Financing models in health care
A characteristic feature of a health system is the way it is financed. Each country has a different health care financing model with specific characteristics. Basically, however, three types of models can be distinguished.
Social security model
Germany is the home country of social security. Here the model was introduced by Otto von Bismarck in 1883 . Other countries with compulsory social insurance include Belgium, Austria, France and Luxembourg.
The social security model is largely financed through membership fees and co-payments. There is a compulsory insurance for employees and workers as long as the income does not exceed the compulsory insurance limit. The contributions are divided between the employer and the employee on the basis of remuneration. Family members - provided they do not receive their own remuneration - are also insured without additional contributions. Artists, students and farmers are also subject to compulsory insurance.
Civil servants, the self-employed, clergy and people who earn more than the income threshold are excluded from joining statutory social insurance or are exempt from it. They are then either members of private health insurance ( PKV ) or voluntary members of statutory health insurance ( GKV ).
The contributions and thus the financing of the statutory health insurance depend on the amount of the remuneration received by the insured. At the same time, there is freedom of choice for all insured persons in Germany. It can therefore happen that health insurance companies realize advantages in the market due to their insurance structure. This advantage arises from members who have fewer illnesses, have a higher income, report fewer non-contributory relatives, incur fewer costs and at the same time pay higher contributions. The risk structure adjustment is intended to solve this problem.
Tax financed insurance model
This type of insurance model is organized through a National Health Service . Great Britain is the prototype for this model. Here the system was created on the basis of the Beveridge model . Other countries, such as Italy or Portugal, also have a national health service, but additionally finance their health system through contributions.
The National Health Service is publicly owned and finances the health system largely through taxes. Every citizen of the country has access without paying contributions. Only dental and ophthalmological treatments and special services, such as a single room in a hospital, require additional payments.
The National Health Service is divided into regional health authorities, which in turn are responsible for the care system in their area. There is a primary doctor system, so that every patient has to register with a family doctor and, in the event of illness, first contact him. These doctors are called " gatekeepers ", who then, if necessary, arrange for a referral to a specialist or to the hospital. With the exception of emergencies, patients therefore have no access to hospitals or specialist treatment.
Private insurance model
In the private insurance model, the state plays almost no role and no other central body regulates the country's health care. Thus there is a free market that is largely controlled by financial means. In addition, there is no compulsory insurance, so the citizens of the country are specifically responsible for their health insurance. The best-known example of a country for this is the USA ( health system of the United States ).
Occasionally, employees are insured through their employer as an additional benefit from the employer. The latter pays the insurance contributions for his employees. A fairly high proportion of the population who are neither insured by their employers nor financially able to afford private health insurance therefore have no insurance cover or only basic security that is financed by the state.
Since this model of private insurance is often criticized in the US for its social injustice, Barack Obama passed a law ( Patient Protection and Affordable Care Act ) that made health insurance compulsory in the US.
Individual evidence
- ↑ Simon, M. (2010): The Health System in Germany - An Introduction to Structure and Functionality, Bern, Hans Huber, p. 24ff.
literature
- Schulenburg, J.-M., Graf von der / Greiner, W. (2000): Health Economics, Tübingen, Mohr Siebeck.
- Simon, M. (2010): The Health System in Germany - An Introduction to Structure and Functionality, Bern, Hans Huber.
- Stapf-Finé, H./Schölkopf, M. (2003): Hospital Care in International Comparison - Figures, Facts, Trends, Düsseldorf, Deutsche Krankenhausverlagsgesellschaft.