Change Your World Week Winter 2022 (Archived)

The Beveridge Model: Single-Payer National Health Service

The Beveridge Model was first developed by Sir William Beveridge in 1948. Established in the United Kingdom and spreading throughout many areas of Northern Europe and the world, this system is often centralized through the establishment of a national health service. The government acts as the single-payer, eliminating competition in the market and generally keeping prices low. Funding health care through income taxes allows for health care to be free at the point of service – after an appointment or operation, the patient does not have to pay any out-of-pocket fees because of their contribution through taxes. Under this system, a large majority of health staff is composed of government employees. A central tenant of this model is health as a human right. Thus, universal coverage is guaranteed by the government and anyone who is a citizen has the same access to care.

The Bismarck Model

Next up is The Bismark Model. The Bismark model is a more decentralized form of healthcare, the Bismark model was created near the end of the 19th century by Otto von Bismarck. Employers and employees fund health insurance in this model – those who are employed have access to “sickness funds” created by compulsory payroll dedications. In addition, private insurance plans cover every employed person, regardless of pre-existing conditions.

National Health Insurance model

This model incorporates aspects of both the Bismarck and Beveridge models. Like the Beveridge model, the government acts as the single payer for medical procedures, and like the Bismarck model, providers are private. Universal insurance does not make a profit or deny claims. There has been a tendency in recent years for countries with Beveridge-type health care systems to incorporate Bismarck characteristics or vice versa, leading to the health care policies in a number of countries like Hungary and Germany to trend towards the mixed model. In some countries like Canada, private insurance contracting is permitted for those who would prefer them.

Health providers are generally private institutions, though the Social Health Insurance funds are considered public. In some countries, there is a single insurer (France, Korea); other countries may have multiple, competing insurers (Germany, Czech Republic) or multiple, non-competing insurers (Japan). Regardless of the number of insurers, the government tightly controls prices while insurers do not make a profit. These measures allow for the government to exercise a similar amount of control over prices for health services seen in the Beveridge model.

The Out-of-Pocket Model: Market-Driven Health Care

The final model, the out-of-pocket model, is what is found in the majority of the world. It is used in countries that are too poor or disorganized to provide any kind of national health care system. In these countries, those that have money and can pay for health care get it, and those that do not stay sick or die. In rural regions of Africa, India, China, and South America, hundreds of millions of people go their whole lives without ever seeing a doctor.

Denmark possesses a universal, decentralized healthcare system where the national government provides block grants from tax revenues to regions and municipalities, which deliver health services. All residents and citizens are entitled to publicly financed care, including largely free primary, specialist, hospital, mental health, preventative, and long-term care services. Additionally, residents may purchase voluntary complementary insurance to cover co-payments for outpatient drugs, dental care, and other services; Supplemental insurance, provided mainly by private employers, offers expanded access to private providers. In comparison, the US residents/citizens may also purchase voluntary or complementary services to cover appointments, outpatient drugs, therapy, and more. Additionally, Americans healthcare is also tied to private employers, who offer expanded access to private providers alike. 

Canada has a decentralized, universal, publicly funded health system called Canadian Medicare. Health care is funded and administered primarily by the country’s 13 provinces and territories. Each has its own insurance plan, and each receives cash assistance from the federal government on a per-capita basis. Benefits and delivery approaches vary. All citizens and permanent residents, however, receive medically necessary hospital and physician services free at the point of use.

To pay for excluded services, including outpatient prescription drugs and dental care, provinces and territories provide some coverage for targeted groups. In addition, about two-thirds of Canadians have private insurance. Canada’s universal, publicly funded health care system — was established through federal legislation originally passed in 1957 and in 1966. The Canada Health Act of 1984 replaces and consolidates the two previous acts and sets national standards for medically necessary hospital, diagnostic, and physician services.

Health Canada, which is the federal ministry of health, plays a key regulatory role in food and drug safety, medical device and technology review, and the upholding of national standards for universal health coverage. The Public Health Agency of Canada is responsible for public health, emergency preparedness and response, infectious and chronic disease control and prevention, and health promotion. This differs from America who have to cover the cost of their healthcare cost out of pocket or through insurance.

The United States does not have a uniform health system and has no universal healthcare coverage. The health disadvantage of the U.S. relative to other high-income countries is health disparities in health services.

Although the U.S is renowned for its leadership in biomedical research and cutting-edge medical technology, its medical system faces significant issues such as preventable medical errors, poor amenable mortality rates, and lack of transparency in treatment. Another problem that Americans are facing is difficulty in finding a good doctor. High costs of care and lack of insurance coverage for low and middle-class families have led to social and economic discrimination in healthcare services.

Fifty million people, 16% of the U.S. population, lack insurance coverage. Medical expenditures such as pharmaceuticals and medical supplies have increasingly become unaffordable for marginalized communities. Therefore, paying medical bills and other medical costs have become high out-of-pocket expenses. Deprived communities continue to lack access to primary healthcare services and rely on emergency departments to treat chronic diseases and preventive care. 

U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable. These patients have acknowledged the difficulty in paying medical bills and other expenditures.

According to U.S. healthcare experts, the cost of new technologies and prescription drugs has risen. The availability of more expensive, state-of-the-art medical technologies and prescription drugs generate demand for more intense, costly services even if they are not necessarily cost-effective. The increased costs of medical services occur due to the rise of chronic diseases, including obesity. Nationally, chronic illnesses contribute huge proportions to healthcare costs, particularly during end-of-life care. For example, patients with chronic illness spend 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.

The APHA  in association with its members and state and regional affiliates works with key decision-makers to shape public policy to address today's ongoing public health concerns. These include ensuring access to care, protecting funding for core public health programs and services, and eliminating health disparities. APHA is also working on other critical public health issues including public health and emergency preparedness, food safety, hunger and nutrition, climate change and other environmental health issues, public health infrastructure, disease control, international health, and tobacco control.

If You wish to join or learn more about the APHA, you can contact them with the following:

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