Friction between the federal government and provinces over policies.
• Private health care emergence has upset the balance and favoured high income population.
• Shortage of doctors and nurses.
• Long wait times
• Scarcity of funding and resources in rural areas.
• Fees set by federal government are unrealistic and don’t take into account the cost of living of the practitioners.
4 HEALTHCARE SYSTEM OF JAPAN
• Japan has a Universal Public Health Insurance system.
• By law all Japanese citizens should have health insurance provided by the state, so coverage is 100%, but a small fraction goes without.
• Average cost of public health insurance for a person is approximately 5% of their salary.
• There are over 53,000 pharmacies, or almost 42 per 100,000 people.
• Number of hospitals: just under 8,500 (“Healthcare in Japan: A guide to the Japanese healthcare system”, 2018).
4.3 HOW THE HEALTHCARE SYSTEM OF JAPAN WORKS
? Healthcare coverage is comprehensive and except for some dental and vision procedures, all other services are covered.
? No “gate-keepers”, citizens are free to choose their own clinics and hospitals.
? HEALTH INSURANCE
• SOCIAL HEALTH INSURANCE (SHI) – Both employer and employee contribute 5% of the salary, and comprises the public healthcare system for all full time employees.
• NATIONAL HEALTH INSURANCE (NHI) – for students, freelancers and employees of small companies.
• NURSING INSURANCE – Further 1.65% of income is charged for those between 40-65 years of age.
• PRIVATE HEALTH INSURANCE – usually not resorted to, but helps to meet the 30% co-pay that citizens have to meet from their side (“Healthcare in Japan: A guide to the Japanese healthcare system”, 2018).
? To ensure affordability medical fees are strictly regulated by the government.
? HOSPITALS –
• There are national public hospitals and private clinics. The private clinics often cover specialized services such as dental, which are not included in the healthcare insurance.
• Hospitals are legally required to run on non-profit basis. Admission to a hospital usually requires a referral from a physician.
• Approximately 70% of medical and drug costs are covered by public health insurance. The remaining 30% has to be borne by the patient. However in the case of the elderly (above 75 years), young children, unemployed and low income households, the co-pay may be further reduced.
? DOCTORS – There is no established General practitioner system in Japan. Most patients directly consult specialists. Japan has fewer physicians per capita than most OECD countries.
4.4 ADVANTAGES AND DISADVANTAGES
• The number of hospitals and hospital beds, in particular acute care beds is high per capita.
• Cost of the system is lower than that of other developed countries.
• The system achieves good medical outcomes.
• Lack of GP system puts strain on specialists whose numbers are also low (2.2 per 1000 population)
• High utilization rates together with over-medication and over-testing have put a strain on the system and it is considered not sustainable.
• Ageing population has put additional strain on the system.
• Preventive care services are not that good.
• Strain on public financing.
5 HEALTHCARE SYSTEM OF THE UNITED KINGDOM
• The United Kingdom has a publicly funded universal healthcare coverage.
• The National Health system (NHS) is run by the department of health and financed by taxation.
• There is a trend towards private care with about 12% of the population taking out private insurance coverage.
5.3 HOW THE HEALTHCARE SYSTEM OF THE UNITED KINGDOM WORKS
? General Practitioners (GP’s) provide primary care and act as gate-keepers to accessing secondary care.
? Free at the point of use for anyone who is a resident of the United Kingdom.
? Public hospitals, private non-profit hospitals and private for-profit hospitals co-exist under the system. Also there are a number of specialized hospitals.
? There is a decentralized regulation of the healthcare system, and administration is carried out at the constituent country level.
5.4 ADVANTAGES AND DISADVANTAGES
• There is 100% coverage and equitable care for everyone.
• Tax paid for system is on par with that of other developed countries, that do not offer universal health care.
• High standard of care with a large healthcare work force.
• Long waiting lists.
• In order for the system to be cost effective, all drug options are not available and some have to be obtained privately.
• No freedom of choice to choose ones GP
• Low wages for the healthcare workforce.
6 HEALTHCARE SYSTEM OF AUSTRALIA
• Australia has a universal public healthcare system which covers 100% of all permanent residents, with private options available.
• Medicare is the public healthcare system. Around 50% have additional private insurance.
6.2 QUICK FACTS
• Average cost of an emergency room visit: free through Medicare.
• Average cost of a doctor’s visit: free through Medicare.
• Number of pharmacies: over 5,000.
• Number of hospitals: approximately 1,300 – 700 public, 600 private (“Healthcare in Australia: A guide to the Australian healthcare system”, 2018).
6.3 HOW THE HEALTHCARE SYSTEM OF AUSTRALIA WORKS
• Medicare is funded through the Medicare levy which is about 2% of the income.
• Private healthcare is not free but there are government schemes in place to encourage people who can afford it to take out private insurance as well.
• Medicare covers GP costs, hospital costs and 85% of specialist’s costs. Prescription drugs are also heavily discounted and the billing is done as a bulk billing process.
• Private Insurance is of three types-
? Hospital insurance
? Extras – services like dental and corrective glasses
? Ambulance insurance.
• Well-developed GP system, referral is needed from a GP to visit a specialist, through Medicare.
6.4 ADVANTAGES AND DISADVANTAGES
• Considered as one of the best healthcare systems in the world.
• Even private insurance is subsidized by the government.
• Good quality of care, with equity in the quality of health facilities and services.
• Low income earners may qualify for Medicare without paying the tax.
• Long waiting lists for hospital medical procedures and even scheduled appointments.
• There are problems with respect to shortage of doctors and nurses and also their distribution in Australia.
• There are concerns regarding the quality and safety of the health services.
• Dental and Vision related issues are not covered.
• Questions about how best to strike a balance between the government and private sector, in providing and funding health services.
• Due to limitations of Medicare, users can still incur costs (“Healthcare in Australia: A guide to the Australian healthcare system”, 2018).